MED 210

GROUP 5 PRESENTATION
QUESTION:
Pneumoconiosis
Pulmonary Tumor
PNEUMOCONIOSIS
INTRODUCTION
pneumoconiosis
Exposure to dusts, gases, vapors and fumes at work can cause several different types of
lung disease:
 Acute bronchitis and even odema from irritants such as sulphur dioxide, chlorine,
ammonia or the oxides of nitrogen
 Pulmonary fibrosis due to mineral dusts
 Occupational asthma
 Hypersensitivity pneumonitis
 Bronchial carcinoma due to industrial agents (e.g. Asbestos, polycyclic
hydrocarbons, radon in mines)
The degree of fibrosis that follows inhalation of mineral dust varies. While iron
(siderosis), barium (baritosis) and tin (stannosis) lead to dramatic, dense, nodular
shadowing on the chest x-ray, their effect on lung function and symptoms is minimal.
In contrast exposure to silica or asbestos leads to extensive fibrosis and disability.
Coal dust has an intermediate fibrogenic effect and used to account for 90% of all
compensated industrial lung diseases in the UK. The term ‘pneumoconiosis’ means
the accumulation of dust in the lungs and the reaction of the tissue to its presence.
The term is not wide enough to encompass all occupational lung disease and is now
generally used only in relation to coal dust and its effects on the lung.
INTRODUCTION CONTI…
 When you breath in dust, the particles can land in
your airway or deep in your lungs. How far into the
lungs the dust goes depends on the size and shape
of particles.
 After the dust particles settle in the lungs, your
immune system may try to get rid of or surrounded
them (causing inflammation) to prevent lung
damage .
 In some cases, the inflammation is severe enough
that scar tissue called pulmonary fibrosis, forms. If
the inflammation or fibrosis is severe enough or
involves a large enough area of the lungs, your
breathing will be affected.
GENERAL OVERVIEW OF LUNG
PHYSIOLOGY: BREATHING
APPLIED ANATOMY
 As we all know, normal respiration begins by
inhaling air through the mouth and nose. This
air flows down your trachea, which divides
into the left and right bronchi, which carry air
to each lung. Once inside the lung, the
bronchi divide into smaller tubes called
bronchioles and each bronchiole ends with
alveoli. The alveoli are responsible for
oxygenating the blood for circulation as well
as removing carbon dioxide from the blood.
DEFINITIONS
pneumoconiosis
 The term pneumoconiosis derives its meaning from
the Greek word: pneuma = air and konis = dust
 The International Labour Organisation defines
pneumoconiosis as “the accumulation of dust in the
lungs and the tissue reactions to its presence”.
 Not included in the definition of pneumoconiosis are
conditions such as asthma, chronic obstructive
pulmonary disease (COPD), and hypersensitivity
pneumonitis, in which there is no requirement for
dust to accumulate in the lungs in the long term.
CONT…,
 In other words
Pneumoconiosis can be defined as the non-
neoplastic reaction of lungs to inhaled
minerals or orgnic dust and the reluctant
alteration in their structure excluding
asthma, bronchitis and emphysema.
CLASSIFICATION O
PNEUMOCONIOSIS
 Silicosis=this is the type becaused by
inhalation of dust ,composed of free silicon
dioxide
 Silicatosis =this is the type caused by
inhalation of mineral dust , which includes
dioxide of silicon and other elements;
magnesium, alumium,iron,calcium
(asbestosis,talcosis,kaolinosis and
cementosis)
CONTI….
 Mentaloconiosis =caused by inhalation of metal
dust:iron,aluminium,barium,manganese(sideros
is, aluminosis, baritosis)
 Carbocobiosis=caused by inhalation of
dust,composed of carbonaceous dust:anthracite
coal,coke,graphite,
soot(anthracosis,graphitosis)
 Pneumoconiosis caused by the mixed
dust=anthrocosilicosis, siderosilicosis
 Pneumoconiosis caused by an organic dust
=bisinosis ,corn pneumoconiosis
CLASSIFICATION
According to character of form,size and
contour of opacity on roentgenogram
 Nodular
 Interstitial (diffused sclerotic)
 Nodal

According to degree of severity

Stage 1
Stage 2
Stage 3
RISK FACTORS
Pneumoconiosis
 Tobacco smoking (active)
 Environmental tobacco smoke exposure
 Pulmonary diseases

