Lung cancer

Question 1

Which form of lung cancer is most associated with smoking?

Answer 1

SCLC

Question 2

Which form of lung cancer is most associated with non-smokers?

Answer 2

Adenocarcinoma

Question 3

What is the most common malignancy to cause SVC obstruction?

Answer 3

Lung cancer

Question 4

A young woman is found to have a primary lung malignancy. What is the most likely histological lesion?

Answer 4

Adenocarcinoma

Question 5

Which cancer is most commonly associated with SIADH?

Answer 5

SCLC

Question 6

What is the most likely form of lung cancer to have a treatable mutation?

Answer 6

Adenocarcinoma

Question 7

What three targetable mutations are seen in lung cancer? Which is the most common?

Answer 7

EGFR mutation - most common

ALK/ROS1 rearrangement

Question 8

What is the main treatment for stage 1 NSCLC?

Answer 8

Surgical resection with curative intent

Question 9

NSCLC with local hilar spread in addition to primary lesion. What is the most appropriate management?

Answer 9

Stage II

Surgical resection, and if >4cm or node positive -> adjuvant chemotherapy

Question 10

Osimertinib is a (1) drug used in (2) cancer that targets the (3) mutation. Its main side effect is (4).

Answer 10

(1) TKI
(2) Stage IV lung
(3) EGFR
(4) acneiform rash

Question 11

What is the most important histopathological feature to be aware of when treating stage IV squamous NSCLC?

Answer 11

PDL1 status

Question 12

What is pembrolizumab? In what setting is it used for lung cancer?

Answer 12

Anti PD-1 antibody. An immune checkpoint inhibitor mAb used in the treatment of metastatic NSCLC.(squamous, or non-squamous without actionable mutation).

Question 13

Small cell lung cancer is classically very sensitive to what treatment?

Answer 13

Chemotherapy

Question 14

What is involved in treatment of metastatic SCLC?

Answer 14

Chemotherapy (cisplatin/etoposide), immunotherapy (atezolizumab) +/- radiotherapy

Question 15

What is the most appropriate treatment for most stage III NSCLC?

Answer 15

Chemoradiotherapy (simultaneous) + immunotherapy (durvalumab - anti-PDL1)

Question 16

A young Asian woman who has never smoked is diagnosed with NSCLC. What is the most likely targetable mutation present?

Answer 16

EGFR typical in Asian/female/non smokers

Question 17

What is standard treatment for limited stage SCLC?

Answer 17

Chemoradiotherapy +/- prophylactic cranial irradiation

Question 18

What is the most common site of metastasis for colon cancer?

Answer 18

Liver

Question 19

How does KRAS mutation status guide therapy in metastatic colon cancer?

Answer 19

KRAS mutations induce resistance to anti-EGFR therapy (e.g. cetuximab) so this cannot be used except in KRAS wildtype tumours

Question 20

What is the most common side effect of anti-VEGF medications?

Answer 20

Hypertension

Question 21

How does treatment differ between oligometastatic and polymetastatic colon cancer?

Answer 21

Oligometastatic - aggressive surgical approach (40% 5YS) + chemo
Polymetastatic - palliative chemo + Mab (anti-EGFR or VEGF)

Question 22

What stage is CRC that has spread to the lymph nodes but not to distant organs?

Answer 22

Stage III