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Second Primary Lung Cancer — RACP Adult Medicine MCQ

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ModerateRespiratorySecond Primary Lung CancerRACP Adult Medicine

A 55-year-old man who quit smoking 5 years ago presents with a chronic cough. He has been cancer-free since treatment for Stage I lung cancer (right upper lobectomy 5 years ago). CT shows a new 15 mm spiculated nodule in the left upper lobe. PET shows intense FDG uptake (SUVmax 8). His contralateral lung function is adequate (predicted post-operative FEV₁ >40%). What is the most appropriate management?

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Correct answer: C — Surgical resection (lobectomy or segmentectomy)

New spiculated nodule with intense PET uptake 5 years after lung cancer surgery is a new primary lung cancer (second primary) until proven otherwise. With adequate lung reserve (predicted post-op FEV₁ >40%), surgical resection is the treatment of choice for early-stage NSCLC. If not surgical candidate: SABR/SBRT (>90% local control rates for stage I). All ex-smokers and current smokers with prior lung cancer remain at high risk for second primaries — annual LDCT screening is recommended.

Reference: Cancer Council Australia – 2024 – Lung Cancer; NCCN 2025