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.