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Q1: Classification and epidemiology (3 min)
- How do you classify lung cancer? Distinguish NSCLC (~85%) from SCLC (~15%) and name the major NSCLC subtypes with their typical location, histology, and immunohistochemistry.
- What is the relative frequency of adenocarcinoma vs squamous vs large cell vs carcinoid? Which is now the commonest?
- Why does modern practice require subtype AND molecular profile (EGFR, ALK, ROS1, PD-L1), not just "NSCLC"?
- What proportion of lung cancer is attributable to smoking? Name three other risk factors and the lesion each favours (asbestos → mesothelioma; radon → adenocarcinoma; second-hand smoke).
Q2: Clinical presentation and paraneoplastic syndromes (3 min)
- A smoker over 40 with a changing cough and haemoptysis — what is the differential, and what red flags demand urgent CT and referral?
- List the four broad groups of presentation: local respiratory, constitutional, metastatic, paraneoplastic. Give two examples of each.
- Recite the paraneoplastic syndromes by histological subtype: SIADH (SCLC), ectopic ACTH/Cushing (SCLC), PTHrP hypercalcaemia (squamous), Lambert-Eaton (SCLC), anti-Hu (SCLC), HPOA/clubbing (NSCLC).
- Describe the Pancoast (superior sulcus) tumour triad.
Q3: Investigations and staging (3 min)
- How would you obtain tissue in (a) a central lesion, (b) a peripheral lesion, (c) mediastinal nodes, (d) a pleural effusion, (e) a supraclavicular node?
- Reproduce the TNM 8th edition T categories by size (under 3, 3-5, 5-7, over 7 cm) and N (N0-N3) and M (M0, M1a/b/c).
- How does SCLC staging differ (limited vs extensive)?
- What molecular tests are essential before first-line therapy in advanced NSCLC, and which trial supports each first-line drug?
Q4: Management (3 min)
- Walk through stage-based NSCLC treatment: stage I-II (surgery ± adjuvant chemo), stage III (chemoradiotherapy + durvalumab, PACIFIC), stage IV (immunotherapy/targeted TKIs).
- For an EGFR-mutant adenocarcinoma: which drug, which trial, and what CNS advantage? (osimertinib, FLAURA, crosses BBB).
- For SCLC limited vs extensive: outline the regimen (etoposide + cisplatin/carboplatin + thoracic RT + PCI).
- Describe how you would manage an oncological emergency: SVCO, spinal cord compression, hypercalcaemia of malignancy.
Q5: Prognosis and pitfalls (2 min)
- Quote 5-year survival by stage (NSCLC stage I ~60-80% down to stage IV under 10%; SCLC limited 20-25% vs extensive under 5%).
- Name four poor prognostic factors (advanced stage, ECOG 3-4, weight loss, high LDH, hypercalcaemia, brain/liver mets).
- What are the classic pitfalls: dismissing smoker's cough; inadequate tissue for molecular testing; non-resolving pneumonia in smoker over 40; treating SCLC like NSCLC; missing a paraneoplastic syndrome.
- What is the role of low-dose CT screening, and which trial established it (NLST — 20% reduction in lung-cancer mortality)?