Lung

Question 1

Disease Management: Early stage T1&T2

Answer 1

Sx followed by chemo +/- RT

Question 2

Disease Management: Limited stage N1&N2

Answer 2

Chemo RT is standard 66/33

Prophylactically treat brain (25/10 or 30/15

Question 3

Disease Management: Advanced stage N3 +/or M1

Answer 3

Chemo only

Question 4

Disease Management: Stage IV

Answer 4

May receive RT only: palliative
high dose: complex planning–>40/16, 55/22
low dose: geometric–>30/10, 20/5, 800/1

Question 5

Disease Management: NSCLC

1. Stage I&II
2. Stage III

Answer 5

1. Could do Chemo or RT pre-op
   Post-op:
   -positive LN 50-54
   -positive surgical margins 54-60Gy

inoperable:
- RT +/- Chemo 60-70
- SBRT

2. Usually inoperable
   6000/30
   Chemo RT

Question 6

Paraneoplastic syndrome

Answer 6

Disease that is caused by cancer cells

• symptoms may affect nerves and muscles
• frequently seen with lung cancer
  - clubbing at end of fingernails (hypertrophic osteoarthropathy)
  - cushings syndrome

Question 7

Superior sulcus tumours (SSTs)

Answer 7

Pancoast

• Chemo/RT then sx
• often unresectable due to nerves, vessels and vertebral bodies

Question 8

SVCO

Answer 8

superior vena cave obstruction
-can be managed with stenting, chemo, RT
Pts present with:
face, neck and arm edema, increased dyspnea, cyanosis, chest vein distention

Question 9

Lung cancer pathology

Answer 9

NSCLC
SCC–> related to tobacco use, central and slow growing, spread to lymphs, bones, liver, brain, more common in men

Adenocarcinoma–>less related to tobacco use, peripherally and fast growing, more likely in women

SCLC
metastasizes quickly and has a poor prognosis
(mesothelioma-Rare)

Question 10

1. lymphatics
2. nodes
3. drainage upper lobe
4. drainage lower lobe

Answer 10

1. Intrapulmonary
   bronchopulmonary
   mediastinal
2. 1-9: mediastinal
   10-14: hilar and peripheral

3.
Lt: Rt sup mediastinum
Rt: Hilar and Paratracheal

4. Lt/Rt: Inf mediastinal and subcarinal

Question 11

Presenting signs and symptoms

Answer 11

Cough and hemoptysis

Question 12

Epi/Eti

Answer 12

Primary tobacco exposure

Radon

Question 13

Prognostic indicators

Answer 13

Stage

Question 14

Acute side effects

Answer 14

esophagitis, dysphagia, heart burn, cough, hemoptysis

Question 15

where do the lungs bifurcate?

Answer 15

Carina

T4-5

Question 16

Anatomical borders

Answer 16

Sup:
-T1-T2
-2-3 cm above clavicles
Inferior:
-T10-T11
-curves over diaphragm

Question 17

Lung treatment technique

Answer 17

palliative APPA 6 or 10MV

includes primary tumour, adj mediastinum +3cm margin. beams angled slightly to avoid spinal cord

Dose >40Gy 3DCRT or IMRT