Lung Cancer FRCR CO2A Flashcards
1
Q
What percentage of all deaths in the UK is lung cancer responsible for?
A
6%
Lung cancer accounts for 22% of deaths from cancer.
2
Q
What is the 5-year survival rate for men with lung cancer?
A
7%
The 5-year survival rate for women is 9%.
3
Q
How has the one-year survival rate for lung cancer changed from 1990-1991 to 2010-2011?
A
Increased from 20.4% to 30.4% for men and from 20.4% to 35.1% for women
This improvement is likely due to more widespread use of palliative therapies.
4
Q
What percentage of lung cancer patients present as an acute medical admission?
A
38%
This is compared to 23% of cancer presentations overall.
5
Q
What role do specialist nurses play in lung cancer treatment?
A
Support the patient and their carers while waiting to discuss treatment options.
6
Q
What is the mean rate of surgery for lung cancer in England and Wales?
A
21.9%
The range is from 15.1% to 30.8%.
7
Q
What is the mean rate of surgery for lung cancer in Scotland?
A
20.5%
8
Q
What treatment offers a possibility of cure for patients unfit for surgery?
A
Radiotherapy
High local control rates are reported with stereotactic ablative radiotherapy (SABR).
9
Q
What is the maximum increase in absolute survival rates due to adjuvant chemotherapy?
A
Up to 4%
10
Q
What percentage of lung cancer patients present with stage IIIB and IV disease?
A
70%
11
Q
What symptoms can palliative radiotherapy effectively improve?
A
Cough, haemoptysis, and pain.
12
Q
What targeted therapy offers improvements in median survival for those with EGFR mutations?
A
Gefitinib
13
Q
What is the incidence of lung cancer in the UK per 100,000 population?
A
45.1 per 100,000
14
Q
What is the mortality rate of lung cancer in the UK per 100,000 population?
A
38.3 per 100,000
15
Q
How many new cases of lung cancer are diagnosed each year in the UK?
A
Around 40,000 cases
16
Q
What trend is observed regarding lung cancer incidence in men and women?
A
Incidence in men is falling, while it continues to rise in women.
17
Q
What age group has seen a 10% increase in lung cancer rates since 1979?
A
35–44 age group
18
Q
What percentage of lung cancer cases are diagnosed in individuals over age 60?
A
80%
19
Q
A
20
Q
What is considered a high-risk population for lung cancer screening?
A
> 30 pack years and aged 55–74
21
Q
What is the primary screening method compared to chest X-ray in lung cancer screening?
A
Low-dose helical CT scans
22
Q
What was the relative risk reduction in lung cancer mortality observed in the national lung screening trial?
A
20%
23
Q
What was the overall reduction in lung cancer mortality reported in the study?
A
6.7%
24
Q
How many CT scans were estimated to be performed to prevent one death from lung cancer?
A
320
25
True or False: The study indicated that chest X-ray was more effective than low-dose helical CT scans.
False
26
Fill in the blank: The national lung screening trial showed a relative risk reduction of _______ in lung cancer mortality.
20%
27
28
What is the major risk factor for lung cancer?
Cigarette smoking, accounting for about 90% of cases.
29
How does smoking cessation affect lung cancer risk?
Reduces the risk of lung cancer to between 30% and 50% of that of continuing smokers after 10 years.
30
What are the two main types of lung carcinoma?
Non-small-cell carcinoma and small cell carcinoma.
31
What is squamous metaplasia?
A change in the ciliated epithelium of the respiratory mucosa due to chronic exposure to tobacco smoke.
32
What industrial exposures are associated with an increased risk of lung cancer?
Nickel, chromium, and some arsenic compounds.
33
How does asbestos exposure affect lung cancer risk?
It appears to increase the risk threefold in smokers and is also a risk factor for mesothelioma.
34
What are 'scar' cancers?
Cancers that occur in areas of lung fibrosis.
35
What anatomical structures are contained in the mediastinum?
Thymic remnant, trachea, oesophagus, heart and great vessels, thoracic duct, lymph nodes, vagus and phrenic nerves, sympathetic trunks.
36
Where does the trachea bifurcate?
At the carina into the right and left main bronchi.
37
What is the function of the pleura?
The parietal pleura lines the thoracic wall and diaphragm, while the visceral pleura covers the lungs.
38
What is the significance of the hilum in lung anatomy?
It is where each lung is attached to the mediastinum and contains the bronchi, pulmonary vessels, lymphatics, and nerves.
39
What is the role of lymphatics in lung cancer?
Lymphatic drainage from the lungs runs to the hilum along the bronchi and can be involved by lung cancer or malignant lymphadenopathy.
40
What do the regional lymph nodes of the thorax define?
They are defined in the 7th Edition International Association for Study of Lung Cancer TNM staging.
41
What types of lung tumors can arise?
Benign, primary malignant (non-small-cell, neuroendocrine, salivary gland, unclassified), or secondary tumors.
42
Where do the majority of bronchial carcinomas arise?
In the major airways – the main or segmental bronchi.
43
What histological classification is important for lung cancer treatment?
The 2004 WHO classification.
44
What is the importance of immunohistochemistry (IHC) in lung cancer?
It is useful in characterizing tumors and deciding if the cancer is metastatic rather than primary.
45
Fill in the blank: Lung cancer is typically _______.
[heterogeneous]
46
What should adenocarcinoma be tested for?
The presence of EGFR-sensitizing mutations.
47
48
What is a combined tumour?
A tumour containing mixed pathological sub-types, where each component is at least 10% of the total tumour volume.
49
How can lung cancer change following treatment?
Lung cancer can change histological subtype.
50
What are the local spread sites for lung cancer?
* Mediastinum
* Pleura
* Chest wall
* Ribs
* Vertebral body
* Diaphragm
51
What are the lymph node stations for lung cancer spread?
* Hilar lymph nodes
* Mediastinal lymph nodes
* Supraclavicular lymph nodes
52
What are common respiratory symptoms of lung cancer?
* Increasing cough
* Breathlessness
* Haemoptysis
* Unresolving pneumonia
53
What is the significance of severe breathlessness in lung cancer?
It may indicate significant obstruction to a major airway or pleural effusion.
54
What is the definition of N1 in lung cancer nodal status?
Ipsilateral hilar and peribronchial lymph nodes.
55
What is the classification percentage for squamous cell carcinoma?
Approximately 22%.
56
What characterizes adenocarcinoma?
Generally peripheral, may arise in scar tissue, and has lepidic, glandular, and papillary architecture.
57
What is the most common cause of superior vena caval obstruction (SVCO) in older patients?
Lung cancer.
58
What are the types of pain syndromes associated with lung cancer?
* Mediastinal pain
* Chest wall pain
* Back pain
* Shoulder pain
* Facial pain
59
What is SIADH and its characteristics?
Inappropriate ADH secretion characterized by low serum sodium and concentrated urine osmolality.
60
What are common systemic symptoms of lung cancer?
