Lung Cancer

Question 1

T1

Answer 1

tumor 3 cm or less in greatest diameter, surrounded by lung or visceral pleura, not in the main bronchus
t1a below 1cm
t1b 1-2cm
t1c 2-3 cm

Question 2

T2

Answer 2

tumor more than 3 cm but less than 5 cm and
involves main bronchus regardless of distance to the carina but without involvement of carina
invades visceral pleura
associated with atelectasis or obstructive pneumonitis that extends to the hilar region either involving part of or the entrire lung

Question 3

T3

Answer 3

more than 5 cm but below 7 cm in greatest diameter

Question 4

T3 structures involved

Answer 4

parietal pleura
chest wall
phrenic nerve
parietal pericardium
separate tumor nodule in the same lobe as primary

Question 5

T4 tumor

Answer 5

more than 7 cm or of any size that invades

Question 6

T4 tumor structures

Answer 6

diaphragm
mediastinum
heart
great vessels
trachea
recurrent laryngeal nerve
esophagus
vertebral body
carina
seperate tumor nodules in a different ipsilateral lobe to thet of the primary

Question 7

N1 means

Answer 7

ipsilateral peribronchial and or ipsilateral hilar LN and intrapulmonary LN

Question 8

N2 means

Answer 8

ipsilateral mediastinal and or subcarinal lymph nodes

Question 9

N3 means

Answer 9

contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene or supraclavicular LN.

Question 10

M1a

Answer 10

separate tumor nodule in a contralateral lobe, tumor with pleural or pericardial nodules
or pleural or pericardial effusions

Question 11

M1b

Answer 11

single extrathoracic metastasis in a single organ

Question 12

M1c

Answer 12

multiple extrathoracic metastasis in a single or multiple organs

Question 13

Tumor upto 5 cm with ipsilateral peribronchial or hilar LN

Answer 13

stage II T2N1

Question 14

tumor more than 4 cm below 7 cm but no node

Answer 14

stage II T3N0

Question 15

Discontinuous tumor nodule outside the parietal pleura in the chest wall or in the diaphragm

Answer 15

M1b or M1c

Question 16

Indication of CT in early stage

Answer 16

tumor size >4cm
poorly differentiated tumor
high risk patient
LVSI
wedge resection
unknown LN status
visceral pleura involvement

Question 17

Indication of RT in early stage

Answer 17

Surgical margin close/positive
mediastinal LN+-extracapsular extension of LN
tumor volume 5 cm
wedge resection/ segmentectomy

Question 18

Operable cases in lung cancer

Answer 18

FEV1>1.5L or >1.2L
stage I, II NSCLC
performance status - 0,1.

Question 19

Role of CT in NSCLC

Answer 19

Neoadjuvant: borderline resectable (stage I-IIIA)
adjuvant CT: N+ve, margin positive, high risk
concurrent and sequential chemo -radiation (IIIB, IIIC and superior sulcus tumor)
palliative: stage IV

Question 20

High risk patient for adjuvant CT

Answer 20

Examples of high-risk factors may include poorly differentiated tumors (including
lung neuroendocrine tumors [excluding well-differentiated neuroendocrine
tumors]), vascular invasion, wedge resection, tumors >4 cm, visceral pleural
involvement, and unknown lymph node status (Nx). These factors independently
may not be an indication and may be considered when determining treatment
with adjuvant chemotherapy

Question 21

ALK positive tumor treatment

Answer 21

ALK Rearrangement Positive
• First-line therapy
Alectinib
Brigatinib
Ceritinib
Crizotinib
Lorlatinib
• Subsequent therapy
Alectinib
Brigatinib
Ceritinib
Lorlatinib

Question 22

EGFR mutated first line targeted therapy

Answer 22

EGFR Exon 19 Deletion or L858R
• First-line therapy
Afatinib
Erlotinib
Dacomitinib
Gefitinib
Osimertinib
Erlotinib + ramucirumab
Erlotinib + bevacizumabc (nonsquamous)
• Subsequent therapy
Osimertinib

Question 23

IF PD 1 positive
if >1%
or if >50%

Answer 23

PD-L1 ≥1%
• First-line therapyd
-Pembrolizumab
-(Carboplatin or cisplatin)/pemetrexed/
pembrolizumab (nonsquamous)
-Carboplatin/paclitaxel/bevacizumabc/
atezolizumab (nonsquamous)
-Carboplatin/(paclitaxel or albumin-bound
paclitaxel)/pembrolizumab (squamous)
-Carboplatin/albumin-bound paclitaxel/
atezolizumab (nonsquamous)
-Nivolumab/ipilimumab
-Nivolumab/ipilimumab/pemetrexed/ (carboplatin
or cisplatin) (nonsquamous)
-Nivolumab/ipilimumab/paclitaxel/carboplatin
(squamous)
PD-L1 ≥50% (in addition to above)
• First-line therapy
Atezolizumab
Cemiplimab-rwlc

Question 24

Preferred chemotherapy for non squamous cell lung cancer

Answer 24

Preferred (nonsquamous)

• Cisplatin 75 mg/m2 day 1, pemetrexed 500 mg/m 2 day 1 every 21 days for 4 cycles.

Question 25

Preferred chemotherapy for squamous cell lung cancer

Answer 25

Preferred (squamous)
• Cisplatin 75 mg/m2 day 1, gemcitabine 1250 mg/m2 days 1 and 8, every 21 days for 4 cycles
• Cisplatin 75 mg/m2 day 1, docetaxel 75 mg/m2 day 1 every 21 days for 4 cycles