Mesothelioma and other cancers

Question 1

Example of a cancer of the pleura

Answer 1

Mesothelioma (cancer of mesothelial cells)

Question 2

Name of histological ‘body’ found in mesothelioma

Answer 2

Psammoma bodies are seen histologically

Question 3

Pathophysiology of mesothelioma

Answer 3

Arises from mesothelial cells (80% pleura, rest are peritoneum and pericardium). Deposition of the asbestos fibres in parenchyma -> penetration of the visceral pleura -> transport of the fiber to the pleural surface -> Development of a malignant plaque (asbestos can apparently facilitate foreign DNA entering the cell -> messing with oncogenes etc)

Question 4

How do asbestos increase risk of cancer

Answer 4

Apparently asbestos facilitate foreign DNA entering the cell

This messes with oncogenes etc

Question 5

Aetiology of mesothelioma

Answer 5

Strong association with asbestos inhalation (80% of cases attributable).
Genetic risk.

Question 6

Epidemiology of mesothelioma

Answer 6

Three times more common in men
Mostly over the age of 75
Poor prognosis

Question 7

Clinical presentation of mesothelioma

Answer 7

Shortness of breath, dull diffuse chest pain (occasionally pleuritic), weight loss, lethargy.
Pleural effusion.
History of asbestos exposure, sometimes.
Potentially a palpable chest wall mass.

Question 8

Diagnostic tests of mesothelioma

Answer 8

CXR: Pleural effusion
Potentially rib destruction
Pleural aspiration: Straw coloured or blood stained
Pleural biopsy: Gold standard

Question 9

Surgical treatment of mesothelioma

Answer 9

Ressection (pleurectomy and decortication may relieve pain and effusions)

Question 10

Medical treatment of mesothelioma

Answer 10

Chemo: Improves survival of patients with unressectable mesothelioma
Radio: Mostly for pain control if at all

Question 11

Cancers of central lung

Answer 11

Squamous cell carcinoma

Small cell carcinoma

Question 12

Aetiology of squamous cell carcinoma

Answer 12

Associated with smoking

Question 13

Pathophysiology of squamous cell carcinoma

Answer 13

Paraneoplastic parathyroid-like actions

Keratin pearls are seen histologically

Question 14

Pathophysiology of small cell carcinoma

Answer 14

Very aggressive, therefore treat solely with chemotherapy regime
Adrenocorticotrophic hormone (ACTH) and Antidiuretic hormone (ADH) are generated ectopically

Question 15

Lung cancer of apex of lung

Answer 15

Pancoasts tumour

Question 16

Cancers of peripheral lung

Answer 16

Adenocarcinoma

Large cell carcinoma

Question 17

Which lung cancer is not associated with smoking

Answer 17

adenocarcinoma (more common in women)

Question 18

Diagnosis of adenocarcinoma

Answer 18

Mucin-positive staining (seen on histology)

Question 19

Which lung cancer is associated with hypertrophic osteoarthropathy

Answer 19

Adenocarcinoma

Question 20

Pathophysiology of large cell carcinoma

Answer 20

Patient is likely to have a poor outcome
Lack light microscopic features of other tumour types
Larger sized anaplastic cells
High cytoplasmic-to-nuclear size ratio

Question 21

Treatment of large cell carcinoma

Answer 21

Surgical excision of the tumour

Question 22

In what type of lung cancer would you see Kulchitsky cells histologically

Answer 22

Small cell carcinoma