Lung carcinoma

Definition Classification – small cell VS non small cell, metastatic, Complication

carcinoid tumour
- Malignancy of lung arising from Local
epithelium of bronchial tree Small cell lung carcinoma
- 2nd place in men after prostate ca - Massive hemoptysis
- 2nd place in women after breast ca
- Approx. 20% of lung ca - Acute SOB
Etiology - Rapid growing - Pleural effusion
- Metastasize rapidly - SVCO
- Smoking - Central lesion - Chest pain by tumour
- Asbestos exposure infiltration of chest wall
- Familial predisposition Non small cell lung ca – commonest approx. 85%. - Nerve palsy phrenic &
- Air pollution Types: recurrent laryngeal nerve
- Horner’s syndrome
Adenocarcinoma - Pericarditis & Atrial Fib
Symptoms/history
- Arises from bronchial musical gland Metastasize
- Non productive cough - Most common
- Productive cough (blood or non blood). If - Arises in peripheral of the lung - Brain
blood - Subtypes: broncholoaveolar ca - Bone pian, anemia, increase
o Bright red active bleeding o From type II pneumocytes Ca+
o Dark red earlier bleed o Along alveolar septa - Liver
- Progressive breathlessness o Solitary peripheral nodule - Adrenal Addison’s
- Chest pain : o Voluminous watery sputum
o Persistent Endocrine
o Severe Squamous cell ca
o Boring - Small cell
o Disturbing sleep - Centrally located o SIADH
o Tenderness - Presented ad cavitary lesion o ACTH Cushing
- Fever high grade2o bacterial - Histo keratin pearl synd
infection - Squamous
- LOW, LOA Large cell ca o PTH  increase
Calcium
- Large peripheral mass on CXR
Physical examination - Histofocal necrosis & no keratinization or Non metastasize CNS complication
gland
General - Confusion
Metastasize - Fits
- Increased JVP SVCO in Pancoasts - Cerebellar syndrome
tumour - Male from colon ca - Proximal myopathy
- Cyanosis - Female from breast ca - Neuropathy
- Clubbing - CXR cannon ball appearance - Polymyositis
- Hypertrophic Pulm osteoarthropathy - Lambert – Eaton syndrome
(wrist swollen & pain) Carcinoid tumours
- Lymph node (hard, discreet, non-tender, Others
- Slow grower
adherent to underlying structure)
- Resectable at diagnosis
- Flap CO2 retention - HPOA
- Facial swelling SVCO - Dermatomyositis
- Pemberton sign +ve - Acanthosis nigrican
Investigation
- Palloranemia in chronic dz - Thrombophlebitis migran
- FBC increase WBC in 2o infection
Respi exam
- ESR >100ml/1hr in malignancy Treatment
- ABG hypoxia & CO2 retention
- Decrease chest movement
- Sputum cytrology, culture, sensitivity Non-small cell  excision if early detection
- Trachea deviation
- Pleural fluid cytology, culture, sensitivity
- Dullness on percussion
- Ultrasound diff between cystic or solid Small cell chemotherapy
- Bronchial breath sound and crepitation
- Bronchoscopy
- Pleural effusion sign – stony dullness,
- Chest x-ray - Cyclophosphamide
no/reduced air entry
- Doxorubicin
Possible differential diagnosis - Vincristine
- etoposide
- Pulmonary TB
- Bacterial pneumonia
- Foreign body aspiration
- Lung abscess
- bronchiectasis