* Anorexia
* Fatigue
* Weight loss
* Sweats
61
What is the recommendation for urgent referral for a chest X-ray?
When a patient presents with haemoptysis or unexplained persistent symptoms such as cough, chest pain, or dyspnoea.
62
What is the role of endobronchial ultrasound (EBUS) in lung cancer management?
To confirm malignancy in enlarged mediastinal nodes with high sensitivity.
63
What is the TNM staging system used for?
To stage both non-small cell lung cancer (NSCLC) and small cell lung cancer.
64
What is the percentage of small cell lung cancer in lung cancer types?
Approximately 15%.
65
Fill in the blank: The histological subtype that is poorly differentiated and contains spindle cells is called _______.
Sarcomatoid
66
True or False: Hypercalcaemia is commonly associated with squamous carcinoma.
True
67
What is a characteristic feature of small cell lung cancer on histology?
Morphologically small cells with round or oval nuclei and scant cytoplasm.
68
What is the typical presentation of facial pain in lung cancer?
Vague, aching, and persistent pain around the ipsilateral jaw, ear, or maxilla.
69
What should be considered before radical treatment in locally advanced NSCLC patients?
MRI of the head.
70
71
What surgical options are available for patients with non-small-cell lung cancer (NSCLC)?
Lobectomy or pneumonectomy, depending on the site and extent of the tumour.
## Footnote
Wedge excision is associated with poor local control and should be avoided.
72
What is the impact of complete ipsilateral mediastinal lymph node dissection on survival in NSCLC patients?
Survival is better for those patients who undergo complete ipsilateral mediastinal lymph node dissection compared with sampling.
73
What was the finding of the NSCLC meta-analysis regarding adjuvant chemotherapy?
A 4% increase in 5-year survival following cisplatin-based adjuvant chemotherapy.
## Footnote
NNT = 25.
74
In which stages of NSCLC is adjuvant chemotherapy most beneficial?
Stage II and III disease.
75
What effect does adjuvant radiotherapy have according to the PORT meta-analysis?
It has a modest effect on local control and a detrimental effect on survival, with a 7% reduction in overall survival at 2 years.
76
What is the percentage of stage IA NSCLC at presentation?
14.5%
77
What is the percentage of stage IV NSCLC at presentation?
35.8%
78
What does T1a in the IASLC classification indicate?
Tumour ≤ 2 cm in greatest dimension.
79
What is the recommendation regarding neoadjuvant chemotherapy before surgery for NSCLC?
Its use is not recommended as the largest randomised trial did not show any survival advantage.
80
What is stereotactic ablative radiotherapy (SABR)?
A treatment for T1/T2a N0 peripheral tumours using very high biological doses with excellent local control rates.
81
What is the maximum biologically effective dose (BED) associated with SABR?
≥ 100 Gy.
82
What is the significance of 4D CT planning in SABR?
It allows for treatment planning based on the patient's respiratory phases.
83
What does CHART stand for in the context of radical radiotherapy?
Continuous hyperfractionated accelerated radiotherapy.
84
What is the typical dose for CHART treatment?
54 Gy in 36 fractions over 12 days.
85
What was the 2-year survival benefit of the CHART trial compared to conventional treatment?
29% for CHART compared to 20% for 60 Gy over 6 weeks.
86
What are some side effects of palliative radiotherapy?
Nausea, acute chest pain, fever, rigors.
87
What is the objective response rate of chemotherapy in advanced NSCLC?
Around 20%.
88
What is the median survival for patients receiving chemotherapy for advanced NSCLC?
9–10 months.
89
What is the survival benefit of adjuvant chemotherapy following radical radiotherapy?
Similar to that achieved with adjuvant chemotherapy following resection.
90
What is the recommendation for palliative radiotherapy to brain metastases?
Only for patients with good performance status.
91
What is the recommended management for radiation pneumonitis?
Oxygen and steroids, usually prednisolone up to 60 mg reduced over 2 weeks.
92
What is the primary consideration in planning radiotherapy for NSCLC?
Ensuring normal tissue constraints are adhered to.
93
What is the significance of the GTV in radiotherapy planning?
It is outlined using diagnostic CT scan and PET information.
94
What does the term 'Palliative RT' refer to?
Radiotherapy aimed at providing symptom relief in patients with advanced cancer.
95
What is the reported 2-year survival rate for concurrent chemoradiotherapy compared to sequential treatment according to the SOCCAR trial?
50% for concurrent treatment compared to 46% for sequential treatment.
## Footnote
M. Maguire et al., 2014
96
What is a good option for palliative treatment of patients with large volume non-small-cell lung cancer?
Palliative radiotherapy to the chest.
## Footnote
This is suitable for patients with large disease volumes.
97
What was the mean rate of chemotherapy treatment for stage IIIb/IV NSCLC PS 0/1 in the UK in 2012?
57.2%.
## Footnote
This has risen from 47.8% in 2008.
98
What does the data suggest about improvement in quality of life (QOL) for patients receiving chemotherapy?
Overall QOL does not deteriorate and may improve slightly.
## Footnote
The data on QOL improvement are less robust.
99
What type of chemotherapy regimen is generally as effective as three drugs but less toxic?
A two-drug combination.
## Footnote
Non-platinum combinations offer no advantage over platinum-containing regimens.
100
What is the preferred first-line treatment for adenocarcinoma patients according to Scagliotti et al., 2008?
First-line pemetrexed.
## Footnote
This treatment improves overall survival.
101
List some regimens used for chemotherapy in non-small-cell lung cancer.
* Cisplatin (80 mg/m2) and vinorelbine (60 mg/m2 orally days 1 and 8)
* Cisplatin (75 mg/m2) and gemcitabine (1250 mg/m2 day 1 and 8)
* Cisplatin (75 mg/m2) and pemetrexed (500 mg/m2 with vitamin B12, folic acid and dexamethasone)
## Footnote
These regimens vary in their dosing and combinations.
102
What was the critical finding of the BTOG 2 trial regarding cisplatin dosing?
Cisplatin 50 mg/m2 showed a lower response rate and overall survival compared to 80 mg/m2.
## Footnote
This highlights the importance of dosing in chemotherapy effectiveness.
103
What is a reasonable substitution for cisplatin in poor PS status patients?
Carboplatin.
## Footnote
Carboplatin is likely to be better tolerated.
104
What does the PARAMOUNT trial suggest about maintenance pemetrexed?
It suggests a 22% reduction in risk of death compared with placebo after achieving stable or responding disease.
## Footnote
This is in the context of adenocarcinoma treatment.
105
What are the NICE recommendations for maintenance pemetrexed?
Only for patients who have not received pemetrexed first-line.
## Footnote
NICE guidance TA190 (2010) covers this topic.
106
What can be considered for second-line treatment in squamous cell carcinoma?
Single agent docetaxel 75 mg/m2 or combined with nintedanib for adenocarcinoma.
## Footnote
This is under the condition of PS 0/1.
107
What is the recommended treatment for patients with PS 2 in second-line therapy?
