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Questions and Answers
What is the most common symptom of Bronchoalveolar Carcinoma/Adenocarcinoma in-situ?
What is the most common symptom of Bronchoalveolar Carcinoma/Adenocarcinoma in-situ?
Bronchoalveolar Carcinoma is not usually resectable.
Bronchoalveolar Carcinoma is not usually resectable.
False
Which imaging technique is considered the initial investigation for Bronchoalveolar Carcinoma?
Which imaging technique is considered the initial investigation for Bronchoalveolar Carcinoma?
CXR
The most common site of metastasis for Bronchoalveolar Carcinoma is the ______.
The most common site of metastasis for Bronchoalveolar Carcinoma is the ______.
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Match the following investigations with their purposes:
Match the following investigations with their purposes:
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Which of the following risk factors is NOT associated with lung cancer?
Which of the following risk factors is NOT associated with lung cancer?
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Small cell lung cancer is more prevalent in females than males.
Small cell lung cancer is more prevalent in females than males.
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What type of treatment has revolutionized the management of lung cancer?
What type of treatment has revolutionized the management of lung cancer?
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Cushing's disease is associated with the hormone __________.
Cushing's disease is associated with the hormone __________.
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Match the following paraneoplastic syndromes with their associated hormones/antibodies:
Match the following paraneoplastic syndromes with their associated hormones/antibodies:
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What is a common complication associated with Squamous Cell Carcinoma of the lung?
What is a common complication associated with Squamous Cell Carcinoma of the lung?
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Adenocarcinoma is more prevalent in males than females.
Adenocarcinoma is more prevalent in males than females.
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What are two clinical features of Superior Vena Cava Syndrome?
What are two clinical features of Superior Vena Cava Syndrome?
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The primary immunohistochemical marker for adenocarcinoma is _____ 4.
The primary immunohistochemical marker for adenocarcinoma is _____ 4.
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Match the following features with their corresponding types of lung cancer:
Match the following features with their corresponding types of lung cancer:
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Which stage of Masoka Thymoma indicates macroscopic invasion into surrounding fatty tissue?
Which stage of Masoka Thymoma indicates macroscopic invasion into surrounding fatty tissue?
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Thymoma is primarily associated with malignant conditions.
Thymoma is primarily associated with malignant conditions.
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Name the most common mediastinal tumor.
Name the most common mediastinal tumor.
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Germ cell tumors are most commonly found in the anterior ______.
Germ cell tumors are most commonly found in the anterior ______.
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Match the following tumor characteristics with their corresponding types:
Match the following tumor characteristics with their corresponding types:
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What is the most common management for a cold abscess in the cervical region?
What is the most common management for a cold abscess in the cervical region?
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A carbuncle typically has a single pus point.
A carbuncle typically has a single pus point.
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Where is a branchial cyst most commonly located?
Where is a branchial cyst most commonly located?
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A branchial sinus or fistula forms due to the failure of fusion of the ____ and ____ arch.
A branchial sinus or fistula forms due to the failure of fusion of the ____ and ____ arch.
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Match the following clinical features with their corresponding conditions:
Match the following clinical features with their corresponding conditions:
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Which type of benign lung tumor is the most common?
Which type of benign lung tumor is the most common?
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CXR appears as cystic lesions in patients with hamartoma.
CXR appears as cystic lesions in patients with hamartoma.
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What is the management technique for a hamartoma?
What is the management technique for a hamartoma?
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The m/c mediastinal tumor is _____ .
The m/c mediastinal tumor is _____ .
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Match the following mediastinal tumors with their corresponding location:
Match the following mediastinal tumors with their corresponding location:
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What is the primary cause of empyema in the exudative phase?
What is the primary cause of empyema in the exudative phase?
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The organized phase of empyema is characterized by the presence of fever and pus.
The organized phase of empyema is characterized by the presence of fever and pus.
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What is the purpose of using VATS during pulmonary procedures?
What is the purpose of using VATS during pulmonary procedures?
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The condition of pus accumulation in the pleural space is known as _____
The condition of pus accumulation in the pleural space is known as _____
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What is the main management approach for a lipoma that is symptomatic or large?
