Lung Cancer

Question 1

What are Pancoast tumours, and how may they present?

Answer 1

Pancoast tumours = apical tumours

They present with pain (due to invasion of the chest wall or brachial plexus) or Horner’s syndrome (ptosis, miosis, ipsilateral anhidrosis)

Question 2

When is hypertrophic osteoarthropathy most commonly seen?

Answer 2

In NSCLC adenocarcinoma

HPOA results in digital clubbing, periostitis and joint swelling

Question 3

Where to lung cancers typically metastasise?

Answer 3

Liver
Bone
Adrenal glands
Brain

Question 4

What percentage of lung cancers are NSCLC vs SCLC?

What are the histological types of NSCLC?

Answer 4

85% NSCLC
15% SCLC

Of NSCLC:

• adenocarcinoma (50%) -> peripherally located
• large cell (10%) -> peripherally located
• squamous (30%) -> centrally located

Question 5

What percentage of NSCLC are EGFR tyrosine kinase mutation positive? And in what population are these usually found?

Answer 5

Approx 10% of NSCLC are EGFR expressing tumours

Typically seen in young, non-smoking, Asian women with adenocarcinomas (rarely seen with squamous or large cell carcinoma)

Question 6

Definite limited stage SCLC and extensive stage SCLC

Answer 6

Limited stage SCLC: confined to one hemithorax, including the primary mass plus hilar, mediastinal, and ipsilateral supraclavicular LNs (ie all known disease can be encompassed by a single radiation field)

Extensive stage SCLC: overt spread of disease beyond the hemithorax, including ipsilateral malignant effusion and metastases to the brain, liver and bone

Question 7

What are the response rates to combined chemoradiotherapy and the median survival rates for limited SCLC and extensive stage SCLC, respectively?

Answer 7

Limited stage SCLC:

• Cisplatin or Carboplatin plus Etoposide
• RTx
• combined chemoRTx decreases local recurrence and increase overall survival
• response rate 80-90%
• median survival 14-18 months
• recurrence in 90-95%

Extensive stage SCLC:

• Cisplatin or Carboplatin plus Etoposide or Irinitecan
• response rate 60-80%
• median survival 8-10 months
• RTx is reserved for symptom palliation

Question 8

What are the predominant histological types of cancer in head and neck cancers?

Answer 8

Most head and neck cancers are squamous cell carcinomas in the nasal cavity, oral cavity (lips, buccal mucosa, tongue, gingiva, floor of the mouth & hard palate), pharynx and larynx

Tumours of the major salivary glands are usually adenocarcinoma or adenoid cystic carcinoma

Question 9

What are the major risk factors for head and neck cancers?

Answer 9

Alcohol
Tobacco use
EBV
HPV 16

Question 10

What are poor prognostic factors in NSCLC?

Answer 10

Reduced performance status
Advanced stage disease
Weight loss >10% in the past 6/12
Persistence of systemic symptoms
Histology: Large cell (least favourable) > Squamous > Adeno (most favourable)

Question 11

What percentage of NSCLCs are EML4-ALK mutation + and what immune therapy do these patients respond well to?

Answer 11

The ALK mutation is found in 4% of adenocarcinoma

Patients with ALK + NSCLC respond well to Crizotinib

• improves progression free survival compared to chemotherapy in 1st line and replapsed disease
• objective response rate 60%
• well tolerated (side effects: GI upset, bradycardia, visual symptoms)

Question 12

What 2 driving mutations should be checked in all patients diagnosed with NSCLC?

Answer 12

EGFR mutation + in 33%

ALK mutation + in 22%