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Lung Tumor
Lung Tumor
24/03/2022
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Objectives
To know the
• epidemiology ,
• etiology,
• pathogenesis ,
• clinical presentation,
• investigation ,
• diagnosis ,
• treatment ,
• complication ,
• prognosis
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• Aetiology
• Cigarette smoking
• Exposure to radon
• industrial materials (e.g. asbestos, silica,
beryllium, cadmium and chromium)
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Cell type %
• Adenocarcinoma 35–40
• Squamous 25–30
• Small-cell 15
• Large-cell 10–15
Bronchial carcinoma
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Lung cancer. An ill-defined mass is noted on the posteroanterior chest x-ray (arrows) (A).
Although this appears to be located near the right hilum, the lateral chest x-ray (B) clearly shows
the mass to be posterior to the hilum. Its shaggy appearance is very suggestive of carcinoma.
Further evaluation by computed tomography scan (C) clearly shows the mass in relation to the
mediastinal structures, such as the pulmonary artery (PA) and aorta (Ao).
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Lung cancer. A, The computed tomography scan shows a 2-cm soft tissue mass in the
middle portion of the left lung (arrow). B, A whole-body positron emission
tomography scan of the anterior chest and upper abdomen done with radioactively
labeled glucose shows markedly increased activity at the same area, indicative of very
high metabolic activity and a high probability of malignancy.
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• Lymphatic spread
• mediastinal
• supraclavicular lymph nodes.
Blood-borne metastases
• Liver.
• Bone.
• Brain.
• Adrenals.
• Skin.
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Symptom
• Cough
• Chest pain
• Cough and pain
• Coughing blood
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• Malaise
• Weight loss
• Shortness of breath
• Hoarseness
• Distant spread
• No symptoms
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clubb
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local
• Cough.
• Haemoptysis.
• Breathlessness .
• Bronchial obstruction.
collapse of a lobe or lung .
• cause pneumonia or lung abscess.
• Recurnt Pneumonia at the same site.
• Stridor (a harsh inspiratory noise) .
• a large pleural effusion
• compressing a phrenic nerve causing diaphragmatic
paralysis.
•
_______________________________________________
• (1)ipsilateral partial ptosis, enophthalmos, miosis and
hypohidrosis of the face.
• (2)pain in the shoulder and inner aspect of the arm,
sometimes with small muscle wasting in the hand
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Mediastinal spread.
• Dysphagia If the oesophagus is involved.
• Invasion of the pericardium, lead to
arrhythmia or pericardial effusion .
• Superior vena cava obstruction.
• left recurrent laryngeal nerve --- causes vocal
cord paralysis, voice alteration and a 'bovine'
cough (lacking the normal explosive
character).
• Supraclavicular lymph nodes -----enlarged.
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Metastatic spread.
Brain
• focal neurological defects,
• epileptic seizures,
• personality change,
Liver : jaundice,
Bone : bone pain
Skin :skin nodules.
• Lassitude, anorexia and weight loss.
• Digital clubbing.
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Endocrine
• Inappropriate antidiuretic hormone secretion
causing hyponatraemia
• Ectopic adrenocorticotrophic hormone secretion
• Hypercalcaemia due to secretion of parathyroid
hormone-related peptides
• Carcinoid syndrome
• Gynaecomastia
• Neurological
• Polyneuropathy
• Myelopathy
• Cerebellar degeneration
• Myasthenia (Lambert-Eaton syndrome,)
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• Digital clubbing
• Hypertrophic pulmonary osteoarthropathy
• Nephrotic syndrome
• Polymyositis and dermatomyositis
• Eosinophilia
Investigations
Aims for
• confirm the diagnosis .
• establish the histological cell type.
• define the extent of the disease.
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Imaging
plain X-rays
Spiral CT
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•Histological
characterisation
•
• flexible bronchoscope.
• 'blind' bronchoscopic washings and
brushings
• percutaneous needle biopsy under CT or
ultrasound guidance .
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thoracoscopy.
needle aspiration or biopsy of affected
o lymph nodes,
o skin lesions,
o liver
o bone marrow.
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• Management
1. Distant metastasis .
2. Invasion of central mediastinal structures
including heart, great vessels, trachea and
oesophagus .
3. Malignant pleural effusion .
4. Contralateral mediastinal nodes .
5. FEV1 < 0.8 L .
6. Severe or unstable cardiac or other medical
condition
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Treatment include:
• effective communication.
• pain relief .
• attention to diet .
• depression and anxiety, need specific therapy.
• drain the pleural cavity.
• pleurodesis with a sclerosing agent.
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• Prognosis
• Very poor .
• 70% of patients dying within a year .
• Only 6-8% of patients surviving 5 years after
diagnosis.
• The best prognosis is with well-differentiated
squamous cell tumours .
Blood-borne metastatic
from many primary tumours :
• breast,
• kidney,
• uterus,
• ovary,
• Testes
• thyroid.
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Diagnosis
No symptoms
• Breathlessness .
• haemoptysis.
radiological examination
• Multiple bilateral cannon balls.
• lobar collapse
• Lymphangitic spread of
carcinoma in the lung
• Lymphatic infiltration may develop in patients
with carcinoma of the
• breast,
• stomach,
• bowel,
• pancreas
• bronchus.
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• CT scans characteristic.
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• Superior mediastinum
• Retrosternal goitre
• Persistent left superior vena cava
• Prominent left subclavian artery
• Thymic tumour
• Dermoid cyst
• Lymphoma
• Aortic aneurysm
• Anterior mediastinum
• Retrosternal goitre
• Dermoid cyst
• Thymic tumour
• Lymphoma
• Aortic aneurysm
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• Posterior mediastinum
• Neurogenic tumour
• Paravertebral abscess
• Oesophageal lesion
• Aortic aneurysm
• Foregut duplication
•
• Middle mediastinum
• Bronchial carcinoma
• Lymphoma
• Sarcoidosis
• Bronchogenic cyst
• Hiatus hernia
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• Radiological examination
CT (or MRI) is the investigation of choice for
mediastinal tumours .
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Surgical exploration
Management
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THANK YOU
Qs
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