Malignancy of lungs and pleura

Question 1

When Sx would make you suspect a sinister pathology?

Answer 1

(1. ) Persistent cough
(2. ) Weight loss
(3. ) Voice change in a smoker
- > malignancy?

(1. ) Night sweats with persistent cough
- > TB or malignancy?

Question 2

What are the different types of cancer and which one is the most common

Answer 2

o	Squamous cell carcinoma (35%)
o	Adenocarcinoma (25%)
o	Small cell carcinoma (20%)
o	Non-small cell (cell undifferentiated) carcinoma (10%) 
o	Neuroendocrine carcinoids (5%)

Question 3

What is Small cell carcinoma associated with and its Mx?

Answer 3

(1. ) Arises from endocrine cells
(2. ) Associated with Lambert-Eaton syndrome, Cushing’s, SIADH
(3. ) High grade, spreads rapidly, associated with smoking
(4. ) Metastasis early (almost always inoperable)
(5. ) Mx = chemo

Question 4

Mx of non-small cell carcinoma

Answer 4

(1. ) It is less grade than small cell

(2. ) Mx = surgery and radiotherapy

Question 5

Signs associated with squamous cell carcinoma

Answer 5

(1. ) Hypercalcaemia related sx
- STONE BONES THRONES GROANS PYSCHIATRIC TONES
- Inc urination, constipation, psychiatric Sx etc

(2. ) Clubbing
(3. ) Hypertrophic pulmonary osteoarthropathy
(4. ) Persistent cough +/= blood
(5. ) Recurrent chest infection
(6. ) Increasing SoB

Question 6

Ix for lung cancer

Answer 6

(1. ) Imaging
- CXR = will show various features from lobar collapse to mass lesions, effusion or malignant rib destruction
- CT = may reveal mediastinal or metastatic spread

(2. ) Biopsy + Bronchoscopy via nose
- Biopsy may be taken as a ‘frozen section’. This determines whether tumour is malignant or benign and will determine where the lobe is resected or not

Question 7

What are the two main primary tumours affecting the pleura

Answer 7

• Pleural fibroma

- Malignant mesothelioma

Question 8

What is a pleura fibroma?

Answer 8

• Localised fibrous tumour of pleura
• 90% are benign.
• They are composed of spindle cells and they can grow and cause local discomfort.
• Mx = surgical resection

Question 9

What is mesothelium?

Answer 9

(1. ) Malignancy of the mesothelial tissue
(2. ) Linked to asbestos - also linked with pleural plaques, pleural effusion, pleural fibrosis, and especially linked to lung fibrosis or asbestosis.
(3. ) Inhaled asbestos is insoluble and can hang around in the body for a long time once inhaled, it causes irritation and acquire mutation that induces pleural neoplasia.
(4. ) It can invade into the local chest wall tissues, spreads into the mediastinum, through bone.
(5. ) Mx = pleurectomy if early-stage mesothelioma
(6. ) 8-12m prognosis after dx