Thoracic oncology

Learning resources

Access online learning resources related to thoracic oncology on the ERS e-learning website.

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CPD framework

The continued professional development (CPD) framework for thoracic oncology is broken down into modules. This framework supports structured learning for respiratory professionals and allows them to navigate the related learning activities and events offered by ERS.

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Modules

1. Carcinogenesis, immunology and defence mechanisms

  1. Carcinogenesis
    1. Basic principles of carcinogenesis, including the dysplastic lesion-carcinoma in situ-invasive lesion sequence
    2. Tumour immunology
    3. Basic principles related to tumour immunology, including the general structure of innate and adaptive immune recognition and immune responses in humans as well as the elimination-equilibrium-escape sequence
  2. Hallmarks of cancer
    1. Self-sufficiency in growth signals
    2. Insensitivity to anti-growth signals
    3. Evasion from programmed cell death (apoptosis)
    4. Limitless replicative potential
    5. Sustained angiogenesis
    6. Tissue invasion and metastasis
    7. Deregulated metabolism
    8. Evasion from the immune system
    9. Genome instability
    10. Inflammation

2. Tobacco - risk factors and epidemiology

  1. Current epidemiology of active and passive smoking, heated tobacco products and smokeless tobacco products as well as other smoked or vape-related products worldwide and nationally in relation to thoracic malignancies
  2. Pathogenic mechanisms of active and passive smoking, heated tobacco products and smokeless tobacco products related to thoracic malignancies
  3. Socio-economic and cultural aspects of tobacco consumption related to thoracic malignancies

3. Indoor and outdoor pollution

Basic principles of indoor and outdoor pollution related to thoracic malignancies


4. Respiratory hazards associated with occupational factors

Occupational carcinogens that cause thoracic malignancies; causal relationships


5. Asbestos-related diseases

  1. Asbestos-related diseases
  2. Non-malignant pleural manifestations (acute benign pleural effusions, rounded atelectasis, diffuse pleural thickening and pleural plaques)
  3. Malignant pleural mesothelioma
  4. Asbestosis
  5. Lung cancer related to asbestos

6. Lung cancer screening

Low dose computed tomography (CT) as an evidence-based measure for lung cancer screening in high risk populations


7. Signs and symptoms

1.Symptoms as potential indicators of thoracic oncological disease:

  1. Dyspnoea
  2. Dysphagia
  3. Chest pain
  4. Bone pain
  5. Headache
  6. Tiredness
  7. Cough
  8. Haemoptysis
  9. Wheezing
  10. Stridor
  11. Hoarseness
  12. Weight loss
  13. Diaphragmatic elevation
  14. Pleural effusion
  15. Pericardial effusion
  16. Superior vena cava syndrome
  17. Pancoast syndrome
  18. Horner syndrome
  19. Enlarged, non-moveable and/or indurated cervical, supraclavicular or nuchal lymph nodes
  20. Neurological signs or symptoms
  21. Paraneoplastic skin disorders (erythema gyratum repens, acanthosis nigérians etc)

2. Awareness of paraneoplastic syndromes including:

  1. Cachexia
  2. Hypercalcemia
  3. Thromboses and pulmonary embolism
  4. Syndrome of inappropriate antidiuretic hormone (hyponatremia)
  5. Ectopic adrenocorticotropic hormone syndrome
  6. Lambert-Eaton syndrome
  7. Clubbing and periostitis

8. Imaging techniques

  1. Chest X-ray
  2. Thoracic ultrasound
  3. Computed tomography (CT) scan
  4. Positron emission tomography (PET)
  5. PET-CT
  6. Ventilation perfusion scan
  7. Bone scan
  8. Octreotide scan
  9. Single-photon emission computed tomography (SPECT)
  10. Magnetic resonance imaging (MRI)
  11. Basic principles of each imaging modality as well as basic radioprotection measures

9. Bronchoscopy

  1. Indications, contraindications, limitations and benefit-risk assessment as well as quality aspects for diagnostic flexible and rigid bronchoscopy and diagnostic techniques in the context of thoracic oncology
  2. Indications, contraindications, limitations and benefit-risk assessment as well as quality aspects for therapeutic bronchoscopy in the context of thoracic oncology (stents, cryotherapy, laser techniques, argon plasma, brachytherapy, electrocautery and photodynamic therapy)
  3. Principles of discontinuation and bridging of anticoagulants
  4. Principles of sedation
  5. Sampling and handling of probes

