Respiratory medicine: limited-stage small cell lung cancer: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Respiratory medicine: limited-stage small cell lung cancer

Sample item

A 62-year-old smoker has a central hilar mass with mediastinal nodes and a serum sodium of 124 mmol/L with concentrated urine. Biopsy shows small round cells with scant cytoplasm, nuclear moulding and a Ki-67 index of 90%. Staging shows disease confined to one hemithorax. What is the mainstay of treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Platinum and etoposide chemotherapy with thoracic radiotherapy

Small cell lung cancer is a rapidly growing neuroendocrine tumour that has usually spread by diagnosis. Limited-stage disease is treated with platinum-etoposide chemotherapy plus thoracic radiotherapy, with prophylactic cranial irradiation for responders. The hyponatraemia is SIADH from the tumour.

Option by option

  • A. Lobectomy with adjuvant radiotherapy

    Surgery is for the rare very early node-negative tumour, not one with mediastinal nodes.

  • B. EGFR tyrosine kinase inhibitor alone

    EGFR inhibitors act on mutations typical of adenocarcinoma, not small cell cancer.

  • C. Platinum and etoposide chemotherapy with thoracic radiotherapy (correct)

    Correct. Combined chemoradiotherapy is the standard for limited-stage disease.

  • D. Radiotherapy alone with observation

    Radiotherapy alone gives poor control of a chemosensitive systemic disease.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Platinum and etoposide chemotherapy with thoracic radiotherapy. Small cell lung cancer is a rapidly growing neuroendocrine tumour that has usually spread by diagnosis.

Why is "Lobectomy with adjuvant radiotherapy" not the answer?

Surgery is for the rare very early node-negative tumour, not one with mediastinal nodes.

Why is "EGFR tyrosine kinase inhibitor alone" not the answer?

EGFR inhibitors act on mutations typical of adenocarcinoma, not small cell cancer.

Why is "Radiotherapy alone with observation" not the answer?

Radiotherapy alone gives poor control of a chemosensitive systemic disease.

What concept does this question test?

It tests Respiratory medicine: limited-stage small cell lung cancer in General Medicine. Limited-stage disease is treated with platinum-etoposide chemotherapy plus thoracic radiotherapy, with prophylactic cranial irradiation for responders. The hyponatraemia is SIADH from the tumour.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Respiratory medicine: limited-stage small cell lung cancer?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.