Consider erlotinib.
## Footnote
This is according to NICE guidance TA162 (2008).
108
What percentage of patients with NSCLC benefit from molecular profiling therapies targeting EGFR mutations?
Around 10%.
## Footnote
This includes patients with sensitising mutations such as exon 19 deletions and exon 21 L858R point mutations.
109
What are common side effects of EGFR-targeted therapies like gefitinib, afatinib, or erlotinib?
* Skin rash
* Paronychia
* Diarrhoea
## Footnote
Pulmonary fibrosis is a rare but serious side effect.
110
What is crizotinib and which receptor does it inhibit?
An orally available selective inhibitor of ALK receptor tyrosine kinase.
## Footnote
It is seen in 2–7% of patients with NSCLC.
111
True or False: Crizotinib is recommended due to its overall survival benefit compared to second-line chemotherapy.
False.
## Footnote
It is not recommended because it lacks an overall survival benefit.
112
113
What is the recommended treatment for good PS SCLC patients?
Chemotherapy, thoracic RT, and prophylactic cranial irradiation (PCI)
## Footnote
Good PS indicates a good performance status in patients.
114
What is the reported median survival for SCLC patients in the UK?
18 to 20 months
## Footnote
The 3-year survival rate is around 15% (Thatcher et al., 2005).
115
What is the 2-year survival rate reported in the US for SCLC patients receiving combined twice-daily concurrent chemoradiotherapy?
Greater than 40%
## Footnote
Data from Turrisi et al. (1999) supports this finding.
116
What treatment should be offered to patients with limited stage SCLC and PS 0/1?
4-6 cycles of cisplatin and etoposide
## Footnote
Dosage: cisplatin (60 mg/m2), etoposide (120 mg/m2 on day 1, 100 mg b.d. on days 2 and 3).
117
What is the advantage of concurrent chemoradiotherapy in SCLC treatment?
Shortens the time from initiation of chemotherapy to completion of radiotherapy
## Footnote
This has been shown to improve 5-year survival (de Ruysscher et al., 2006).
118
What is the recommended radiotherapy dose for PCI in SCLC patients?
25 grays in 10 fractions
## Footnote
This is effective and associated with few side effects.
119
What benefit does PCI provide for SCLC patients?
Reduces the risk of brain metastases by more than 50%
## Footnote
Improves overall survival at 3 years from 15% to 21% (Arriagada et al., 1997).
120
What should be considered for patients with limited disease who fail first-line treatment?
Thoracic radiotherapy
## Footnote
Recommended doses: between 30 Gy in 10 fractions and 8 Gy in 1 fraction.
121
What is the significance of a 6-month remission period in SCLC treatment?
Re-treating with first-line chemotherapy is appropriate
## Footnote
Rapid relapse is associated with a poor prognosis.
122
What are the components of the CAV regimen for second-line chemotherapy?
Cyclophosphamide, doxorubicin, and vincristine
## Footnote
Dosage: cyclophosphamide (700 mg/m2), doxorubicin (40 mg/m2), vincristine (1.2 mg/m2) every 21 days.
123
What is the dosage for topotecan in second-line chemotherapy?
Oral 2.3 mg/m2/day or i.v. 1.5 mg/m2/day on days 1-5 every 21 days
## Footnote
This is an alternative second-line regimen.
124
True or False: Patients who have not relapsed after three years are unlikely to relapse subsequently.
True
## Footnote
However, they have an increased risk of second primary lung tumors and smoking-related diseases.
125
What chemotherapy regimen should be offered to poor performance and metastatic patients?
First-line chemotherapy with carboplatin and etoposide
## Footnote
Patients must be informed of a high risk of sepsis.
126
127
What is bronchoscopic brachytherapy appropriate for?
Patients with a very small, superficial and localised endoluminal T1 NSCLC who are medically inoperable and patients with a symptomatic endoluminal tumour who have had previous external beam RT to the limits of the lung and/or spinal cord tolerance.
128
What did the RCT comparing external beam RT with brachytherapy show?
External beam treatment gives better palliation of symptoms and less serious morbidity.
129
What is required for patients undergoing bronchoscopic brachytherapy?
Patients need to be fit enough and have adequate lung function to tolerate bronchoscopy and insertion of a fine-bore tube.
130
What is the technique for brachytherapy in lung cancer?
A fine-bore polythene tube is passed via the suction channel into the relevant bronchus, past the site of the tumour, and the bronchoscope is withdrawn over the catheter.
131
What is the typical dose for palliation in bronchoscopic brachytherapy?
10–15 Gy in a single-fraction HDR at 1 cm from the centre of the source.
132
What has not been determined regarding radical-intent brachytherapy?
The optimum regimen of radical-intent brachytherapy.
133
What fractionated regimes have been used in radical-intent brachytherapy?
22.5 to 42 Gy in 3–6 fractions, weekly.
134
What are current areas of interest in NSCLC?
* Radical radiotherapy dose escalation (I-START and IDEAL trials)
* IMRT for radical RT
* SABR for central lung tumours
* Adjuvant radiotherapy following surgery (LungART trial)
* Molecular profiling to identify further active agents (CRUK Stratified Medicine Project)
* Benefit of whole brain RT for patients with brain metastases (QUARTZ trial)
135
What are bronchial carcinoids?
Rare neuroendocrine tumours comprising fewer than 5% of primary lung tumours.
136
What age group do bronchial carcinoids tend to occur in?
Younger age group (≤ 40 years) and are not associated with smoking.
137
What types of bronchial carcinoids are there?
* Central carcinoid
* Peripheral carcinoid
* Atypical carcinoids
138
What is the primary treatment for bronchial carcinoids in the absence of metastatic disease?
Surgery.
139
What is carcinoid syndrome?
Consists of paroxysmal flushing, bronchoconstriction, diarrhoea, abdominal pain, and right heart failure.
140
What are the elevated levels in urine that indicate carcinoid syndrome?
Elevated 5-hydroxyindoleacetic acid levels.
141
What is thymoma?
An uncommon tumour that presents as an anterior mediastinal mass, arising from cells of epithelial and lymphocytic origin.
142
What is the best indicator of overall survival in thymoma?
Degree of invasion.
143
What paraneoplastic syndromes are associated with thymoma?
* Myasthenia gravis
* Red cell aplasia
* Acquired hypogammaglobulinaemia
* Rarely, ectopic Cushing’s syndrome, polymyositis/dermatomyositis, SLE, and hypertrophic pulmonary osteoarthropathy.
144
What is the usual dose of postoperative RT for invasive thymoma?
45–50 Gy in 2 Gy fractions to the tumour bed.
145
What chemotherapy has been used in metastatic thymoma?
Cisplatin-based combination chemotherapy.