What is the main management approach for a lipoma that is symptomatic or large?
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Match the following phases of empyema with their characteristics:
Match the following phases of empyema with their characteristics:
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Dercum's disease is characterized by the presence of multiple lipomas.
Dercum's disease is characterized by the presence of multiple lipomas.
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What is the most common cause of cervical lymphadenopathy in India?
What is the most common cause of cervical lymphadenopathy in India?
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A collar stud abscess occurs in the case of ______ lymphadenopathy.
A collar stud abscess occurs in the case of ______ lymphadenopathy.
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Match the following features with their corresponding conditions:
Match the following features with their corresponding conditions:
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Which of the following features is characteristic of a sebaceous cyst?
Which of the following features is characteristic of a sebaceous cyst?
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Dermoid cysts can be found in the outer canthus of the eye.
Dermoid cysts can be found in the outer canthus of the eye.
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What is the management approach for an inflamed sebaceous cyst?
What is the management approach for an inflamed sebaceous cyst?
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A dermoid cyst is formed when epithelial tissue is trapped along the lines of ______ fusion.
A dermoid cyst is formed when epithelial tissue is trapped along the lines of ______ fusion.
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Match the following types of cysts with their features:
Match the following types of cysts with their features:
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Which stage describes a tumor that is greater than 3 cm but less than or equal to 5 cm, or involves the main bronchus without carina?
Which stage describes a tumor that is greater than 3 cm but less than or equal to 5 cm, or involves the main bronchus without carina?
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Radiotherapy is classified as the first line of treatment for all stages of thymic carcinoma.
Radiotherapy is classified as the first line of treatment for all stages of thymic carcinoma.
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What is the primary association of squamous cell carcinoma in terms of smoking?
What is the primary association of squamous cell carcinoma in terms of smoking?
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The paraneoplastic syndrome associated with small cell carcinoma is __________.
The paraneoplastic syndrome associated with small cell carcinoma is __________.
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Match the following carcinoma types with their primary pathogenesis:
Match the following carcinoma types with their primary pathogenesis:
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Study Notes
Bronchoalveolar Carcinoma/Adenocarcinoma in-situ
- Good prognosis, usually resectable
- Multifocal spread
- Spread along bronchoalveolar lining with lepidic pattern
- Common symptoms: Cough, hemoptysis, pain, weight loss
- Most common metastasis sites: Brain (leading to symptoms), adrenal gland (usually asymptomatic), bones, lymphatic spread
Work-up
- Initial investigation with CXR
- HRCT for determining extent of tumor
- Initial Oncology Consultation for biopsy type:
- CT-guided biopsy
- Mediastinoscopy to check operability and take biopsy
- EBUS FNAC to check operability and take biopsy
- PET-CT for staging
Small cell (Oat cell) Lung Cancer (SCLC)
- Strongest association with smoking
- Males are more affected than females
- Poor prognosis
- Highly sensitive to chemotherapy
- Most frequently presents with paraneoplastic syndromes
Paraneoplastic Syndromes
- Cushing's disease: Caused by Adrenocorticotropic hormone
