Lung Cancer

Question 1

Four non smoking environmental risk factors for lung cancer

Answer 1

Radon and polycyclic aromatic hydrocarbons
Ionising radiation
Asbestos

Question 2

Commonest symptoms of lung cancer

Answer 2

Cough, weight loss, SOB, chest pain, haemoptysis, bone pain

Question 3

What is survival for stage 1a lung cancer IE lowest stage possible?

Answer 3

70%

Question 4

Which stages of NSCLC are potentially curable?

Answer 4

Stages 1-3

Question 5

Which stage groupings of NSCLC are operable? What TNM stage does the top value correspond to?

Answer 5

Stage 1 to stage 3a
T3 N2
( IE must not invade trachea or have contralateral hilar or cervical nodes)

Question 6

What is a T1 NSCLC?

Answer 6

Less than or =3cm and not more proximal than lobar bronchus

Question 7

T2 NSCLC is

Answer 7

> 3cm but

Question 8

T3 NSCLC is

Answer 8

Either >7cm or
Invades stuff eg chest wall, diaph, phrenic nerve, mediastinal pleura, main bronchus within 2cm of carina, tumour nodule but in same lobe

Question 9

T4 NSCLC is

Answer 9

Based on what it invades 
Trachea or carina 
Recurr laryngeal nerve 
Oesophagus 
Vertebral body 
Nodule but in a different LOBE (same lobe is T3)

Question 10

N1 NSCLC is

Answer 10

Ipsilateral hilar nodes

Question 11

N2 NSCLC is

Answer 11

Ipsilateral mediastinal

Subcarinal

Question 12

N3

Answer 12

Contralateral hilar
Contralateral mediastinal
Cervical

Question 13

If a Node is positive on PET and >1cm in NSCLC is that it?

Answer 13

No have to biopsy as the false positive rate is 25% (COPD, infection)

Question 14

What is the false negative rate in PET for NSCLC in small less than 1cm nodes?

Answer 14

20%

Question 15

What is the purpose of EBUS in the work up of NSCLC? What about mediastinoscopy?

Answer 15

Systematically stage nodes including the mediastinum

Mediastinoscopy was the old gold standard but it’s rubbish do it only if EBUS negative but high suspicion

Question 16

What is the post op mortality for a lobectomy and pneumonectomy?

Answer 16

Lobectomy 2-4%

Pneumonectomy 6-8%

Question 17

When is a pneumonectomy indicated for NSCLC?

Answer 17

Invading main bronchus, main pulmonary artery

Question 18

What is the treatment for a stage 2 NSCLC (squamous cell) resected with clear margins?

Answer 18

Adjuvant cisplatin vinorelbine (5% improvement in survival based on platinum chemo)

Question 19

What is limited versus extensive stage small cell lung cancer?

Answer 19

Limited stage is T1/T2 NO NODES

Any nodes is extensive stage

Question 20

Management of extensive stage small cell lung cancer?

Answer 20

Chemo 4-6 cycles cis etop followed if respond by
Thoracic DXT
And
PCI

Question 21

What T stage is a 8cm Lung cancer?

Answer 21

T3 because it is more than 7cm

Question 22

What N stage is a lung cancer with ipsilateral hilar nodes?

Answer 22

N1

Question 23

What do you do if a patient with lung cancer has a predicted post op FEV1 and DLCO of

Answer 23

Cardiopulmonary test must be more than 15ml/kg/min to be operable

Question 24

What is the benefit of definitive CT/RT in nsclc which is stage 3a?

Answer 24

10% survival benefit at 2 years

Question 25

What is dose of PCI for limited stage and extensive stage

Answer 25

25 Gy in 10# limited

20 Gy in 5# extensive stage

Question 26

In NSCLC which subtype should have Pem and which should have Gem?

Answer 26

Squamous- Gem (a girl called Gemma is putting moisturiser on)
Non squam IE adeno- Pem ( a boy called Adnan is writing with a pen)