10. Advanced endoscopy

  1. Indications, contraindications, limitations and benefit-risk assessment as well as quality aspects for each procedure (including EBUS/EUS) in the context of thoracic oncology
  2. Different ranges of the methods
  3. Basic lymph node anatomy/stations of the mediastinum
  4. Principles of discontinuation and bridging of anticoagulants
  5. Principles of sedation
  6. Sampling and handling of probes

11. Thoracoscopy

  1. Indications, contraindications, limitations and benefit-risk assessment as well as quality aspects for diagnostic thoracoscopy in the context of thoracic oncology
  2. Indications, contraindications, limitations and benefit-risk assessment as well as quality aspects for therapeutic thoracoscopy in the context of thoracic oncology (talc pleurodesis)
  3. Principles of discontinuation and bridging of anticoagulants
  4. Principles of sedation
  5. Sampling and handling of probes

12. Other sampling techniques

  1. Pleural tap
  2. Pleural needle biopsy
  3. Chest tube insertion and management
  4. Blind pleurodesis

13. Pathology

  1. Basic principles of diagnostic steps in pathology related to thoracic malignancies
    1. light microscopy: Small cell carcinoma (SCC) vs non small cell carcinoma (NSCLC), squamous vs non-squamous carcinoma, carcinoids
    2. role of immunohistochemistry
    3. molecular pathology: actionable mutations (EGFR, BRAF, MET, NTRK1, Her 2) and gene rearrangements (ALK, ROS1, RET), resistance mutations
  2. Basic principles of proper handling of samples in suspected thoracic malignancies
  3. Tissue preservation and quality of samples (adequate tumour contents) for light microscopy, immunohistochemistry and molecular pathology (DNA and RNA studies)
  4. Liquid biopsy (cell free DNA, circulating tumour DNA)

14. Evaluation of patient fitness for diagnostics and therapy

Basic principles of evaluation of patient fitness for diagnostics and therapy


15. Multidisciplinary team and multidisciplinary team meeting

  1. Importance of multidisciplinary teamwork throughout the continuum of thoracic malignancies
  2. Multidisciplinary team meeting as the hallmark of decision-making in the process of care for patients with thoracic malignancies
  3. Quality requirements and monitoring for diagnosis, treatment and follow-up

16. Thoracic surgery

  1. Basic principles and indications of thoracic surgery in thoracic oncology
  2. Types of thoracic surgery
  3. Role of thoracic surgery in diagnosis as well as curative and palliative treatment

17. Radiotherapy

  1. Basic principles and indications of radiotherapy in thoracic oncology
    1. Tomotherapy, stereotactic body radiotherapy (SBRT), proton therapy
    2. Quality monitoring and guidelines for safety
    3. Irradiation of extra thoracic disease with its specific complications/side effects

2. Role of radiotherapy in curative and palliative treatment


18. Systemic pharmacotherapy

  1. Basis of cytotoxic therapy and biological/targeted therapy
    1. Describe the basic principles of chemotherapy and biological/targeted therapy as well as drug toxicities
  2. Indications and contraindications for systemic therapy including chemotherapy and targeted agents
    1. Non-small cell lung carcinoma (NSCLC)
    2. Small cell lung cancer (SCLC)
    3. Mesothelioma
    4. Thymoma
    5. Other mediastinal tumours

19. Immunotherapy

  1. Basic principles and methods of cancer immunotherapy
  2. Indications and contraindications for immunotherapy including combination therapy with chemotherapies
  3. NSCLC
  4. SCLC
  5. Mesothelioma
  6. Describe the basic principles of immunotherapy planning

20. Rehabilitation

  1. Basic principles and indications of rehabilitation programmes
  2. Value of rehabilitation programmes in the pre-operative setting as well as after completion of tumour-specific therapy

21. Smoking prevention and cessation

  1. Effects of smoking, heated tobacco products and smokeless tobacco products as well as other smoked or vape-related products on the health of the individual in relation to thoracic oncology
  2. Beneficial effects of smoking cessation for preventing thoracic malignancies as well as during and after treatment of thoracic malignancies
  3. Treatment modalities for smoking cessation

22. Palliative care including treatment of tumour-related symptoms and complications

  1. Basic principles of palliative care in thoracic oncology including its early integration as well as end-of-life care
  2. Basic principles and options regarding treatment of the following tumour-related symptoms and complications:
    1. Dyspnoea
    2. Pain
    3. Tracheobronchial stenosis
    4. Haemoptysis
    5. Cough
    6. Sialorrhea
    7. Nausea/vomiting
    8. Seizures
    9. Pathologic fractures
    10. Vertebroplasty
    11. Vena cava syndrome

