4. Lung Cancer, Pleural Disease and Palliation

Question 1

which type of cancer accounts for >90% of lung malignancies?

Answer 1

lung/bronchial carcinoma

Question 2

Name 7 aetiological agents of bronchial carcinoma

Answer 2

1. smoking
2. radon gas
3. asbestos
4. polycyclic aromatic hydrocarbons
5. ionising radiation
6. occupational - arsenic, chromium
7. pre-existing lung disease

Question 3

Describe the main divisions of bronchial carcinoma

Answer 3

1. small cell lung cancer
2. non-small cell lung cancer
   - further divided into adenocarcinoma, squamous cell carinoma and large cell carcinoma

Question 4

Describe the histology of the following:

1. small cell carcinoma
2. adenocarcinoma
3. squamous cell carcinoma
4. large cell carcinoma

Answer 4

1. derived from neuroendocrine cells - crowded small cells; sparse cytoplasm. Associated with paraneoplastic syndrome. Arise centrally and metastasize early
2. arise from mucous secreting glandular cells; commonly metastasises
3. arise from keratin producing squamous cells; highly invasive. Metastasises relatively late.
4. derived from neuroendocrine cells; often poorly differentiated. metastasizes early.

Question 5

where do lung cancers commonly metastasize to? (3)

Answer 5

1. liver
2. bone
3. brain

Question 6

Name the 7 main investigations for ?lung CA

Answer 6

1. CXR - may reveal coin shaped lesion or mediastinal enlargement
2. contrast CT - for TNM staging
3. PET
4. Bronchoscopy
5. Biopsy
6. FBC and serum biochemistry
7. Pulmonary function tests - important to assess fitness for treatment

Question 7

1. What is the main treatment for NSCLC?
2. What is the main treatment for SCLC?
3. What is erlotinib targeted for?
4. What is pembrolizumab targeted for?
5. What is crizotinib targeted for?

Answer 7

1. surgery or radical radiotherapy. Chemoradiation if stage III+
2. chemotherapy (cisplatin based)
3. EGFR+ NSCLC
4. ROS1+ NSCLC
5. PD-L1+ NSCLC

Question 8

What is the main cause of mesothelioma?

Answer 8

asbsetos exposure

Question 9

describe clinical features of mesothelioma (8)

Answer 9

1. SOB
2. Cough
3. pleuritic chest pain
4. fullness in chest
5. pleural effusion
6. constitutional symptoms
7. dullness to percussion
8. diminished breath sounds

Question 10

How is mesothelioma managed?

Answer 10

palliative chemoradiation

pleuredesis to prevent pleural effusions

Question 11

How does asbestos generally cause lung disease?

Answer 11

fibres are inhaled and retained in the lungs
inflammatory response towards fibres is mounted, leading to tissue damage and fibrosis
some fibres can migrate to pleura

Question 12

1. What are pleural plaques?
2. how to patients with pleural plaques usually present?
3. how are they diagnosed?

Answer 12

1. discrete, circumscribed areas of hyaline fibrosis of the parietal pleura. Can become calcified over time.
2. typically asymptomatic, but can cause chest pain and restrictive lung impairment
3. CXR/CT

Question 13

1. What is diffuse pleural thickening?
2. What pattern of impairment is seen?
3. How is it detected?

Answer 13

1. non circumscribed fibrous thickening of the visceral pleura, with areas of adherence to the parietal pleural and obliteration of the pleural space
2. restrictive
3. CT

Question 14

What kind of pleural effusion can be caused by asbestos?

Answer 14

exudative

Question 15

What is rounded atelectasis?

Answer 15

infolding of thickened viceral pleura, with collapse of intervening lung parenchyma

Question 16

1. What is asbestosis?

2. what area of the lung does it commonly affect?

Answer 16

1. diffuse, interstitial pulomary fibrosis

2. bases