Lung Cancer

Question 1

Risk factors

Answer 1

Cigarette smoking

Radiation
Toxins - asbestos, inhlaed metals, passive smoking
Pulmonary fibrosis
HIV

Question 2

Types

Answer 2

Adenocarcinoma - 40%
Squamous cell - 20%
Large cell - 7%
Small cell - 13%
Other - 20%

Question 3

Presentation

Answer 3

LATE - symptoms of metastatic disease

Cough
Haemoptysis
Chest pain
Dyspnoea
Hoarse voice
SVC obstruction

Pancoast tumour
Hypercalcaemia
SIADH

Question 4

SCLC features

Answer 4

Smokers

Early mets
Chemo and radiosensitive
Bulky lymphadenopathy
Para-neoplastic syndromes

Question 5

SCLC poor prognostic factors

Answer 5

Extensive stage
Poor performance status
Hyponataemia
Elevated ALP
Elevated LDH

Question 6

Treatment of limited stage SCLC

Answer 6

1 lung = limited stage

Concurrent Chemoradiotherapy
Brain radiotherapy

20-30% cure rate

Question 7

Treatment of Extensive stage SCLC

Answer 7

Incurable
Chemotherapy - Platinum and etoposide
Radiotherapy

10-12 month survival

Question 8

Mesothelioma

Answer 8

Asbestos and tobacco
Long latency between exposure and cancer

Pleural cancer

Generally incurable
Surgery = extraplueral pnuemonectomy
Chemo - cisplatin + pemetrexed

Question 9

Stage 1 NSCLC

Answer 9

Stage 1A = Primary <3cm

Stage 1B = Primary 3-5cm

RESECTABLE

Question 10

Stage 2 NSCLC

Answer 10

Stage 2A = Primary 5-7cm
or Primary <5cm and hilar LNs

Stage 2B = Primary >7cm
or primary invading chest wall
or primary 5-7cm with hilar lymph nodes

GENERALLY RESECTABLE

Question 11

Stage 3 NSCLC

Answer 11

Stage 3A = primary invading mediastinum +/- hilar LNs
or primary invading chest wall and hilar LNs
or Primary <5cm with ipsilateral LNs

Stage 3B = Contralateral LNs

SOMETIMES RESECTABLE

Question 12

Adjuvant Chemotherapy

Answer 12

Stage 2 and 3 post resection

Cisplatin and Vinorelbine

Question 13

Treatment of stage 3 non-resectable NSCLC

Answer 13

Can use neoadjuvant chemo if borderline cases

Radical combined chemoradiotherapy –> cure rate 20-30%

Question 14

Treatment of Stage 4 NSCLC

Answer 14

Chemotherapy:
- Platinum + pemetrexed

PD-1 inhibitors

EGFR inhibitors

ALK inhibitors

VEGF inhibitor - Bevacizumab and chemotherapy

Question 15

EGFR Positive metastatic NSCLC

Answer 15

15% of NSCLC
Female, asian, non-smokers, adenocarcinoma

Erlotinib

• ACNEIFORM RASH
• 8-12 months –> resistance

Question 16

ALK positive metastatic NSCLC

Answer 16

5% NSCLC
Non smokers, younger, adenocarcinoma

Crizotinib

Also works for ROS1 fusion mutations

Question 17

PD-1 inhibitors

Answer 17

30% of NSCLC

• If PD-L1 >50%

Nivolumab and Pembrolizumab