lung cnacer

Question 1

The two classifications of lung cancer

Answer 1

NSCLC and SCLC

Question 2

What is the presentation of small cell lung cancer

Answer 2

Really aggressive tumours that present having metastsised initally will respond well to chemotherapy but relapse quickly

Question 3

Which type of lung cancer are the paraneoplastic syndromes associated with

Answer 3

SCLC - SIADH cushings syndrome and lambert eaton myesthenic syndrome

Question 4

What are the different types of NSCC

Answer 4

Squamous cell cancinoma -

Adenocarcinoma -

Large cell carcinoma -
mesothelioma , carcinoid sarcoma and lymphoma

Question 5

Features of squamous cell carcinoma

Answer 5

close to bronchi and linked to cigarette smoking - also associated with PTH related peptite that can lead to malignant hypercalcaemia

Question 6

Features of adenocarcinoma

Answer 6

peripheral more frequent in women who dont smoke with asbestos exposure. Associated with activating mutations in EGFR and ALK

Question 7

Features of large cell carcinoma

Answer 7

less differentiated and metastaise early

Question 8

When is a CT scan used

Answer 8

to asses the extent of the disease local and distant mets

Question 9

When is a PET scan used

Answer 9

in pts with operable disease to check distant mets not picked up by CT

Question 10

When is bronchoscopy used

Answer 10

to see bronchial tree to allow for biopsy and bronchial washing

Question 11

When is PFT used

Answer 11

for assessing underlying lung disease

Question 12

When is cardiopulmonaary excersize testing used

Answer 12

for patietn considered for surgical resection to insure they are fit enough for surgery

Question 13

Management of SCLC

Answer 13

palliative chemo
if localised radiotherapy
if peripheral chemotherpy
prophylactic crainial irratidations

Question 14

How are complications such as SCLO and spinal cord compression treated

Answer 14

with chemotherapy as SCLC is very sensitive to chemotherapy but most relapse

Question 15

How is radiothaerapy used to treat primary tumour

Answer 15

local control is achieved therefore relapse occurs in another site which means improved palliative control

Question 16

Why is prophylactic crainial irradiation used

Answer 16

prevents the dev of brain mets offered to patients with good response to chemotherapy

Question 17

Which lung cancer should be considered systemic

Answer 17

SCLC - as it presents early with mets

Question 18

Management of NSCLC

Answer 18

Surgery -

Radiotherapy -

Chemotherapy -

Question 19

When is sugery offered in NSCLC

Answer 19

if stage 1 and 2 - mediastinal involvement is CI to surgery adjuvant chemotherapy will be needed in positive surgical margins

Question 20

When is chemotherapy offered and how in NSCLC

Answer 20

metastatic and locally advnaced where no activating mutation/ translocation or PDL1 expression
Carboplatin and gemcitabine or carboplatin/cisplatin and pemetrxed
Second line docetaxel

Question 21

When is radiotherapy offered in NSCLC

Answer 21

Sterotactic ablative body radiothrapy peripherally in the lungs - delivers a small number of large dose radiptherapy to a small conformal volume arounf the lung tumour

Question 22

Which patients are tested for egfr and ALK at time of diagnosis and what does it indicate

Answer 22

patients with adenocarcinoma and it indicaties that tyrosine kinase inhibtors can be used like afatinib erlotinib getfitnib for EGFR

CRIZOTINIB FOR ALK

Question 23

if on targeted regime for egfr and alk can they be treated with second time targeted therapies osimertinib and ceritinib rather than the standard chemo of targeteted regime

Answer 23

yes

Question 24

If patient has advnaced NSCLS with PDL1 expression what can be used

Answer 24

Immunotherapy before or after therapy can have a prolonged benefit