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Egyptian Board Thoracic Diseases study materials
Egyptian Board Thoracic Diseases study resources

Egyptian Board Thoracic Diseases: Thoracic Oncology and Pleural Diseases

Egyptian Board Thoracic Diseases · Work through your exam, one topic at a time.

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Thoracic Oncology and Pleural Diseases

Domain 8 - Thoracic Oncology and Pleural Diseases

This domain tests lung cancer histology, staging, molecular testing and pleural fluid interpretation. The Board often combines a pleural effusion with a decision about drainage, or a lung nodule with staging and targeted therapy.

Core rules

  • Lung cancer types: adenocarcinoma (most common, peripheral), squamous cell carcinoma (central, cavitation), small cell carcinoma (central, rapid growth, paraneoplastic syndromes).
  • Staging is TNM. Non-small cell lung cancer stages I–II are usually surgical; stage III is multimodality; stage IV is systemic therapy. Molecular testing for EGFR, ALK, ROS1, BRAF and PD-L1 is standard in advanced non-squamous NSCLC.
  • SCLC is staged as limited or extensive. Limited disease is confined to one radiation field; treatment is concurrent chemoradiotherapy. Extensive disease is platinum plus etoposide plus immunotherapy.
  • Pleural fluid is an exudate by Light criteria if any one of: pleural protein/serum protein >0.5, pleural LDH/serum LDH >0.6, or pleural LDH > two-thirds the upper limit of normal serum LDH.
  • Parapneumonic effusion with pH <7.20, glucose <3.3 mmol/L, positive Gram stain or frank pus requires chest drainage. Malignant effusion is managed with drainage and pleurodesis or indwelling catheter.

Worked example

A 62-year-old smoker has a 3 cm right upper-lobe mass, no nodal uptake on PET-CT and no distant metastases. Biopsy shows adenocarcinoma. TNM is T1b N0 M0, stage IA2. Treatment is surgical resection, usually lobectomy with nodal sampling. If the tumour were 5 cm with ipsilateral mediastinal nodes, it would be stage IIIA and require multimodality therapy. If EGFR mutation were present in stage IV disease, an EGFR tyrosine kinase inhibitor would be preferred over chemotherapy.

Traps that cost marks

  • Using Light criteria without paired serum protein and LDH.
  • Calling a transudate an exudate in heart failure without considering diuretic effect.
  • Not draining a parapneumonic effusion with pH <7.20.
  • Staging SCLC with TNM instead of limited versus extensive disease.
  • Omitting molecular testing in advanced non-squamous NSCLC.

Key points

  • Adenocarcinoma is the commonest lung cancer and often peripheral.
  • Advanced non-squamous NSCLC needs EGFR, ALK, ROS1 and PD-L1 testing.
  • SCLC: limited versus extensive; platinum plus etoposide.
  • Light criteria: any one positive criterion defines an exudate.
  • Parapneumonic effusion with pH <7.20 needs chest drainage.