Early-stage non-small-cell lung cancer — SCE Respiratory MCQ

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ModerateLung CancerEarly-stage non-small-cell lung cancerSCE Respiratory

A 70-year-old woman has a peripheral adenocarcinoma confirmed on CT-guided biopsy. PET-CT shows an isolated 2.1 cm left upper lobe lesion without nodal or distant uptake. FEV1 is 82% predicted and TLCO 78% predicted. ECOG performance status is 0. What is the most appropriate management?

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Correct answer: E — Lobectomy with systematic nodal sampling

This is biopsy-proven, apparently early-stage NSCLC: a solitary 2.1 cm peripheral lung adenocarcinoma with no PET-avid nodal or distant disease is clinical T1cN0M0, and she is physiologically fit for curative surgery with ECOG 0 and preserved FEV1/TLCO. In current UK practice, the preferred curative treatment for a fit patient with resectable stage I NSCLC is lobectomy, with hilar and mediastinal lymph node sampling or en bloc nodal resection for accurate staging and local control. SABR is reserved for patients who decline lobectomy or in whom surgery/lobectomy is contraindicated. Pembrolizumab monotherapy is for selected advanced disease, concurrent chemoradiotherapy is for unresectable/locally advanced disease or nonsurgical stage II/III scenarios, and observation is inappropriate for confirmed operable lung cancer.

Reference: NICE guideline NG122: Lung cancer: diagnosis and management. Published 2019; last updated 8 March 2024; last reviewed 10 February 2026. Recommendations 1.5.1, 1.5.3, 1.5.5 and 1.5.8. https://www.nice.org.uk/guidance/ng122/chapter/Management