Lung Cancer Flashcards
At what size does a pulmonary nodule require a Brock Score Performing?
GREATER than or EQUAL TO 8mm or 300mm3 on volumetry
What are the measurement criteria for a nodule to require follow up?
GREATER or EQUAL to 5mm or 80mm3. If 5-6mm then requires follow up scan at 1 year. If 6-8mm or 80mm3 then needs follow up at 3 months.
What is the first line chemotherapy for patients with locally advanced/metastatic non-SCLC with EGFR+ mutations?
Gefitinib as per NICE recommendations.
Which positive tumour markers would you expect to see in an adenocarcinoma?
TTF-1
CK 7
Napsin A
Which positive tumour markers would you expect to see in a squamous cell lung cancer?
CK5
CK6
p63
TTF-1 negative
Which positive tumour markers would you expect to see in a Small Cell lung cancer?
TTF-1
Neuroendocrine markers e.g.
CD56, synaptophysin, chromogranin
When can Pembrolizumab be used as first line chemotherapy?
If confirmed NSCLC and PD-L1 expression is >50% with NEGATIVE ALK and EGFR mutations
What is the median survival time of a patient with malignant mesothelioma following diagnosis?
9.5 months
At what level of lidocaine usage during bronchoscopy may a patient develop toxicity?
> 9.6mg/kg
Although doses of up to 15.4 mg/kg may be used without adverse effects
What is the treatment of choice for limited stage SMALL CELL lung cancer?
First line is cisplatin-based chemotherapy. This is usually with concurrent radiotherapy if it can be encompassed in a field and WHO 0-1.
If unfit for concurrent therapy then can consider sequential chemotherapy and radiotherapy if the tumour responds to chemo
When is carboplatin used in treatment of mesothelioma?
Cisplatin-based combination chemotherapy is first line. If this cannot be tolerated then carboplatin can be substituted.
Usually if RENAL IMPAIRMENT, WHO 2+ or significant comorbidities
When should prophylactic cranial irradiation be offered in small cell lung cancer? What is the dose?
If a patient has Performance Status 0-2 with LIMITED STAGE disease that has NOT PROGRESSED on first line treatment.
The dose is 25 Gy in 10 fractions
In which demographics are EGFR mutations more common?
Females, non-smokers and those of Asian-Pacific descent.
Most common in non-small cell tumours with adenocarcinoma differentiation
Which antibodies are associated with neurological syndromes in lung cancer patients?
Which type of lung cancer are they associated with?
Anti-Hu antibodies.
Associated with small cell lung cancer.
Can cause symptoms such as limbic encephalitis
How many lung segments are there? How are they distributed?
19 in total
10 right, 9 left
3 RUL
2 RML
5 RLL
3 LUL
2 Lingula
4 LLL
What are the components of the Lent score and how are they scored?
LDH- from pleural fluid
<1500 = 0, >1500 =1
ECOG Performance Status
0 = 0, 1 = 1, 2 = 2, 3/4 =3
Neutrophil:Lymphocyte Ratio (Pleural Fluid)
<9 = 0, >9 = 1
Tumour Type
Mesothelioma, Haematological = 0
Breast, Gynae, Renal = 1
Lung cancer, Other = 2
0-1 = Low Risk (319 day med survival)
2-4 = Medium Risk (130 days)
5-7 = High risk (44 day median)
In what size of tumour can SABR be used?
LESS THAN OR EQUAL TO 5cm
A patient has begun chemotherapy for metastatic lung cancer but developed an acneiform rash, what is the most likely causative agent?
Erlotinib- causes an acneiform rash in around 2/3 of patients
Development of rash is thought to be associated with better prognosis.
At what predicted post-op FEV1 (%) would pre-op assessment with CPET be recommended?
What is a satisfactory CPET result?
If predicted post-op FEV1 is LESS THAN 30% then CPET and other investigations are required.
A CPET result of >15ml/kg/min is considered satisfactory
What is the indication for pembrolizumab as 1st line immunotherapy?
What are common/possible side effects?
In NON-SMALL CELL cancers with
PD-L1 expression >50% and NEGATIVE EGFR and ALK mutations
Side effects include nausea, diarrhoea, fatigue and pyrexia but it can also cause immunotherapy-related hypophysitis (inflammation of the pituitary gland): Hypocortisolism, hypothyroidism and hypogonadism
What is the first line treatment for non-squamous NSCLC with ROS-1 mutation?
Crizotinib is 1st line.
When is osimertinib used in the treatment of lung cancer?
Indicated in EGFR T790M mutation cancer where there is disease progression after first line treatment with erlotinib or gefitinib
What is Lambert-Eaton Myaesthenic syndrome? With which cancer and which antibodies is it associated?
Paraneoplastic phenomenon usually presenting with proximal muscle weakness that improves with repetition of the exercise.
Often associated with small cell lung cancer.
Associated with antibodies vs voltage-gated calcium channels
What are the chemotherapy agents that may be used in ALK POSITIVE mutations?
Alectinib, Ceritinib and Crizotinib
What is the median survival of limited stage SMALL CELL lung cancer treated with chemotherapy?
15-20 months
What is the 30-day mortality rate for lobectomy and pneumonectomy respectively?
2.3% for lobectomy
5.8% for pneumonectomy
Individual risk can be calculated with thoracoscore
What is the recommended first line imaging in patients with localised signs or symptoms of bone mets?
X-ray should be the first line imaging.
If inconclusive then can consider a bone scan or MRI.
Urgent MRI is required if suspected spinal cord compression
What is the most appropriate initial treatment in malignant spinal cord compression?
Dexamethasone (16mg if oral) or equivalent IV
To continue with a dose of 16mg daily until surgery or other treatment can be initiated
What are the Herder score cut off points in investigating lung cancer?
<10% should continue on the monitoring algorithm
10-70% should consider image-guided biopsy, excision biopsy or CT surveillance depending upon patient preference
>70% should consider excision biopsy or non-surgical management
What are the first-line options available for chemotherapy in malignant mesothelioma? What are the requirements?
First line options are either CISPLATIN-PERMETREXED chemotherapy or NIVOLUMAB-IPILIMUMAB in patients with performance status 0-1.
Bevacizumab may be added in
NIVOLUMAB-IPILIMUMAB is first line treatment of choice if good performance status
Which type of mediastinal mass may show Antoni A and Antoni B regions on histology?
Schwannoma.
May present as a posterior mediastinal mass
What grading system is used in the classification of thymoma?
Masaoka-Koga classification system
3 main stages
1: Completely encapsulated tumour
2: Macroscopic invasion into surrounding fatty tissue or adhered to but not invading the mediastinum
3: Macroscopically invading into adjacent structures e.g. pericardium/great vessels/lung
What grading system is used in the classification of teratoma?
Gonzalez-Crussi grading system
What is the median survival for Stage IVA lung cancer?
100 days
