pleural malignancy

Question 1

what is the primary pleural malignancy

Answer 1

mesothelioma

Question 2

how does the tumor promote development of exudate effusion (6)

Answer 2

lymphatic block (normally drains pleural effusion); tumour dissemination; tumor secreting VEGF; tumor secreting inflammatory mediators; driver oncogenes; transcription factors

Question 3

pathology of exudate effusion development from the host (6)

Answer 3

angiogenesis (vessels have leaky walls); vascular hyperpermeability; inflammatory signalling; host cell recruitment (macrophages, mast cells etc.); transcription factors; immune system

Question 4

what is the most common cancer in women

Answer 4

breast

Question 5

what is the most common cancer in men

Answer 5

lung

Question 6

3 signs that the primary cancer is elsewhere (not pleural)

Answer 6

dysphagia; change in bowl habit; lumps

Question 7

what symptoms are associated w pleural malignancy (8)

Answer 7

pleural effusion; SOB; cough; dull chest pain –> occurs over months-weeks; weight loss; fatigue; loss of appetite

Question 8

what is ECOG performance status (5)

Answer 8

Eastern Cooperative Oncology Group performance scale - a simple measure of functional status;
0 - fully active, able to carry on all pre-disease performance without restriction
1 - restricted in physically strenuous activity but ambulatory and can carry out light work
2 - ambulatory and capable of self care but unable to carry out any work
3 - capable of only limited selfcare, confided to bed/chair for >50% of time, need help w washing/dressing
4- completely disabled, cannot carry out self care, completely confined to bed or chair

Question 9

on examination what may be seen in a pt w pleural malignancy (5)

Answer 9

increased resp rate; cachectic; decreased air entry; decreased lung expansion; dull percussion note; decreased vocal resonance

Question 10

investigations for pleural malignancy (6)

Answer 10

1. CXR - massive effusion often seen, may see masses
2. bloods (U&Es, FBC, CRP, clotting)
3. thoracic ultrasound - diaphragm/pleural thickening, nodularity, effusion
4. CT scan - in women CT chest, abdo and pelvis
5. pleural aspiration - total protein, LDH, check cytology
6. thoracoscopy - effusion treatment and biopsy, IOC insertion may be done, risk of bleeding and pulmonary oedema

Question 11

treatment for pleural malignancy (4)

Answer 11

1. treat underlying malignancy if pleural isnt primary
2. therapeutic aspiration
3. chest drain and pleurodesis
4. indwelling pleural cather insertion
   pleurectomy (rare)

Question 12

when is an indwelling pleural catheter considered

Answer 12

trapped lung or failed pleurodesis

Question 13

whats is pleurodesis

Answer 13

part of the pleural space is artificially obliterated. It involves the adhesion of the visceral and the costal pleura.