Respirology - Cancer

Question 1

Discuss the 4Ts of Anterior Compartment Mass

Answer 1

• Thymoma
• Thyroid enlargement
• Teratome
• Tumours (lymphoma, esophageal, parathyroid)

Question 2

Discuss the types of bronchiogenic lung cancers

Answer 2

Small Cell Lung Cancer
- central location with oat cell and neuroendocrine histology
- Disseminated at presentation
- Poorest survival
- Strong correlation with smoking
Adenocarcinoma
- Location is peripheral with glandular, mucin producing histology
- metastisize early
- weak correlation with smoking
Squamous cell carcinoma
- central location with keratin and intracellular bridges histology
- have local invasion first
- strong correlation with smoking
Large cell Carcinoma
- peripheral with anaplastic, undifferentiated histology
- early metastasis
- strong correlation with smoking

Question 3

Discuss the presentation of lung cancer

Answer 3

Primary
- cough that changes in character
- dyspnea
- hemoptysis
- Clubbing
- Constitutional symptoms
Metastasis
- pleural effusion, atelectasis
- hoarseness
Superior Vena Cava Syndrome
- obstruction of SVC
Lung Apex
- horners syndrome of miosis, anhydrosis and ptosis through compression of ipsilateral sympathetic plexus
Paraneoplastic Syndrome

Question 4

Discuss the treatment for lung cancer

Answer 4

Small Cell
- Limited stage then radiation with possible chemothrapy and prophylactic brain radiation
- Extensive stage chemothrapy
Non-Small Cell
- Stage I-IIA: complete surgical resection with post-operative chemotherapy for IIB
- Stage III: chemotherapy, radiotherapy and possible surgery
- Stage IV: systemic therapy or molecular based therapy