chest “

2-b

By definition :
Its primary malignant tumor of the lung

Etiology
Risk factors Tumor
personal history
1- Age : 05 old age
2- Sex : more in males
3- Occupation :asbestosis, uranium
4- Residence :pollution

, 
radiation

5- special habits
chemical
cancer carcinogenic 3,4-Benzpyrene
skin
squamous metaplasia irritation of bronchi
squamous cell carcinoma cancer columnar to suqamus
lined by columnar epitheliam bronchi adenocarcinoma
squamous metaplasia squamous carcinoma
 physical ,, effect physical and chemical 
cancer tongue cigarette lung cancer physical pipe
filter

cancer lip and tongue 

rheumatology scleroderma , diseases

etiology and definition

pathology

Pathology
Gross picture , Microscopic and spread tumor
Gross picture 1
fungal , nodular , ulcer : Shape 
small bronchi 30 % , Central large bronchi % 05 : Site 
peripheral
pancoast tumor apex 

Microscopic picture 2
“ small cell carcinoma and Non small cell carcinoma :
squamous cell carcinoma Most common type
small and non small squamous or non squamous
most malignant is small cell carcinoma most malignant

Small cell carcinoma

functioning APUD Cells , % 20 
ectoderm , endoderm and mesoderm ectodermal in origin
normal human skin skin and nervous tissue ectoderm
ectoderm APUD  skin and nervous tissue
functioning

chemo sensitive 3 treatment small cell carcinoma 

survival rate triple 9 chemotherapy
oncology 6 3
tumor survival rate
5 years survival rate
 oat cell carcinoma microscope small 



Non Small cell carcinoma

smoker squamous cell carcinoma Non small cell carcinoma 
% 30
Middle age female adenocarcinoma 
 chemotherapy radiotherapy smoker smoker
SMOKER tumor

rare large cell carcinoma ALVEOLAR 

Spread Microscopic picture

Spread 3
direct , blood or lymphatic tumor spread 
Direct spread 
mediastinum  central pleura  Peripheral

Lymphatic spread 
lymphatic spread **
interbronchial L.N Right lung Tumor cells left lung right lung
thoracic duct ,, cervical paratracheal L.N mediastinum L.N

base of left lung **

Right lung or base of eleft lung

supraclavicular lymph node Left lung

Cervical then thoracic duct lung Apex of left

Blood spread 
suprarenal metastaisis liver , bone , brain blood spread
suprarenal metastasis Tumors
 tumors characteristic metastasis 
tumor heart metastasis ? Melanoma
metastaiss

metastasis ? heart malignant cells tumors 

metastasis heart cancer cells
its very strange
heart cancer
melanoma metastasis

Clinical picture
intrathoracic and extrathoracic bronchogenic carcinoma clinical picture 
manifestations

Intrathoracic manifestations


pleurisy irritation of pleura pleurisy bronchogenic carcinoma Pleurisy* 

Pleural effusion bronchogenic carcinoma Pleural effusion 
Lymphatics Most common is Hemorrhagic
empyema abcess infection chylous
haemorhhagic most common transudate azygos vein

, , rapid reaccumulate malignant effusion 

Massive
effusion mediastinal shift to the same side
hemorrhage collapse bronchogenic carcinoma trachea shifted
trachea shifted effusion trachea collapse
collapse malignant effusion same side
shifted trachea to same side effusion Trachea
 resolution oneumonia Pneumonia 
recurrent

tumor necrosis tumor abcess Abcess 

infection midline necrosis and hemorrhage
sloughing and aspiration necrotic tissue
abcess infection collapse bronchus tumor
3 abcess bronchogenic carcinoma
a- infection of necrotic tissue in the middle of the tumor
b- Necrotic tissue sloughing and aspiration
c- abcess infection collapse bronchus tumor

unilateral bronchiectasis Bronchieactasis 

emphysema partial obstruction tumor COPD COPD 

lymph node tumor Mediastinal syndrome 

coin TB Bronchogenic carcinoma Tb 
shadow
wheezes tumor bronchial asthma 

subacute core pulmonale lymphatics 

intrathoracic manifestations
extrathoracic manifestations

extrathoracic manifestations
by metastasis extrathoracic manifestations tumor
neurological manifestastion metastasis in brain 1
jaundice liver metastasis 2
Bone pain bone metastasis 3