146
NCCN 2025, Limited stage SCLC
CT f/b Durvalumab (consolidative Treatment)
147
PRIMARY THERAPY FOR EXTENSIVE STAGE SCLC NCCN 2025
Carboplatin AUC 5 day 1 and etoposide 100 mg/m2
days 1, 2, 3 and atezolizumab 1200 mg day 1 every 21 days x 4 cycles followed by
maintenance atezolizumab 1200 mg day 1, every 21 days (category 1 for all)
4 to 6 cycles
148
SCLC Limited stage:
clinical stage
I–IIA (T1–2,N0,M0) Treatment
Lobectomyj,l
(preferred) and
mediastinal lymph
node dissection or
sampling
if R0, Adjuvant Systemic Therapy
if, R1/R2 Systemic therapym + concurrent RT
Medically
inoperable or
decision made
not to pursue
surgical resection: SABRn
or
Systemic therapym
+ concurrent RT
149
Limited stage
IIB–IIlC (T3–4,N0,M0;
T1–4,N1–3,M0) Treatment SCLC
Systemic therapym +
concurrent RTn
Look for response, if Complete response or partial response: * Durvalumabm,cc,dd (category 1)
* Prophylactic cranial irradiation
(PCI)n,
if Stable disease, limited stage: Durvalumab
150
NSCL
T1–3,
N1 nodes
positive,
M0 Treatment
operable: Surgery f/b observation for N0 and adj. Chemo for N+
Inoperable : Definitive CRT f/b Durvalumabt (if no EGFR exon 19
deletion or L858R) (category 1)
or
Osimertinib (if EGFR exon 19
deletion or L858R) (category 1)
151
Adj Chemo for T1-3, N1 NSCLC
Non Squamous: Cisplatin 75 mg/m2
day 1, pemetrexed 500 mg/m2
day 1 every 21 days for 4 cycles
Squamous: Cisplatin 75 mg/m2
day 1, gemcitabine 1250 mg/m2
days 1 and 8, every 21 days for 4 cycles
* Cisplatin 75 mg/m2
day 1, docetaxel 75 mg/m2
day 1 every 21 days for 4 cycles
152
CK7 + and CK 20 + Cancers
1. urothelial cancers
2. ovarian mucinous cancers
3. pancreatic cancers
4. cholangiocarcinoma
153
CK7 + and CK 20 - Cancers
1. Lung AC
2. BReast Cancer
3. Thyroid Cancers
4. Endometrial cancers
5. cervical cancer
6. Salivary gland cancers
7. cholangiocarcinoma
8. pancreatic carcinoma
154
CK7 - CK 20 - cancers
1. HCC
2. RCC
3. Prostate
4. SCLC
5. H&N cancers
155
CK7 - CK 20 + cancers
merckel cell cancer
CRC
156
What is the most common cause of death from cancer in the industrialized world?
Lung cancer
## Footnote
Lung cancer accounts for 25% of all cancer deaths in the UK and 28% in the USA.
157
How many new lung cancer patients are there per year in the UK?
37,000
## Footnote
In the USA, there are 170,000 new patients per year.
158
At what age is lung cancer rarely diagnosed?
Below 40 years
159
What is the median age at diagnosis for lung cancer?
60 years
160
What is the lifetime risk of developing lung cancer for men in the UK?
1 in 13
161
What is the lifetime risk of developing lung cancer for women in the UK?
1 in 20
162
What percentage of lung cancer deaths in men is attributed to smoking?
Up to 92%
163
What is the age-adjusted relative risk of developing lung cancer for heavy smokers (more than 20 cigarettes per day)?
20 times that of life-long non-smokers
164
How long does the risk of developing lung cancer remain elevated after smoking cessation?
15–20 years
165
What percentage increase in lung cancer incidence is caused by passive smoking?
24%
166
What percentage of lung cancers is caused by passive smoking?
About 3%
167
What percentage of lung cancer cases in men may be attributable to occupational factors?
Up to 15%
168
What is the association between asbestos and lung cancer?
Increases incidence of mesothelioma and lung cancer, particularly in smokers
169
What does radon account for in terms of lung cancer deaths in the UK?
Around 2000 lung cancer deaths (6% of total) per year
170
Name some industrial carcinogens associated with lung cancer.
* Uranium
* Arsenic
* Nickel
* Vinyl chloride
171
What lung diseases may increase the risk of lung adenocarcinomas?
* Previous tuberculosis
* Silicosis
* Fibrosing alveolitis
172
What genetic factors increase lung cancer risk?
* TP53 gene mutations
* Retinoblastoma (RB) gene mutations
* Xeroderma pigmentosum
* Bloom's syndrome
* Werner's syndrome
173
What is the risk of developing a second lung cancer for long-term survivors of lung cancer?
Increased risk
174
How does radiotherapy in breast cancer patients affect lung cancer risk?
Increases risk if they are smokers
175
Where does lung cancer typically arise?
In the mucosa of the bronchi or the lung parenchyma
176
What hypothesis is suggested regarding the pathogenesis of invasive lung cancer?
It is the endpoint of a multi-step process due to cumulative genetic abnormalities
177
What causes the genetic abnormalities involved in lung cancer pathogenesis?
Carcinogens in tobacco smoke
178
What are the two well-known pre-invasive lesions?
Atypical adenomatous hyperplasia (AAH) and diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH)
## Footnote
AAH manifests as localized ground glass areas on CT scan and progresses to invasive adenocarcinoma at an unknown rate. DIPNECH manifests as small nodules and thickened bronchiolar walls associated with a mosaic pattern of air trapping on CT scan.
179
What is the most important distinction in lung tumors?
Small cell carcinoma (SCLC) and non-small cell carcinoma (NSCLC)
## Footnote
SCLC accounts for 15-25% of lung cancers and has a different presentation, natural history, and response to treatment compared to NSCLC.
180
What characterizes small cell carcinoma (SCLC)?
Highly malignant neuroendocrine tumor, presents as large central masses with atelectasis and extensive mediastinal lymphadenopathy
## Footnote
Two-thirds of patients have detectable metastases at diagnosis.
181
What are the subtypes of non-small cell lung carcinoma (NSCLC)?
* Squamous cell carcinoma
* Adenocarcinoma
* Large cell carcinoma
* Adenosquamous carcinoma
* Carcinomas with pleomorphic, sarcomatoid, and sarcomatous elements
* Carcinoid tumors
* Carcinomas of salivary gland type
* Unclassified
## Footnote
Each subtype has distinct characteristics and behaviors.
182
What is the typical presentation of squamous cell carcinoma?
Large central lesions with associated atelectasis, pneumonitis, and hilar and mediastinal lymphadenopathy
## Footnote
Cavitation is seen in up to 10% of cases.
183
What distinguishes adenocarcinoma from other types of lung cancer?
Usually presents as small peripheral lesions with a high propensity for nodal and distant spread
## Footnote
The proportion of adenocarcinoma has been increasing over time.
184
What is the prognosis of typical carcinoid tumors?
Excellent prognosis
## Footnote
These tumors are not linked to smoking and can occur centrally or peripherally.
185
What are common respiratory symptoms in lung cancer patients?
