Thoracic oncology

Question 1

Performance Status

Answer 1

0 - able to carry out normal activity without restriction
1 - Restricted in strenous activity but ambulatory and able to carry out light work
2 - ambulatory and capable of all self care but not able to carry out any work activities. up and about >50%
3 - symptomatic and in chair > 50% but not bedridden
4 - completely disabled. cannot carry out any self care. confined to bed or chair

Question 2

Brock Model

Answer 2

Age
Gender
FH lung cancer
Emphysema
Nodule size
Nodule count
Nodule type
Nodule in upper lobe
Spiculation

Question 3

Squamous cell carcinoma chemo

Answer 3

PDL1 > 50 - Pembrolizumab
PDL1 <50 or progression - Gemcitabine or vinorelbine + carboplastin or cisplatin

Doxetaxel

Atezolizumab
Nivolumab
Pembrolizumab (PDL1 >1)

Question 4

Adenocarcinoma chemo

Answer 4

eGFR - Afatinib, dacomitinaib, enotinib, getitinib, osimertinib
ALK - Alectinib, brigatinib, ceritinib, crizotinib, loratinib
ROS1 - Crizotinib, entrectinib
PDL1 >50% - pembrolizumab
PDL1 < 50% or no mutation or progression - pemetrexed and cisplatin

Question 5

Mesothelioma chemo

Answer 5

Cisplatin and pemetrexed +/- bevacizumab
ciaplatin and ralitrexed
carboplatin and pemetrexed

Question 6

Small cell chemo

Answer 6

etoposide and cisplatin/carboplatin
add radiotherapy in WHO 0-1
Px cranial radiation if no progression after chemo in WHO 0-1
Topitecan PO if IV chemo not tolerated

Question 7

Paraneoplastic

Answer 7

Small cell - LEMS, limbic encephalitis anti HU, SIADH, ACTH
Squamous - PTH

Question 8

Immunohistochemistry - adenocarcinoma

Answer 8

TTFI
CK7
Napsin A
E Cadherin

Question 9

Immunohistochemistry - squamous

Answer 9

P63
CK5
CK6
CEA