- SIADH: Caused by Antidiuretic hormone
- Acromegaly: Caused by Growth hormone-related peptide
- Lambert-Eaton syndrome: Caused by Anti-VGCC
Pathology
- SIADH: Syndrome of inappropriate secretion of antidiuretic hormone
- VGCC: Voltage gated calcium channel
- Azzopardi effect & salt & pepper appearance
- IHC Markers: Chromogranin, NCAM (Neural cell adhesion molecule)
- Deposition of DNA around blood vessels appears as blue/purple staining on staining
Superior Vena Cava (SVC) Syndrome
- Oncological emergency
- Clinical features: Facial and cerebral edema, seizures
- Diagnosis: CECT
- Management:
- Radiotherapy to shrink the tumor
- Steroids to reduce intracranial pressure
Squamous Cell Carcinoma (SCC) Lung
- Centrally placed
- Association: Associated with smoking, most common lung cancer in smokers
- Complications: Can lead to a Pancoast tumor, which can put pressure on surrounding structures
Adenocarcinoma
- Predominantly affects females over males
- Most common lung cancer overall
- Peripherally placed and slow-growing
- Develops in pre-existing lung cavities (due to TB or bronchiectasis)
- Early metastasis is a risk
- IHC marker: NAPSIN 4
- Associated with ALK and RAS mutations
Thoracic Inlet
- Symptoms: Dyspnea, stridor
- Sympathetic chain presentation: Horner's syndrome
- Ptosis
- Miosis
- Enophthalmos
- Anhydrosis
Thymoma
- Most common mediastinal tumor
- Located in the anterior mediastinum
- Usually benign
- Associated with Myasthenia gravis
- Management: Excision
- Small lesions: Transcervical excision
- Large lesions: VATS/Thoracotomy
- Masoka Thymoma Staging:
- Stage 1: Macroscopically completely encapsulated, no microscopic capsular invasion
- Stage 2: Macroscopic invasion into surrounding fatty tissue or mediastinal pleura, microscopic invasion into the capsule
- Stage 3: Macroscopic invasion into neighboring organs (Pericardium, great vessels, lungs)
- Stage IVA: Pleural or pericardial dissemination
- Stage IVB: Lymphogenous or hematogenous metastasis
Germ cell tumors
- Most common extra gonadal site: Anterior mediastinum
- Male predominance
- Benign form: Teratoma
- Malignant form: Tumor markers (AFP, LDH, β-hCG)
- Management:
- Excision
- Chemotherapy for malignant tumors
Active space
- Cold abscess in the cervical region
- Fluctuant swelling
- Confirmation: Antigravity aspiration followed by Ziehl-Neelsen staining (risk of sinus tract formation if aspirated from below)
- Management: Anti-tubercular therapy
Carbuncle
- Multiple small abscesses coalesce to form a large abscess
- Common in individuals with diabetes
- Multiple pus points
- Most common location: Nape of the neck
- Management: Drainage with a cruciate incision
Branchial Cyst
- Failure of obliteration of cervical sinus, which forms during fusion of 2nd and 6th arch
- Location: Swelling over the neck, anterior border of SCM, junction of upper and middle 1/3rd of neck
- Clinical features: Fluctuation (Cystic swelling), transillumination positive
- Management: FNAC followed by surgical excision
Branchial Sinus/Fistula
- Failure of fusion of 2nd and 6th arch
- Location: Anterior border of SCM, between middle and lower 1/3rd
- Management: Excision
Hamartoma
- Most common benign lung tumor
- Mostly asymptomatic
- Symptoms: Cough, hemoptysis
- Investigations:
- CXR: Coin shaped lesions
- CT: Confirmatory
- Management: VATS guided excision
Mediastinal Tumors
- Anterior Mediastinum: 3Ts
- Thymoma (most common)
- Teratoma
- Terrible Lymphoma
- Middle Mediastinum: Cystic lesions, Pericardial cyst, Lymphoma, Mesenchymal tumors
- Superior Mediastinum: Lymphoma, Thyroid, Parathyroid
- Posterior Mediastinum: Neurogenic tumor (most common in children), Cystic lesions
Interventions
- Pleurodesis: TALC/Tetracycline
- Strip pleura: Using VATS
- Space created by: Collapsing one lung via a double lumen endotracheal tube
- ICD
Empyema
- Accumulation of pus in the pleural space
- Causes:
- Pulmonary infection
- Aspiration of pleural effusion
- Trauma
- Extrapulmonary sources
- Unresolved pneumonia
- Bronchiectasis
- Tuberculosis
- Fungal infections
- Lung abscess
- Penetrating injury