* Cough (70%)
* Dyspnoea (60%)
* Chest pain/discomfort (50%)
* Haemoptysis (41%)
## Footnote
More than 90% of patients are symptomatic at presentation.
186
What symptoms can arise due to compression of the recurrent laryngeal nerve?
Hoarse voice
## Footnote
Other nerves can cause different symptoms such as breathlessness and shoulder pain.
187
What percentage of lung cancer patients present with superior vena cava obstruction (SVCO)?
4%
## Footnote
This is most common with small cell lung cancer.
188
What is the purpose of staging in lung cancer evaluation?
* Establish histologic type
* Define extent of disease
* Assess fitness for appropriate treatment
## Footnote
These steps are crucial for determining the best management approach.
189
What imaging is typically first used for lung cancer evaluation?
Chest X-ray
## Footnote
It may show lung lesions with or without lymphadenopathy and other associated conditions.
190
What does a CT scan help assess in lung cancer?
Resectability of the tumor
## Footnote
Encasement of proximal pulmonary arteries/veins and mediastinal involvement suggest an unresectable tumor.
191
What is the sensitivity of flexible bronchoscopic biopsy in lung cancers?
60-70% for central tumors
## Footnote
Sampling using multiple techniques improves diagnostic yield.
192
What are the complications of CT guided percutaneous needle aspiration/biopsy?
* Bleeding
* Pneumothorax
## Footnote
Core biopsies improve sensitivity compared to aspirates.
193
What is a common paraneoplastic syndrome associated with lung cancer?
Syndrome of inappropriate ADH secretion (SIADH)
## Footnote
SIADH is commonly associated with small cell lung cancer.
194
What is the significance of hypercalcaemia in lung cancer?
Common in squamous cell carcinomas (15%)
## Footnote
It can be due to excess parathyroid hormone or PTH-related peptides.
195
What is the typical histological feature of typical carcinoid tumors?
Polygonal cells arranged in distinct organoid, trabecular or insular growth pattern
## Footnote
They typically show <2 mitotic figures per 10 HPF and no necrosis.
196
What techniques provide the highest diagnostic yield for lung cancer?
Multiple techniques (biopsy, brushings and washings) give the highest diagnostic yield (sensitivity of 83–88%)
## Footnote
The combination of these techniques enhances the likelihood of an accurate diagnosis.
197
What is CT guided percutaneous needle aspiration/biopsy useful for?
It is useful in peripheral tumours
## Footnote
This method allows for targeted sampling of tumors located away from the central structures of the lungs.
198
How does core biopsy compare to aspirates in terms of sensitivity?
Core biopsies improve the sensitivity compared with aspirates
## Footnote
Core biopsies provide a larger tissue sample, which can lead to more accurate diagnoses.
199
What are some complications associated with CT guided needle aspiration/biopsy?
Complications include bleeding and pneumothorax
## Footnote
These complications can arise from the invasive nature of the procedure.
200
What is fine needle aspiration suitable for?
Sampling lymph nodes, skin nodules and liver and adrenal metastases
## Footnote
This technique is minimally invasive and can provide quick results.
201
What additional procedures are required when dealing with pleural effusion?
Aspiration, biochemical analysis and cytology together with multiple pleural biopsies
## Footnote
These steps help in determining the nature of the effusion and any underlying conditions.
202
What is the sensitivity range of sputum cytology?
10–97%
## Footnote
The wide variation indicates that sputum cytology is not consistently reliable.
203
For whom should sputum cytology be reserved?
Patients with central tumours who are unable to tolerate or unwilling to undergo bronchoscopy or other invasive procedures
## Footnote
This approach is a less invasive alternative for those patients.
204
What does staging determine in lung cancer?
Prognosis and guides treatment
## Footnote
Understanding the stage of cancer is crucial for planning the appropriate therapy.
205
What staging system is used for lung cancer?
TNM staging
## Footnote
The TNM system classifies cancer based on tumor size (T), lymph node involvement (N), and metastasis (M).
206
How can small cell lung cancer also be staged?
Using a simple staging classification
## Footnote
This alternative method provides a straightforward approach to assess the cancer's extent.
207
What is the significance of accurately distinguishing stages II, IIIA, and IIIB in lung cancer?
It is important in deciding optimal surgical treatment for potentially operable patients.
208
What is the recommended treatment for Stage II lung cancer?
Lobectomy or pneumonectomy with mediastinal sampling or dissection.
209
What treatment options are available for Stage IIIA lung cancer?
Neoadjuvant chemotherapy followed by radical surgery or radical chemoradiotherapy.
210
Is Stage IIIB lung cancer resectable?
No, Stage IIIB disease is considered unresectable.
211
What is the role of PET scans in mediastinal staging?
PET scans have higher sensitivity, specificity, and accuracy in detecting mediastinal disease compared to CT scans.
212
What is the sensitivity of PET scans for detecting mediastinal disease?
87% sensitivity.
213
What is the negative predictive value of PET scans in lung cancer staging?
High negative predictive value for exclusion of N2/N3 disease.
214
What is one limitation of PET scans?
False-positive 'hot spots' due to inflammatory processes in 13-17% of cases.
215
What is the role of MRI scans in lung cancer staging?
MRI has a limited role but may be useful for evaluating vascular and vertebral body invasion.
216
What is the advantage of Endobronchial ultrasound (EBUS) in mediastinal staging?
EBUS can characterize lymph nodes smaller than 1 cm.
217
What is the sensitivity and specificity of EBUS for lymph node staging?
Sensitivity of 95% and specificity of 100%.
218
What is the purpose of Endo-oesophageal ultrasound (EUS) with fine needle aspiration?
To assess sub-aortic, subcarinal, and paraoesophageal lymph nodes.
219
What is the diagnostic yield of Transbronchial needle aspiration (TBNA)?
Sensitivity of 78% and high specificity approaching 100%.
220
What is generally regarded as the gold standard for preoperative mediastinal evaluation?
Mediastinoscopy.
221
What are the mortality and morbidity rates associated with mediastinoscopy?
Mortality rates are negligible, but morbidity rates, especially arrhythmias, are reported at 0.5-1%.
222
What is the definition of limited stage in small cell lung cancer?
Tumor confined to the hemithorax of origin, the mediastinum, and the supraclavicular nodes.
223
What is the definition of extensive stage in small cell lung cancer?
Tumor that is too widespread to be included in limited-stage disease.
224
What factors influence the management of lung cancer?
Type of lung cancer, stage, performance status, co-morbidities, and cardiopulmonary reserve.
225
What are the treatment options for patients with Stage I–II non-small cell lung cancer?
* Surgery alone
* Surgery followed by radiotherapy
* Surgery followed by chemotherapy
* Radical radiotherapy
226
What is the postoperative mortality rate for lobectomy?
2-4%.
227
What is the higher mortality rate associated with pneumonectomy?
6-8%.
228
What is the purpose of wedge or segmental resection in lung cancer treatment?
Useful in patients with peripheral tumors and impaired lung function.
