Thoracic Oncology and Mediastinal/Tracheal/Esophageal Disease
This domain tests staging and multidisciplinary treatment of thoracic malignancy and complex airway or esophageal disease. The exam rewards stage-based decisions over isolated operative enthusiasm.
Core rules
- Lung cancer staging includes CT and PET-CT plus nodal assessment when it changes management; stage determines resection, systemic therapy or radiotherapy.
- Mediastinal masses are classified by compartment; anterior masses include thymoma, lymphoma and germ-cell tumors, and biopsy route matters.
- Esophageal cancer staging uses endoscopic ultrasound, CT and PET; treatment is often multimodal, and resection is selected by stage and fitness.
- Tracheal stenosis requires airway assessment and may need resection with primary anastomosis; do not dilate repeatedly without a plan.
Worked example
A 60-year-old with dysphagia has a mid-esophageal lesion and a suspicious celiac node. The correct reasoning is to complete staging before resection because nodal disease changes intent. Endoscopic ultrasound-guided biopsy and PET-CT guide neoadjuvant therapy planning; proceeding straight to esophagectomy risks overtreatment and incomplete staging.
Traps
Do not biopsy a resectable thymoma through the pleural space without planning; do not ignore celiac nodes in distal esophageal cancer; do not resect tracheal stenosis before securing the airway; do not treat all mediastinal masses as thymoma.