L5: Lung Cancer Flashcards
Types of Lung Cancer
…… is the most common site for metastasis from other body tumors.
Lung
Etiology of Bronchogenic Carcinoma
Etiology of Bronchogenic Carcinoma
- Smoking
Etiology of Bronchogenic Carcinoma
- Air Pollution
Etiology of Bronchogenic Carcinoma
- Lung Diseases
as
- post TB
- Interstitial lung fibrosis
- COPD
- Asbestosis
- Silicosis
Etiology of Bronchogenic Carcinoma
- Dietary Factors
Etiology of Bronchogenic Carcinoma
- Gender & Radial Differences
Etiology of Bronchogenic Carcinoma
- Inheritance
Pathology of Bronchogenic Carcinoma
Pathology of Bronchogenic Carcinoma
- Microscopy
Pathology of Bronchogenic Carcinoma
- Site
Pathology of Bronchogenic Carcinoma
- Spread
Presentation of bronchial carcinoma
Symptoms of Bronchial carcinoma
Symptoms of Bronchial carcinoma
- Symptoms due to irritation and/ or obstruction of the bronchus with the tumor itself
Symptoms of Bronchial carcinoma
- Symptoms due to intra thoracic extrapulmonary extension due to compression and or infilliation of the chest wall, pleura, diaphragm, mediastinum with the tumor or its draining lymph nodes
Symptoms of Bronchial carcinoma
- Symptoms due to metastasis
Symptoms of Bronchial carcinoma
- Systemic non- metastatic paraneoplastic symptoms
Signs of Bronchial Carcinoma
General Examination in Bronchial Carcinoma
- Breathlessness
- due to bronchial carcinoma or the associated disease as COPD and / or ischemic heart disease
Signs of Bronchial Carcinoma
- None
….
Signs of Bronchial Carcinoma
- General Examination
General Examination in Bronchial Carcinoma
- Stridor
due to tracheal obstruction.
General Examination in Bronchial Carcinoma
- Clubbing
hypertrophic pulmonary osteoarthropathy (HPOA).
General Examination in Bronchial Carcinoma
- Tachycardia
due to vagal nerve infiltration.
Signs of Bronchial Carcinoma
- Local Examination
Local Examination in Bronchial Carcinoma
- localized Wheezes
- due to fixed partial bronchial obstruction with tumor mass or its lymph nodes, the wheezes do not disappear after coughing.
Local Examination in Bronchial Carcinoma
- Signs of Pleural Effuasion
due to spread or metastasis to the pleura:
- Stony dullness
- decreased tactile vocal fremitus
- decreased or absent breath sounds
Local Examination in Bronchial Carcinoma
- Diaphragmatic Paralysis Signs
- basal dullness with reversed tidal percussion.
Local Examination in Bronchial Carcinoma
- Signs of Lobe or lung collapse
- impaired note
- decreased tactile vocal fremitus
- decreased or absent breath sounds
Local Examination in Bronchial Carcinoma
- Positive Despine Sign
due to mediastinal lymphadenopathy.
Local Examination in Bronchial Carcinoma
- Pancoast Tumor
(apical bronchial carcinoma): dull Kronig’ s isthmus.
Def of Pancoast’s tumor
The Pancoast’s tumor invades …….
Mediastinal syndrome is a sign of …..
inoperability
Causes of Mediastinal syndrome
is caused BY compression or direct invasion by tumor to:
- Superior vena cava, Subclavian artery, Trachea, Esophagous,
- left recurrent laryngial nerve and phernic nerve.
CP of Mediastinal syndrome
CP of Paraneoplastic Syndrome
CP of Paraneoplastic Syndrome
- Endocrine
- Cushing’s syndrome.
- Gynecomastia
- Hypercalcaemia.
- Acromegally.
- Water intoxication.
- Carcinoid syndrome
INvx for Bronchial Carcinoma
- Chest X-Ray
INvx for Bronchial Carcinoma
INvx for Bronchial Carcinoma
- CT
- For accurate localization and evaluation of hilar and mediastinal lymph nodes and for staging.
INvx for Bronchial Carcinoma
- Sputum Cytology
INvx for Bronchial Carcinoma
- Bronchoscopy
INvx for Bronchial Carcinoma
- Biopsy
Assessment of operability of lung cancer
Assessment of operability of lung cancer
- Clinical
Clinical signs of inoperabity
- (poor pulmonary or heart function), mediastinal syndrome
Assessment of operability of lung cancer
- rads
Radiological signs of inoperability
- large tumors with or without local or distant spread;
- stages Illb and VI.
Assessment of operability of lung cancer
- Bronchoscopy
Bronchoscopic signs of inoperability
- tumors affecting the trachea or the main airway adjacent to the carina
Staging of Bronchial Carcinoma
- NSCLC
Assessment of operability of lung cancer
- Assesment of Mets
Staging of Bronchial Carcinoma
- SLCC
Staging of Bronchial Carcinoma
DDx of Bronchial Carcinoma
TTT of Bronchial Carcinoma
TTT of Bronchial Carcinoma
- Aim
to cure sometimes, to relieve often and to comfort always
TTT of Bronchial Carcinoma
- Surgery
TTT of Bronchial Carcinoma
- Palliative
Palliative TTT in Bronchial Carcinoma
- Chemotherapy
Palliative TTT in Bronchial Carcinoma
- radiotherapy
Palliative TTT in Bronchial Carcinoma
- endobronchial therapy
It is done to control hemoptysis and obstructed central airways: eg laser
Palliative TTT in Bronchial Carcinoma
- Supportive TTT
- Psychotherapy for anxiety, depression and insomnia.
- Analgesics for pain (morphia).
- Nutritional support.
- Treatment of concomitant diseases
Def of Bronchial Adenoma (Carcinoid Tumor)
- It is a locally malignant tumor, usually affecting the middle aged females and originates from neuroendocrine cells (APUD).
Incidence of Bronchial Adenoma (Carcinoid Tumor)
usually affecting the middle aged females
Prognosis of Bronchial Adenoma (Carcinoid Tumor)
Good
CP of Bronchial Adenoma (Carcinoid Tumor)
CP of Bronchial Adenoma (Carcinoid Tumor)
- Hemoptysis
frank and recurrent
CP of Bronchial Adenoma (Carcinoid Tumor)
- Lobe Collapse
which is usually acute, and followed with
- aeration (fleeting shadows),
- localized area of dullness and decreased intensity of breath sounds.
CP of Bronchial Adenoma (Carcinoid Tumor)
- Partial Obstruction
Partial obstruction of the bronchi:
- localized emphysema, localized area of hyperresonance.
CP of Bronchial Adenoma (Carcinoid Tumor)
- Others
DDx of Bronchial Adenoma (Carcinoid Tumor)
INVx for Bronchial Adenoma (Carcinoid Tumor)
INVx for Bronchial Adenoma (Carcinoid Tumor)
- X-Ray
- Normal.
- Coin shadow.
- Area of atelectasis.
INVx for Bronchial Adenoma (Carcinoid Tumor)
- CT
For accurate localization and evaluation of
- hilar and mediastinal lymph nodes.
INVx for Bronchial Adenoma (Carcinoid Tumor)
- Bronchoscopy
bleeds easily so, this must be considered in biopsy taking
TTT of Bronchial Adenoma (Carcinoid Tumor)
TTT of Bronchial Adenoma (Carcinoid Tumor)
- Surgery
- Pneumonectomy, lobectomy, segmentectomy or
- sleeve resection according to the site of the tumor.