229
What is a bronchoplastic or 'sleeve' resection designed to do?
Spare lung tissue as an alternative to pneumonectomy.
230
What is bronchoplastic or ‘sleeve’ resection designed to do?
Spare lung tissue as an alternative to pneumonectomy.
231
What is the local recurrence rate associated with certain lung cancer procedures?
3–5 times.
232
How much does certain lung cancer treatment reduce survival rates?
Reduces survival by 5–10%.
233
What is radical radiotherapy used for?
Treating patients with medically inoperable stage I/II lung cancer if lung function is adequate.
234
What was the 4-year survival rate for radiotherapy compared to surgery in a randomized trial?
7% vs. 23%.
235
What is the typical dose for conventional radical radiotherapy?
60 Gy in 30 fractions over 6 weeks.
236
What is the 2-year survival rate after conventional radical radiotherapy?
About 20%.
237
What does CHART stand for in radiotherapy?
Continuous hyperfractionated accelerated radiotherapy.
238
How many fractions and total dose does CHART consist of?
54 Gy in 36 fractions over 12 continuous days.
239
What is the local control rate of stereotactic radiotherapy for stage I tumors?
>90%.
240
What is the proven role of postoperative radiotherapy after complete surgical resection of stage I–II lung cancer?
There is no proven role.
241
In what cases might radiotherapy be offered postoperatively?
In incomplete resection and/or unexpected N2 disease.
242
What is the impact of routine radiotherapy in N0–N1 disease?
Significantly decreases survival.
243
What should be considered for patients with stage I and II non-small cell lung cancer?
Adjuvant chemotherapy.
244
What is the recommended chemotherapy for stage IB and II lung cancer?
Postoperative cisplatin-based combination chemotherapy.
245
What were the 5-year overall survival rates in the NCIC JBR 10 trial for stage IB and II disease?
Increased from 54% to 69%.
246
What chemotherapy combination was used in the ANITA trial?
Vinorelbine and cisplatin.
247
What is the minimal pulmonary function for pneumonectomy according to Table 9.1?
FEV1 ≥2 L.
248
What is the recommended radiation dose for radical radiotherapy in stage I & II?
50 Gy/20 fractions (microscopic).
249
What are the options for stage III A lung cancer treatment?
* Radical chemoradiotherapy
* Surgery alone or with postoperative radiotherapy
* Neoadjuvant chemo-radiotherapy or chemotherapy followed by surgery
* Radical radiotherapy
* Palliative chemotherapy
* Symptomatic treatment and palliative radiotherapy
250
What is the expected 5-year survival for stage IIIA lung cancer?
<10 to 40%.
251
What are treatment options for stage IIIB lung cancer without malignant effusion?
* Radical chemoradiotherapy
* Neoadjuvant chemoradiotherapy or chemotherapy followed by surgery
* Radical radiotherapy
* Palliative chemotherapy
* Symptomatic and supportive care
252
What is the usual first-line regimen for small cell lung cancer?
Carboplatin (AUC 5–6) + etoposide.
253
Which chemotherapy agents are not given with concurrent radiotherapy due to 'radiation recall'?
* Adriamycin
* CAV
* ACE
254
What is the role of palliative chemotherapy in lung cancer management?
Considered only in patients with good performance status (0-2).
255
What is the significance of the IALT trial in lung cancer?
Showed a survival advantage with adjuvant chemotherapy in resected stage IIIA disease.
256
What is the prognosis for patients with Stage IIIB with malignant effusion or Stage IV disease?
Both are incurable and carry a similar prognosis
## Footnote
The treatment aim is palliative with the intention of improving symptoms as much as disease control.
257
What is the response rate of chemotherapy in patients with Stage IIIB or IV cancer?
20–40%
## Footnote
The duration of response is approximately 6 months, with a median overall survival of less than 1 year.
258
How much survival benefit does chemotherapy provide for patients with Stage IIIB or IV cancer?
6–8 weeks
## Footnote
Response rates for an individual reflected overall survival in a meta-analysis.
259
What symptomatic benefits are associated with chemotherapy?
* Reduced palliative radiotherapy requirements
* Reduced analgesia
* Weight stabilization
* Maintenance of performance status
## Footnote
Toxicity is frequently seen, especially with combination chemotherapy.
260
In which patients does chemotherapy show greater benefit?
Fit patients of good performance status (WHO 0 or 1)
## Footnote
In these patients, combination chemotherapy can be offered.
261
What combination of drugs improves overall survival in patients with locally advanced or metastatic adenocarcinoma?
Cisplatin and pemetrexed
## Footnote
This combination improves overall survival compared to cisplatin and gemcitabine.
262
What type of treatment is recommended for less fit or elderly patients with cancer?
Single agent treatments, palliative radiotherapy, biological agents, or appropriate trials
## Footnote
These options can be considered for less fit or elderly patients.
263
What has recent phase III studies shown regarding maintenance treatment?
Pemetrexed and erlotinib are useful in patients who had not progressed after first-line chemotherapy
## Footnote
Maintenance treatment can help maintain quality of life.
264
What is the standard treatment for patients with limited stage SCLC and good performance status?
Combination chemotherapy with platinum regime and concurrent thoracic radiotherapy
## Footnote
Prophylactic cranial radiotherapy is also included.
265
What is the recommended chemotherapy regimen for small cell lung cancer?
* Platinum and etoposide for 4–6 cycles
* Supportive care
* Clinical trial options
## Footnote
Multiple agent chemotherapy is shown to be better than single agent.
266
What is the impact of thoracic radiotherapy on survival in patients with limited stage SCLC?
Reduces the risk of death by 14%
## Footnote
This is equivalent to a 5% absolute increase in 3-year survival.
267
What is the role of prophylactic cranial irradiation (PCI) in SCLC?
Reduces the risk of brain metastasis by 54%
## Footnote
PCI also reduces the risk of death by 16%.
268
What is the common chemotherapy regimen for extensive stage SCLC?
Chemotherapy with platinum and etoposide
## Footnote
This regimen has shown to prolong survival.
269
What are the characteristics of patients most likely to benefit from EGFR-targeted therapies?
* Female
* Adenocarcinoma (especially bronchoalveolar subtype)
* Non-smokers
* Asian
## Footnote
Increased EGFR protein expression and mutations enhance response.
270
What are the common side effects of EGFR inhibitors like erlotinib and gefitinib?
* Rash
* Diarrhoea
* Pneumonitis
## Footnote
Rash often reflects drug activity.
271
What is the recommended timing for administering PCI after primary treatment?
Without delay after primary treatment
## Footnote
Optimal timing is not clear, but early administration is advised.
272
What is the typical dose regimen for PCI in the UK?
30 Gy in 10 fractions over 2 weeks
## Footnote
Other regimens include 20 Gy in 10 fractions and 36 Gy in 18 fractions.
273
What is the significance of re-irradiation in NSCLC patients?
It is an option if more than 6 months after previous radiotherapy and spinal cord can be avoided
## Footnote
This may improve symptom management.
