Management of Lung Cancer

This was a Telehealth Presentation offered in Saskatoon on April 7, 2009 by Dr. Shahid Ahmed, MD, FACP, FRCPC, Saskatoon Cancer Centre.

PRETEST: You may want to test yourself on the following five questions before watching the videos.

1. Standard treatment for limited stage small cell lung cancer is:

   1. Surgery followed by adjuvant chemotherapy
   2. Radiation
   3. Chemo / Radiation
   4. Chemo / Radiation followed by surgery
   5. Chemotherapy alone

2. The case mortality rate for lung cancer is:

   1. 25%
   2. 100%
   3. 50%
   4. 85%
   5. 10%

3. A 59-year old woman with 25-pack history of smoking presented with cough and SOB. CXR showed a RUL mass. Biopsy showed adenocarcinoma. CT chest and abdomen showed 4 cm RUL mass with meidastinal lymphadenopathy. The most appropriate initial management would be:

   1. Proceed to surgery
   2. Mediastinoscopy
   3. Radiation therapy
   4. Colonoscopy to r/o a primary colorectal cancer
   5. Chemotherapy followed by radiation

4. A 60-year old man presented with 6 weeks h/o cough, SOB, RUQ pain and 15 lb wt loss. CSR showed a large right hilar mass. CT showed SVC with extensive liver mets. Lab revealed impaired LFT. A FNA of lung mass confirm small cell cancer. The initial management:

   1. Observation
   2. Chemotherapy
   3. Emergent RT
   4. SVC Stenting
   5. Anticoagulation

5. Which of the following statements is not true:

   1. Adjuvant chemotherapy in resectable lung cancer prolongs survival
   2. Chemotherapy compared with best supportive care prolongs survival in patients with advanced lung cancer
   3. Chemo / RT vs RT has been associated with a superior survival in patients with limited stage SCLC
   4. PCI prolongs survival in patients with SCLC who achieved a good response to treatment
   5. Adjuvant radiation therapy in resected non-small cell lung cancer has been associated with prolong survival