Non-surgical treatment for Lung Cancer

Question 1

What is the most common malignancy and leading cause of cancer-related mortality

Answer 1

Lung Cancer

Question 2

Investigations of Lung Cancer (3)

Answer 2

CXR
CT
Bronchoscopy

Question 3

Histological Sub-types (2)

Answer 3

NSCLC- non small cell lung cancer

SCLC- Small cell lung cancer

Question 4

NSCLC (3)

Answer 4

Squamous
Adenocarcinoma
Large cell

Question 5

Other histological subtypes of lung cancer (4)

Answer 5

Pleural mesothelioma
Epitheloid
Sarcomatous
Biphasic

Question 6

Doubling time of Non-small Cell Lung Cancer

Answer 6

129 days

Question 7

What is the maximum operable/resectable of NSCLC

Answer 7

25%

Question 8

Tests used for staging

Answer 8

PET

Question 9

Purpose of MDT

Answer 9

Discuss results and therapeutic options

Question 10

Options for treatment (5)

Answer 10

Surgery
Radiotherapy
Chemotherapy
Targeted therapies
Supportive care only

Question 11

Stages in Eastern Cooperative Group Performance Status Measurement

Answer 11

5

Question 12

1 (ECOG)

Answer 12

asymptomatic; well

Question 13

2 (ECOG)

Answer 13

Symptomatic, able to do light work

Question 14

3 (ECOG)

Answer 14

Has to rest for >50% of the day

Question 15

4 (ECOG)

Answer 15

Bed bound

Question 16

5 (ECOG)

Answer 16

Dead

Question 17

What are the 3 essential information to determine optimal therapy

Answer 17

Pathology
Stage
Performance status

Question 18

Treatment options for NSCLC

Answer 18

Surgery

Adjuvant Therapy

Question 19

For NSCLC when is it good and detrimental to give adjuvant

Answer 19

Good- Stage IB and II- cisplatin

Detrimental- mediastinal N2 nodes

Question 20

What trial proved the effectiveness of Durvlumab after CRT

Answer 20

PACIFIC Trial

Question 21

Dose of radical RT for Stage III NSCLC

Answer 21

55Gy +

Question 22

Number of fractions in Radical RT for stage III NSCLC

Answer 22

30

Question 23

What is essential before starting radical RT

Answer 23

Pulmonary Function Test

Question 24

What type of treatment is ChemoRT

Answer 24

Systemic

Question 25

What is SABR

Answer 25

Stereotactic Ablative radiotherapy

Question 26

Dose of SABR (2)

Answer 26

54Gy in 3 fractions

High dose

Question 27

When is SABR suitable

Answer 27

Useful if not fit for surgery
Tumours up to 4-5 cm
>2cm awat from airways and proximal bronchial tree

Question 28

Treatment decisions in NSCLC are also affected by

Answer 28

Co-morbidity (angina, COPD)

Question 29

Features of Stage IV NSCLC

Answer 29

Incurable
Palliation is essential
RT- symptom benefit
Chemo- symptomatic and survival

Question 30

What should be measured during NSCLC stage III and IV (3)

Answer 30

Quality of life: Painful bone metastases (RT single fraction)
Brain metastases 9resection, RT, steroids, erlotinib)

Question 31

Features of Bone pain from metastases (3)

Answer 31

Worse at night
Pathological fracture
Palliative RT

Question 32

New developments in NSCLC (2)

Answer 32

Targeted drugs for adenocarcinoma (ALF, ROS, BRAF, EGFr)

Immunotherapy

Question 33

Examples of Tyrosine Kinase Inhibitors

Answer 33

Erlotinib, Geftinib, Afatinib

Question 34

Mechanism of Nivolumab

Answer 34

Blocks the binding of PD-1 (T ecll) to PDL-1 and PDL2 (tumour cell)

Question 35

Preentation of small cell lung cancer is identical to

Answer 35

secretory syndromes SIADH, cushings

Question 36

Treatment for SCLC (4)

Answer 36

Chemo
Combination of drugs (Cisplatin + etopside)
Early thoracic RT
Prophylactic cranial radiation

Question 37

2 types of SCLC

Answer 37

Limited and extensive

Question 38

features of possible lung cancer screening (2)programme

Answer 38

At risk population

Low dose CT