274
What is the role of docetaxel in relapsed pre-treated NSCLC?
Improved median survival of 3 months over best supportive care
## Footnote
It can be considered in fit patients who have previously received platinum-based chemotherapy.
275
What is the main modality of treatment for extensive stage SCLC?
Chemotherapy
## Footnote
A recent Cochrane review showed that chemotherapy prolongs survival in patients with extensive SCLC.
276
What improves survival in patients with extensive SCLC who achieve complete response after primary chemotherapy?
Thoracic radiotherapy
## Footnote
Improves survival to a similar extent as that of limited stage disease.
277
What is the one-year risk of brain metastases in patients receiving PCI compared to those who do not?
15% vs. 40%
## Footnote
Patients who received PCI had a lower risk of brain metastases.
278
What is the median survival following relapse after first-line chemotherapy?
Approximately 4 months
279
What percentage of patients with sensitive disease respond to second-line chemotherapy?
30–40%
## Footnote
Median survival for sensitive disease with second-line chemotherapy is 6 months.
280
What are the two groups of patients following relapse after first-line chemotherapy?
* Sensitive group
* Resistant group
281
Which factors are important prognostic factors in early stage NSCLC?
* Tumour staging
* Nodal status
282
Which demographic generally has a better prognosis in advanced stage NSCLC?
Females
283
What indicates poor prognosis in lung cancer?
* Significant weight loss (>10% within last 3 months)
* Large cell histology
284
What is the 5-year survival rate for Stage I non-small cell lung cancer (NSCLC)?
60–80%
285
What is the treatment for localized carcinoid tumors?
Surgery
286
What is the locoregional failure rate for atypical carcinoids?
23%
287
What is the treatment for metastatic carcinoid?
Combination chemotherapy using regimes as in SCLC
288
What percentage of patients present with mixed small and non-small cell lung cancer?
2%
289
What is the typical 5-year survival for patients with synchronous isolated adrenal metastases?
10–23%
290
What treatment is given to patients with synchronous isolated brain metastases?
Resection or radiosurgical ablation with complete excision of the primary tumor
291
What is the common symptom in advanced NSCLC that can be debilitating?
Breathlessness
292
What should be done for patients with advanced lung cancer presenting with hypercalcemia?
Regular testing and treatment with hydration, bisphosphonates
293
What is the initial treatment for superior vena cava obstruction?
Steroids and radiotherapy
294
True or False: Patients with multiple primary lung tumors are managed as two individual tumors.
True
295
Fill in the blank: Patients with operable tumors and good performance status are treated with _______.
[chemoradiotherapy followed by surgery and postoperative chemotherapy]
296
297
What is the primary symptom management for lung cancer patients experiencing breathlessness?
Simple measures such as the use of a fan, teaching relaxation techniques, and cautious use of oral morphine.
298
What is the recommended follow-up schedule for patients after curative treatment for NSCLC?
Routine follow-up every 3–6 months for 2 years, then 6–12 months thereafter.
299
What is mesothelioma?
An aggressive tumour arising from the cells of pleura and peritoneum.
300
How many new cases of mesothelioma are diagnosed annually in the UK?
Just over 2000 new cases.
301
What is the median age at diagnosis for mesothelioma?
60 years.
302
Which gender is more commonly affected by mesothelioma?
Males are five times more commonly affected than females.
303
What is the primary aetiological factor associated with mesothelioma?
Asbestos exposure.
304
What type of asbestos is strongly linked to mesothelioma?
Amphibole (blue and brown) asbestos.
305
What are the four histological subtypes of mesothelioma?
* Epithelial (40%)
* Sarcomatoid (20%)
* Mixed (35%)
* Undifferentiated (5%)
306
What is the important histopathological diagnosis for mesothelioma?
Adenocarcinoma.
307
What imaging methods are initially used for mesothelioma diagnosis?
Chest X-ray and CT scan.
308
What does a CT scan typically show in cases of mesothelioma?
Unilateral pleural effusion, nodular pleural thickening, and tumour encasement of the lung.
309
What is the latency period after asbestos exposure for mesothelioma?
Ranges from 15–50 years.
310
What is the recommended staging system for mesothelioma?
International Mesothelioma Interest Group (IMIG) staging system.
311
What percentage of mesothelioma patients are eligible for potentially curative treatment?
10–15%.
312
What is the median survival for the majority of mesothelioma patients?
Less than 12 months.
313
What is extrapleural pneumonectomy (EPP)?
Radical treatment involving resection of the entire parietal and visceral pleura en bloc with underlying lung.
314
What is the commonest toxicity reported in mesothelioma chemotherapy?
Neutropenia.
315
What is the recommended dose of pemetrexed for mesothelioma treatment?
500 mg/m2 IV on day 1 followed by cisplatin 75 mg/m2 for 4–6 cycles.
316
What are the two prognostic predictive models for mesothelioma?
* EORTC
* CAL-B
317
What is the prognosis for patients categorized as good in the EORTC system?
Median survival of 10.8 months.
318
What is the significance of mesothelioma as a notifiable disease?
Patients diagnosed are automatically eligible for some benefits and allowances.
319
What is malignant peritoneal mesothelioma characterized by?
Abdominal symptoms due to ascites and tumour mass.
320
Fill in the blank: Mesothelioma consists of up to ______ of all mesotheliomas.
10–15%
321
What are the two types of cavities from which mesothelioma can arise?
Peritoneal and pericardial cavities
## Footnote
Mesothelioma can occur in various locations, but peritoneal and pericardial are specific sites of concern.
322
What percentage of all mesotheliomas does malignant peritoneal mesothelioma consist of?
10–15%
## Footnote
This indicates a significant but minority proportion of mesothelioma cases.
323
What are common symptoms of malignant peritoneal mesothelioma?
Abdominal symptoms due to ascites and tumour mass
## Footnote
Ascites refers to fluid accumulation in the abdominal cavity.
324
What characterizes diffuse peritoneal mesothelioma?
Multiple nodules involving the entire peritoneal surface
## Footnote
This widespread involvement complicates treatment options.
325
How is tissue diagnosis for mesothelioma typically made?
By biopsy
## Footnote
Biopsy is crucial for confirming the diagnosis and ruling out other diseases.
326
What are the treatment options for peritoneal mesothelioma?
Systemic chemotherapy, cytoreductive surgery, intraperitoneal chemotherapy, and radiotherapy
## Footnote
Treatment plans can vary based on the patient's condition and disease extent.
327
What performance status (PS) is considered for maximal cytoreduction and intraperitoneal hyperthermic chemotherapy?
Good PS (0–1)
## Footnote
Performance status is a measure of a patient's general well-being and ability to perform daily activities.
328
What chemotherapy agent is commonly used for treating peritoneal mesothelioma?
Mitomycin C
## Footnote
Mitomycin C is used in various cancer treatments, including mesothelioma.
329
What was the median survival range reported for patients treated with intraperitoneal hyperthermic chemotherapy?