23. Patient and family support

  1. Teach the patient to recognise early side effects and to contact his/her physician
  2. Importance of a multidisciplinary team for both acknowledgement of the patient and provision of care and surveillance

24. Management of paraneoplastic syndromes

  1. Basic principles of management of the following paraneoplastic syndromes:
    1. Cachexia
    2. Hypercalcemia
    3. Thromboses and pulmonary embolism
    4. Syndrome of inappropriate antidiuretic hormone (hyponatremia)
    5. Ectopic adrenocorticotropic hormone syndrome
    6. Lambert-Eaton syndrome and other neurological disorders (e.g.anti-HU associated symptoms)
    7. Clubbing and periostitis
  2. Awareness that the presence of paraneoplastic syndromes per se does not exclude curative treatment in thoracic oncology

25. Thromboembolic disease in thoracic oncology

  1. Prevention of thromboembolism in thoracic oncology
  2. Diagnostic and therapeutic management of thrombosis and pulmonary embolism in thoracic oncology

26. Thoracentesis including a chest tube and a tunnelled indwelling pleural catheter

  1. Indications, contraindications, limitations and benefit-risk assessment as well as quality aspects for thoracentesis including a chest tube and a tunnelled indwelling pleural catheter
  2. Principles of discontinuation and bridging of anticoagulants
  3. Principles of sedation

27. Common side effects of systemic therapies and their management

  1. Side effects of chemotherapy and their management
    1. Haematological side effects: neutropenia, febrile neutropenia, anaemia and thrombopenia
    2. Mucositis/oesophagitis
    3. Alopecia and dermatological toxicity
    4. Nausea, vomiting and diarrhoea
    5. Neurotoxicity
    6. Ototoxicity
    7. Hepatic toxicity
    8. Nephrotoxicity
    9. Cardiovascular toxicity
    10. Extravasation: infertility and teratogenesis
    11. Electrolyte imbalance
    12. Side effect in patients with thoracic oncological disease treated with systemic therapy
  2. Side effects of targeted therapy and their management
    1. Dermatological toxicity
    2. Diarrhoea
    3. Hepatic toxicity
    4. Cardiovascular toxicity
    5. Pulmonary toxicity
    6. Nephrotoxicity
  3. Side effects of immunotherapy and their management
    1. Pneumonitis
    2. Dermatological toxicities
    3. Hepatic toxicity
    4. Cardiovascular toxicity (e.g. myocarditis)
    5. Endocrinological toxicities
    6. Nephrotoxicity
    7. Neurological toxicities
    8. Side effect in patients with thoracic oncological disease treated with immunotherapy
    9. Hematologic toxicity
  4. Oncologic therapies in the context of viral pandemics

28. Common radiation-induced side effects and their management

  1. Radiation-induced pneumonitis (short-term) and fibrosis (long-term)
  2. Radiation-induced oesophagitis
  3. Cardiac toxicity
  4. Tracheal complications
  5. Skin reactions
  6. Secondary malignancy
  7. Radiation-induced side effect in patients with thoracic malignancies treated with radiotherapy
  8. Risk of radiotherapy-induced malignancies
  9. Risk of radiation-induced malignancies

29. Solitary pulmonary nodules

  1. Basic principles of solitary pulmonary nodule management including radiological characteristics as well as core diagnostic and follow-up strategies
  2. Up-to-date guidelines for the management of solitary pulmonary nodules

30. Malignant pleural mesothelioma

Basic principles of diagnostic (recommended procedures and histopathology) and therapeutic management of malignant pleural mesothelioma including multi-modal treatment modalities


31. Mediastinal tumours

Basic principles of diagnostic and therapeutic management of common mediastinal tumours (thymoma and lymphoma)


32. Common metastatic pulmonary tumours

Metastatic pulmonary tumours as a differential diagnosis of pulmonary nodules/masses (e.g. pulmonary metastasis in thyroid, colorectal, prostate, renal or mammary gland carcinoma as well as soft tissue sarcoma and osteogenic sarcoma)


33. Malignant pleural effusion

Basic principles of diagnostic and therapeutic management of malignant pleural effusion


Guidelines on thoracic oncology

Access the catalogue of ERS guidelines, statements and technical standards relating to the topic of thoracic oncology.

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