Neoplasm of lung

Types

1.Benign

Bronchial adenoma

2.Malignant

Primary-Bronchial carcinoma

Secondary-From thyroid ,osteosarcoma ,testes ,ovary and breast

Bronchial carcinoma

Important killer malignancy

Male>Female(Relates to smoke)

Etiology

1.Tobacco smoke(Total amount of smoke and tar content)

2.Occupational(Silicon ,glass factory)

3.Urban area(Polluted air)

Pathology

Origin-Bronchial epithelium/mucous membrane

Types of bronchial carcinoma

1.Squamous cell carcinoma(35%)/central carcinoma

2.Small cell carcinoma(30%)

3.Adenocarcinoma(20%)/peripheral carcinoma

4.Large cell carcinoma(15%)

Clinical features

1.Age>50 years

2.Male>Female

3.H/O smoking

4.Symptoms-Cough ,hemoptysis ,weight loss ,anorexia ,fever if infected obstruction ,breathlessness if complete obstruction

5.Neck metastasis-Painful neck swelling

6.Distant mestastasis-Chest/Bone pain ,spinal cord(paralysis) ,brain(epilepsy) ,liver(Enlarged tender liver , skin(palpable solitary nodule)

7.Sign-Enlarged mediastinal node

            Features of superior venacaval obstruction

            Hoarseness of voice(Pressure on left recurrent laryngeal nerve)

Why not gives pressure on right branch-As right branch hooks up with 1st part of right subclavian artery ,being superficial and away from mediastinal nodes

Left branch hooks up with arch of aorta ,being deep and near mediastinal nodes

Paraneoplastic syndrome

Syndrome complex in bronchial carcinoma which cannot be described by tumor itself

Features

1.Neurological

Polyneuropathy

Cerebellar degeneration

Myelopathy

Eaten lambert syndrome

2.Endocrine

SIADH

PTH like tumor-Hypercalcemia

Ectopic ACTH

Carcinoid syndrome

3.Musculoskeletal

Clubbing

Dermatomyositis

Polymyositis

4.Hematological

Anaemia

Investigation

1.Blood-CBC ,HB ,TC ,DC

2.Sputum for malignancy

3.X ray chest PA and lateral view-Homogenous irregular opacity ,sun ray appearance ,well defined Hillar lymphadenopathy , collapse lobe with tracheal shift

4.Confirm-Bronchoscopy ,biopsy ,CT scan ,FNAC

Staging

Stage-1-Only local

Stage-2-Local +Hillar

Stage-3-Mediastinal nodes

Stage-4-Distant metastasis

Carcinoma with pleural effusion-Stage 4 as already distant metastasis

Treatment

1.General-Nutrition diet ,O2 ,antibiotics ,paracetamol

2.Specific-

Small cell carcinoma-Radio/chemotherapy

Non small cell carcinoma-

          Stage 1or 2-Surgery

          Stage 3 or 4-Radio/chemotherapy

3.Palliative-Local radiotherapy

Pancoast tumor

Tumor arising from lung apex .It  involves cervical sympathetic chain causing Horner's syndrome

Pancoast syndrome-Pancoast tumor with pain along inner aspect of arm along ulnar distribution due involvement of C8 ,T1 and T2 nerve root