Lung Cancer

Question 1

Lung cancer more likely to disseminate early

Answer 1

Small cell lung cancer

Question 2

Percentage of Lung Cancer that’s Small Cell vs Non-Small Cell

Answer 2

15% small cell
85% non-small cell

3% other (carcinoid, sarcomatoid)

Question 3

Types of NSCLC?

Answer 3

adenocarcinoma (40% LC)
squamous cell (35%)
large cell (10%)

Question 4

General approach to Lung Cancer management by stage?

Answer 4

Stage 1 to 2: surgical resection/ lobectomy (or SABR if contra-indicated), can need neoadjuvant chemo

Stage 3a: surgery or chemo/ radio

Stage 3b+: chemo/ palliation

+/- targeted therapy

Question 5

Are checkpoint inhibitors more likely to work in SCLC or NSCLC?

Answer 5

NSCLC

Question 6

Specific stage for SCLC?

Answer 6

Stage 1 (operable)

Limited-stage (confined to 1 anatomical area - 30%)

Extensive stage

Question 7

Symptoms of mets to lungs?

Answer 7

Usually, develop in parenchyma or pleura are asymptomatic,

Rarely develop within the bronchi -> haemoptysis.

Question 8

Lung cancer approx % cancer diagnoses and deaths?

Answer 8

9%, 19%

Question 9

Active treatment options in stage IV Lung Cancer

Answer 9

immunotherapy

if driver mutations treat (EGFR, ALK rearrangement, ROS1)

Palliaitve radiatiotherapy

Question 10

Risk factor for EGFR mutation in lung cancer?

Answer 10

non-smoker, young women, east asian descent

Question 11

Side effects of anti EGFR meds in lung cancer (and examples)

Answer 11

Acneiform rash,

diarrhoea, nail changes, pulm toxicity etc etc

Erlotinib, gefitinib, afatinib

Question 12

Risk factor for ALK mutation in lung cancer?

Abnormality in ALK mutation?

Answer 12

NSCLC (Adenocarcinoma)
- Asian
- 50-60% men,
- never or light smokers

Inversion in chromosome 2 that fuses EML4 gene with ALK gene

Question 13

Common metastatic site for SCLC?

Answer 13

Brain

(therfore CT staging and consideration radiotherapy reccommended