Tumours of the lung and pleura

Question 1

What is the typical clinical presentation of lung cancer?

Answer 1

1) Persistent cough
2) Haemoptysis
3) Breathlessness
4) Chest pain
5) Unintentional weight loss
6) Lymphadenopathy

Question 2

What are some features of adenocarcinoma?

Answer 2

1) It is a non-small cell carcinoma
2) Histologically must show gland formation or mucin production
3) Most often peripheral
4) Most common type of lung cancer
5) Immunohistochemistry –> TTF1 and napsin A

Question 3

What are some features of squamous cell carcinoma?

Answer 3

1) It is a non-small cell carcinoma
2) Histologically must show keratin formation, intercellular bridges
3) More often central (stronger smoking association)
4) Often cavitating
5) Immunohistochemistry –> p63 and cytokeratin 5

Question 4

What are some features of small cell carcinoma?

Answer 4

1) Primative poorly differentiated neuroendocrine tumours
2) Very aggressive with extremely poor prognosis
3) Disease often more present in lymph nodes than lungs
4) Surgery is typically ineffective due to amount of extrapulmonary tumour

Question 5

What are some features of carcinoid tumours?

Answer 5

1) Neuroendocrine tumour
2) Considered low grade malignancy (but some do metastasise)
3) Usually very well defined on imaging
4) Can be cured by local resection
5) Immunohistochemistry –> Synaptophysin and Chromogranin

Question 6

What mutation tests need to be carried out on newly diagnosed non-small cell lung cancers in order to select appropriate treatment?

Answer 6

1) EGFR mutation
2) ALK translocation
3) ROS1 translocation
4) PD-L1 expression (Immunotherapy)

If ALL negative patients are only eligible for chemotherapy.

Question 7

What are some features of mesothelioma?

Answer 7

Very rare malignancy.

Most malignant pleural tumours are metastases (especially from lung and breast).

90% related to asbestos exposure (builders, electricians, plumbers, shipyard workers). 20-30 year lag from exposure to cancer.

VERY poor prognosis –> usually die within months of diagnosis.

Typically more chest pain and little/no lyphadenopathy.

Question 8

What are paraneoplastic syndromes?

Answer 8

A group of rare disorders that are triggered by an abnormal immune system response to a cancerous tumour known as a “neoplasm.”

Question 9

What are some common paraneoplastic syndromes?

Answer 9

1) Cushing’s syndrome (ACTH)

2) Syndrome of inappropriate ADH
secretion (SIADH) –> hyponatremia

3) Hypercalcaemia
4) Clubbing
5) Neurological disorders (cerebellar degeneration, myasthenia)