34–92 months
## Footnote
This range indicates variability in patient outcomes based on individual circumstances.
330
What is the 5-year survival rate range for patients undergoing this treatment?
29% to 59%
## Footnote
Survival rates can significantly vary based on factors like disease stage and treatment response.
331
What is the range of perioperative morbidity for these patients?
25% to 40%
## Footnote
Morbidity refers to complications or adverse effects resulting from treatment.
332
What chemotherapy drugs are considered for patients with good PS and inoperable tumors?
Cisplatin and pemetrexed
## Footnote
These agents are often used in combination for enhanced effectiveness.
333
What is the median survival time for patients treated with chemotherapy for peritoneal mesothelioma?
13.1 months
## Footnote
This reflects the limited efficacy of treatments in certain patient populations.
334
What is the typical treatment approach for patients with poor performance status?
Symptomatic and supportive care
## Footnote
This approach focuses on improving quality of life rather than curative treatment.
335
What is the overall median survival for patients with peritoneal mesothelioma?
Around 12 months
## Footnote
This statistic underscores the aggressive nature of the disease.
336
What is the significance of overexpressed EGFR in mesothelioma?
It indicates potential targets for therapy
## Footnote
EGFR is a common target in cancer treatment due to its role in cell proliferation.
337
What were the results of trials with gefitinib and erlotinib for mesothelioma?
Gefitinib showed limited activity (<10%), and erlotinib produced no responses
## Footnote
These findings highlight challenges in targeting EGFR in mesothelioma.
338
What is the role of TKIs in mesothelioma treatment?
They act on the VEGF pathway
## Footnote
Targeting the VEGF pathway aims to inhibit tumor blood supply.
339
What were the findings regarding bevacizumab in mesothelioma treatment?
No improvement in survival or response compared to chemotherapy alone
## Footnote
This suggests that bevacizumab may not be effective in this context.
340
What is rapirnase, and what were its results in clinical trials?
An antineoplastic ribonuclease from frogs' eggs, with a median overall survival of 6 months
## Footnote
Rapirnase showed some activity in patients who had progressed after chemotherapy.
341
What is thymoma?
An epithelial tumour arising from the thymus, accounting for nearly half of all primary mediastinal tumours.
342
What is the peak incidence age range for thymoma?
40–60 years.
343
Is there a gender predilection for thymoma?
No.
344
What classification system is used for thymoma?
WHO classification based on histological assessment.
345
List the types of thymoma according to WHO classification.
* Type A
* AB
* B1
* B2
* B3
* Carcinoma
* New entities
346
What is the 10-year survival rate for Type A thymoma?
4–7%.
347
What is the 10-year survival rate for B3 thymoma?
20–36%.
348
What is the main prognostic factor for thymoma staging?
Invasion.
349
What is the Masaoka staging system used for?
Postoperative staging of thymoma.
350
What is the treatment of choice for early-stage thymoma?
En bloc surgical resection.
351
What is the recurrence rate after complete excision of a stage I thymoma?
Less than 2%.
352
What is the role of radiotherapy in stage I thymoma?
No proven role.
353
What is the recommended treatment for patients with stage II thymoma?
Adjuvant radiotherapy may reduce relapse risk.
354
What is the standard chemotherapy combination for thymomas?
Cisplatin, doxorubicin, and cyclophosphamide (CAP) or etoposide and cisplatin (EP).
355
What is the 10-year survival rate for non-invasive (stage I) thymoma?
67–80%.
356
What are common symptoms of thymoma?
* Chest pain
* Cough
* Dyspnoea
* Dysphagia
* Hoarseness
* Respiratory tract infections
* Superior vena caval obstruction
357
What imaging modality is used to evaluate thymoma?
CT scan.
358
What does a chest X-ray typically show for large thymoma?
Mediastinal widening or anterior mediastinal mass.
359
What is the prognosis for patients with myasthenia gravis and thymoma?
30–40% of thymoma patients have myasthenia gravis.
360
What is the 5-year survival rate for stage IV thymoma?
50%.
361
What is the follow-up recommendation for thymoma patients?
Monitor up to 10 years with clinical examination, blood tests, and CT staging.
362
Fill in the blank: The most common second primary cancer associated with thymoma is _______.
colorectal.
363
What is the prognosis for patients with autoimmune diseases such as lupus erythematosus and thymoma?
Poor prognosis.
364
True or False: CT-guided FNA is the most reliable method for tissue diagnosis in thymoma.
False.
365
What is the recommended procedure if CT-guided biopsy is inconclusive?
Anterior mediastinotomy.
366
What is the median survival for patients treated with chemotherapy for thymoma?
38 months.
367
What treatment may be considered for patients with pleural disease (IIb) who cannot receive radiotherapy?
Adjuvant chemotherapy.
368
What is the significance of myasthenia gravis in thymoma patients?
It is associated with a higher incidence of thymoma.
369
What is a potential treatment for patients who are chemotherapy refractory with demonstrable uptake on In-labelled octreotide scan?
Somatostatin analogues plus prednisolone.
370
What does PTV stand for in radiation therapy?
PTV = GTV + 1.5–2 cm
## Footnote
GTV refers to the Gross Tumor Volume.
371
Name three critical organs that need to be considered in radiation therapy.
* Lung
* Heart
* Spinal cord
372
What is the energy level used in radiation therapy for thymoma?
6 MV
373
What is the field arrangement for radiation therapy in thymoma?
* Single anterior
* Unequally weighted (2:1) or Antero-posterior
* Anterior wedge pair
* Multiple field
374
What is the radiation dose for complete excision or microscopic disease in thymoma?
50 Gy in 20–25 fractions over 5 weeks
375
What is the radiation dose for macroscopic disease in thymoma?
* 55 Gy in 20 fractions
* 60 Gy in 30 fractions
376
What is the preoperative radiation dose for thymoma?
45 Gy in 20 fractions
377
What special consideration is there for patients with lupus erythematosus during radiation therapy?
Dose modification to minimize late toxicity
378
What does CAP stand for in chemotherapy for thymoma?
Cisplatin, doxorubicin, and cyclophosphamide
379
What is the dosage schedule for CAP chemotherapy?
Cisplatin (50 mg/m2), doxorubicin (50 mg/m2), cyclophosphamide (500 mg/m2) given on day 1, repeated every 21 days for a maximum of eight cycles if stable or responsive disease after 2 cycles.
380
What does EP stand for in chemotherapy for thymoma?
Cisplatin and etoposide
381
What is the dosage schedule for EP chemotherapy?
Cisplatin 60 mg/m2 on day 1 and etoposide 120 mg/m2 on days 1, 2, and 3, cycles repeated every 3 weeks for a maximum of eight cycles.
382
What are common issues in palliative care for advanced thymoma?
* Dyspnoea due to pleural effusion
* Locally advanced tumour
383
What factors influence prognosis in thymoma?
Clinical stage and histology
384
True or False: The most important prognostic factor in thymoma is the patient's age.
False