- Surgery
- Esophageal perforation
- Subphrenic abscess
- Osteomyelitis of ribs or vertebrae
Phases
- Exudative phase: Fever & pus, imaging shows collection of pus, most commonly caused by Staph.aureus, management: Aspiration + antibiotics
- Fibrinopurulent phase: Pus and pleura thicken, management: Chest tube insertion
- Organized phase: Thickened pleura entraps the lung, management: Stripping of pleura/VATS + decortication
Lipoma
- Encapsulated collection of fat that causes swelling
- Clinical features:
- Skin can be pinched over the swelling
- Pseudofluctuation
- Slip sign (+)
- Dercum's disease: multiple lipomas/lipomatosis
- Management:
- Observation for non-symptomatic or small lipomas
- Excision if symptomatic or large
- Common locations: Retroperitoneum, Thigh, Between shoulder blades
- High potential for sarcomatous change
Cervical Lymphadenopathy
- Most common cause in India is tuberculosis
- Tubercular Cervical Lymphadenopathy:
- Infection of cervical lymph nodes with tubercular bacilli
- Deep fascia → Cervical LN → Caseous necrosis
- Periadenitis → Matting of lymph nodes
- Adherence to fascia → LN coalesce → Collar stud abscess/cold abscess
Sebaceous Cyst
- Sites: Anywhere except palms and soles
- Swelling: Where skin cannot be pinched
- Discharge: Whitish
- Pain: Sometimes
- Center: Whitish center, Punctum (Characteristic)
- Complications:
- Inflamed sebaceous cyst (Infected), multiple sebaceous cysts: Seen in scrotum and scalp
- Sebaceous horn: Secretions harden to form a horn-like structure
- Management: Excision of cyst
Dermoid Cyst
- Formed when epithelial tissue is trapped along the lines of embryonic fusion
- Sites: Outer canthus of eye, Post auricular region
- Clinical features: Cystic swelling, skin can be pinched over the swelling
- Investigations: X-ray/CT to rule out intracranial extension before surgery
- Management: Surgical excision
- Impantation Dermoid: Occurs due to injury, especially after ear piercing, management: Surgical excision
Thorax and Mediastinum Staging and Management
- Staging:
- T1: ≤3 cm surrounded by lung/visceral pleura, not involving main bronchus
- T1a(mi): Minimally invasive Carcinoma
- T1a: ≤1 cm
- T1b: >1 to ≤2 cm
- T2: >2 to ≤3 cm
- T3: >3 to ≤5 cm or involvement of main bronchus without carina or invasion of visceral pleura or atelectasis or post obstructive pneumonitis extending to hilum
- T4a: >3 to ≤ 4 cm
- T4b: >4 to ≤5 cm
- T1: ≤3 cm surrounded by lung/visceral pleura, not involving main bronchus
- Management:
- Surgery for stages T1-T2,T3
- Procedures: Lobectomy, Pneumonectomy, Sleeve resection
- Approach: Posterolateral thoracotomy
- Complications: Bleeding, Respiratory infection
- Radiotherapy: Squamous cell carcinoma is highly radio-sensitive
- Chemo/Immunotherapy: Latest modality, useful in advanced cancer
- Surgery for stages T1-T2,T3
Summary Table
- SCC: Males > Females, central, strong association with smoking
- Adeno Ca: Females > males, peripheral, not strongly associated with smoking
- Small cell Ca: Males > females, central, strong association with smoking
- Large cell Ca: Males > Females, both central and peripheral, association with smoking
- Paraneoplastic syndromes:
- SCC: None
- Adeno Ca: Migratory thrombophlebitis
- Small cell Ca: Cushing's syndrome, SIADH
- Large cell Ca: Gynecomastia
- Pathogenesis
- SCC: P53
- Adeno Ca: Kras, EGFR, ALK
- Small cell Ca: L-myc
- Large cell Ca: None
- Precursor Lesion:
- SCC: Carcinoma in situ (CIS)
- Adeno Ca: Adenocarcinoma in situ, Atypical adenomatous hyperplasia (AAH)
- Small cell Ca: DIPNEH (Diffuse idiopathic pulm neuroendocrine hyperplasia)
- Large cell Ca: None
- Note:* The summary table highlights associations, but not all individuals with these features will have the specific cancer type mentioned.
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Description
This quiz covers important information regarding Bronchoalveolar Carcinoma and Small Cell Lung Cancer. Learn about their presentations, diagnostic work-ups, and associated paraneoplastic syndromes. Assess your knowledge about the prognosis and metastasis of these conditions.