non metastatic **
metastasis tumor
small cell tumor hormones and mediators functioning tumor 
carcinoma
premalignant syndrome C.P
CNS manifestations mediators Tumor
 subacute cerbellar atrophy cerebellum 
dermatomyositis peripheral neuritis , ,
CNS manifestations

endocrinal manifestations **
cushing syndrome ACTH tumor 
hyperparathyroidism Parathyroid hormone , 
SIADH ADH 
Gynecomastia estrogen 
cushing tumor
moon face , obesity and buffalo hump

3  **
hypokalemia and alkalosis cushing
chemical not clinical cushing

hypercalcemia parathyroid hormone

gynecomastia Estrogen Hyponatermia ADH

Hematological manifestation
Leukmoid reaction immature irritation Bone Marrow

Migratory superficial trousseau sign tumor **

Stomach and pancreas tumors thrombophlebitis

Skin manifestations
Hyperpigmentation , Herpes zoster and Acanthosis nigricans
insulin resistance DM Acanthosis nigricans
defect
receptors

stage 4 Clubbing
 3 pancoast tumor

pancoast tumor
subclavian artery and sub first rib clavicle , sternum
Innominate Innominate vein Internal jagular subclavian vein clavian vein
Superior vena cava
apex sympathetic chain lower trunk of brachial plexus
apex tumor

2 nerves , 2 bone , 2 vessels

lower trunk of brachial horner Sympathetic chain 2 Nerves : : 
C8& T1 wasting small muscles of hand plexus

erosion and pathological fracture clavicle and first rib 2 Bones 

unequal pulse , unequal pressure and unilateral ischemia subclavian artery 2 vessels 
male congestion , edema of head and neck internal jagular clubbing

paramalignant syndrome pancost tumor

Investigations
investigations
Laboratory 1
anemia , Leukmoid reaction and polycythemia Blood
hypercalcemia and hypnatermia

2- sputum examination
Malignant cells
pathologist sputum % 05 Chinese **


Radiological 3
Xray
Coin shadow cancer Xray 
erosion of clavicle and first rib 
 pleural effusion with mediastinum shift to same side 
unilateral bronchiectasis unresolved pneumonia 
festooned appearance mediastinal mass 
Normal xray doent exclude Bronchogenic cancer completely normal xray

full body brain ct Abdominal CT chest CT

CT
CT CT
CT upper limb CT upper limb shoulder
4–3 CT Lower limb CT wrest , Hip 

Tumor PET SCAN 

metastasis femur ,, gamma camera
PET CT CT Lesion femur
CT lesion PET

instrumental
Bronchoscope
central biopsy mass 
saline , peripheral 
malignant cells bronchoscope
CT guided biopsy
tumor bronchoscope 
prognosis diagnosis surgically operable or non operable

Treatment
tumor bronchogenic carcinoma treatment treatment
non surgical surgical
fit for surgery local infiltration no metastasis surgical 

distant bronchogenic carcinoma 

distant metastasis PET SCAN metastasis
CT chest or bronchoscope infiltration
 not infiltrating the surroundings bronchoscope
vocal cords bronchoscope 
tumor recurrent laryngeal nerve
mediastinum
trachea bronchoscope trachea 
fixed to serrroundigs
L.N carina 
widening carina L.N enlargement bronchus
By the time of diagnosis 1 carina tumor 
metastasis to Lymph node tumor
Non operable bronchoscope

T4 point of bifurcation carina 

other lung fit ? Fit

lung pneumonectomy
155 COPD smoker
resectable % 25 25 155 25 operable % 25
1 155 0 1 4 4
0

bronchus chemo and radiotherapy surgery

mcq
Small cell ACTH endocrinal manifestastion paramalignant syndrome
squamous type squamous cell carcinoma parathormone hormone carcinoma
hypercalcemia tumor small cell carcinoma hypercalcemia
squamous

Chest

2-b