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Lung Cancer

Lung Cancer
Tumor arising from the respiratory epithelium
(bronchi, bronchioles, or alveoli).
Caused by carcinogens and tumor promoters
inhaled via cigarette smoking.
Its incidence peakes between ages 55 and 65
y/o.
20 pack-years of tobacco exposure or more has
been considered to contain the highest risk
populations.
COPD increases the risk of lung cancer.
How does it causes cough?

Neoplasm
Airway
infiltrates the
infiltration/ Cough
mucosa of the
obstruction
large bronchi
Types of Lung Cancer
Non-Small Cell Lung Cancer (NSCLC)
Squamous cell carcinoma, arising from the bronchial
epithelium and typically more central in location.
Adenocarcinoma, arisign from mucous glands and
typically more peripheral in location.
Large cell carcinoma, a heterogenous group of poorly
differetiated tumors.
Small Cell Lung Cancer (SCLC)
It is of bronchial origin and typically begins as a central
lesion that can often narrow or obstruct bronchi.
Clinical Manifestations
The clinical findings depends on:
Local tumor growth,
Obstruction of adjacent structures,
Growth in regional nodes through lymphatic
spread
Growth in distant metastatic sites after
hematogenous dissemination,
Presence of paraneoplastic syndromes.
Clinical Manifestations
Major presenting complaints:
Cough (Chronic cough, >8 weeks) (75%)
Weight loss (40%)
Chest pain (40%)
Dyspnea (20%)
Early stage:
May be asymptomatic.
Central or endobronchial growth symptoms:
Cough,
Hemoptysis,
Wheeze and stridor,
Dyspnea,
Postobstructive pneumonitis (fever and productive cough).
Peripheral growth symptoms:
Pain from pleural or chest wall involvement,
Dyspnea on a restrictive basis,
Symptoms of lung abscess (from tumor cavitation).
Regional spread in the thorax (by contiguous growth or
by metastasis to regional lymph nodes):
Tracheal obstruction,
Esophageal compression with dysphagia,
Recurrent laryngeal nerve paralysis with hoarseness,
Phrenic nerve paralysis with elevation of the
hemidiaphragm and dsypnea,
Sympathetic paralysis with Horners syndrome
(enophthalmos, ptosis, miosis, and ipsilateral loss of
sweating).
Malignant pleural effusion leads to dyspnea.
Tumor growing in the apex of the lung:
Pancoasts syndrome.
Shoulder pain that characteristically radiates in the ulnar distribution
of the arm,
Radiologic destruction of the first and second ribs.
Involves the VIII cervical , I and II thoracic nerves.
Superior vena cava syndrome (from vascular obstruction):
Edema and engorgement of the vessels of the face, neck, and arms,
Non-productive cough,
Dyspnea
Pericaridal and cardiac extention with resultant tamponade
(compression of a joint), arrhythmia, or cardiac failure.
Lymphatic obstruction with resultant pleural effusion.
Lymphangitic spread through the lungs with hypoxemia and
dyspnea.
Extrathroacic metastatic disease:
CNS metastases leads to headache, nausea, altered
mental status, and possible seizures.
Bone metastases with pain and pathologic fractures.
Bone marrow invasion with cytopenias or
leukoerythroblastosis.
Liver metastases causing liver dysfunction, biliary
obstruction, anorexian, and pain.
Lymph node metastases in the supraclavicular region
and in the axilla and groin.
Adrenal metastases. Rarely cause adrenal
insufficiency.
Paraneoplastic Syndromes
Common in patients with lung cancer and
may be the presenting finding or first sign of
recurrence.
Endocrine syndromes: hypercalcemia and
hypophophatemia.
Systemic symptoms: anorexia, cachexia,
weight loss, fever, and suppressed immunity.
Laboratory Examinations
Chest X-Ray or Chest computed tomography (CT)
Nodule, enlarging mass, persistent/nonresolving
infiltrate, atelectasis, mediastinal or hilar adenopathy,
and pleural effusion may be seen.
Histological laboratory tests:
Sputum cytology,
Bronchial biopsies,
Pleural fluid,
Lymph node sampling,
Needle aspirations.