Lung Cancer & Mediastinal Masses

Question 1

What is Pancoast’s syndrome?

Answer 1

Pancoast’s syndrome

• Symptoms associated with a superior pulmonary sulcus tumour
• Shoulder and arm pain
• Horner’s syndrome (ipsilateral ptosis, miosis, anhidrosis = droopy eye lid, no sweat on one side of the forehead)
• Weakness and atrophy of hand muscles

Causes: NSCLC, other neoplasms, infectious diseases

Question 2

What is Horner’s syndrome?

Answer 2

Horner’s syndrome (ipsilateral ptosis, miosis, anhidrosis = droopy eye lid, no sweat on one side of the forehead)

Question 3

Compare and contrast Adenocarcinoma and Squamous Cell Carcinoma of the Lung.

Answer 3

Both Adenocarcinoma and Squamous Cell Carcinoma are Non Small Cell Lung Cancers.

Adenocarcinoma: most common subtype, women, non-smokers, can have a lepidic growth pattern (slow), peripheral nodule/mass, airspace disease, commonly misdiagnosed as a pneumonia

Squamous cell carcinoma: FAST growing, central, large, cavitary lesion, involves major airways

Question 4

What are the CXR findings of a benign single pulmonary nodule?

Answer 4

CXR: central, diffuse, concentric calcification, popcorn

Question 5

What are the CXR findings of a benign single pulmonary nodule?

Answer 5

CXR: irregular, spiculated, eccentric calcification

Question 6

How is small cell lung cancer staged vs. non small cell lung cancer staged?

Answer 6

Small cell lung cancer: limited (inside thorax; curative chemotherapy +/- radiation) or extensive (outside thorax; palliative chemotherapy)

Non small cell lung cancer: TNM staging

• Stage 1 (in lung) = surgery
• Stage 2/3 (in mediastinum)
• Stage 4 (metastases) = palliative care +/- chemotherapy/radiation for symptom control

Question 7

What is the differential diagnosis for a mass found in the anterior mediastinum?

Answer 7

Differential diagnosis of a anterior mediastinal mass = 4 Ts
Thymoma
Thyroid enlargement
Teratoma
“Terrible” lymphoma/Tumours (parathyroid, esophageal, angiomatous)