COPD, IPF, SS-ILD

 Systemic diseases: HIV
 Air pollution (indoor and outdoor)

domestic cooking fuels

petroleum product combustion exhaust exposure
 Environmental exposure

Radon, arsenic, nickel, choromium, asbestos and silica

 Dietary factors

Alcohol consumption,
intake of vitamins, fruits and vegetables
 Hormonal therapy

 Genetic factor

familial
specific gene abnormalities (nonhereditary)
PATHOPHYSIOLOGY
pneumoconiosis
 After inhalation of dust, the alveolar macrophages converge upon
extra-cellular particles and engulf them. If the number of particles is
large, the elimination mechanism fails and dust containing
macrophages collect in the interstitium especially in perivascular and
peribronchiolar regions.
 According to the amount of dust and cell accumulation, the alveolar
walls either protrude into the alveolar spaces or obliterate them.
 At the same time, a delicate supporting framework of the fine
reticulin fibers develops between the cells and in the case of dust with
fibrinogenic potential, the proliferation of collagen fiber follows.
 The dust particles are released and reingested by other macrophages.
 Some dust-laden macrophages continually migrate to lymphatics or to
bronchioles where these are eliminated.
 Migration is increased by infection or edema of the lungs.
SIGNS AND SYMPTOMS
Pneumoconiosis
 A chronic cough feeling of tightness in the chest (called simple pneumoconiosis as
first stage which develops after 10-12 years of exposure. It’s also characterized by
fever and expectoration)
 An increased production of mucus
 The development of a blue tint in the lips or fingernails (cyanosis)
 A cough
 Shortness of breath
 Chest pain
 Difficulty inn breathing
 Wheezing
 Bluish coloration of the skin
 Swelling
 Liver enlargement due to heart failure
 If pneumoconiosis causes severe lung fibrosis, breathing can become extremely
difficult. When this happens, the patient’s lips and fingernails may have a bluish
tinge
 In very advanced disease, there also may be signs of leg swelling caused by too
much strain on the heart
CONT…,
 Shortness of breath
 Fluid in the chest (pleural effusion)
 Cancer that spreads to other parts of the
body (metastasis)
HOW TO MAKE DIAGNOSIS
pneumoconiosis
 History of exposure=occupational
 Signs and symtoms
 Radiological finding
 Decreased total lung capacity ,vital capcity and
residue volume

 Lung function test: varies from normal to

obstructive or restrictive or combination of both.
 Diffusion decreased
 Dysponea on exertion.
DIAGNOSIS CONT…
 X-ray chest: small nodules, 1-10 mm in upper
lung zones, ground glass appearance of the
lung.
 Show egg-shell hilar calcification and
progressive massive fibrosis,it also shows
snow-storm appearance in the lung fields
 Emphysematous bullae are present in the
upper zone then later affect the lower lobes.
MANAGEMENT
Pneumoconiosis
Abnormalities include; progressive massive fibrosis, with deterioration of
pulmonary function and Dysponea.
 Pneumoconiosis has no cure. Treatment is given to prevent worsening once
diagnosed.
 Terminate exposure to prevent PMF.
 Corticosteroid e.g. oral prednisone, pulmonary lavage, lung transplant or
chest physiotherapy
 Treat complications: Pneumothorax, COPD, cor pulmonale, T.B, vascular
disease.
 AMBROXOL dosage:

adult: the recommended oral dose is 30-120mg/day in 2-3 divided dosed.

 ATOVAQUONE dosage;

Adult: the recommended oral dose is 1500mg (10ml) once daily,

administered with a meal.
 ORAL PREDNISONE dosage;

40-50mg daily for at least five days or untill recovery

COMPLICATIONS
Pneumoconiosis
 Tuberculosis in almost 25% patients
 Pulmonary massive fibrosis
 Autoimmune diseases like rheumatoid arthritis
and scleroderma
 Lung cancer
 Death especially in acute and accelerated
silicosis
 Mesothelioma
 Cancer of the peritoneum
 Cor pulmonale
PROGNOSIS
Pneumoconiosis
Pneumoconiosis is a chronic, long-term, lung
disease. You can live with it but there could
be some complications that pop up like;
 Progressive respiratory failure
 Lung cancer
 Tuberculosis (but this is now rare)
 Heart failure caused by pressure inside the
lungs
 Part two

PULMONARY TUMOR
INTRODUCTION
Pulmonary tumor
 Tobacco consumption is the primary cause of
lung cancer.
 Voluntary or involuntary cigarette exposure
accounts for 80% to 90% of all cases of lung
cancer
 Indoor radon exposure is now the 2nd cause in
the USA
HEALTHY LUNG TISSUE
DISEASED LUNG TISSUE
DEFINITION
Pulmonary tumor
 This is an abnormal rate of cell division or
cell death in the lung tissue or in the airway
that lead to the lungs. Also known as lung
tumor
CONT..
Pulmonary tumor
 It starts when abnormal cells grow out of
control in the lung. Invading nearby tissues
and form tumors. Lung tumor can start
anywhere in the lungs and affect any part of
the respiratory system. The cancers cells can
spread, or metastasize, to the lymph nodes
and other parts of the body.
TYPES OF LUNG TUMOR
Two main Types of Lung tumor:

Small Cell Lung Cancer (20-25% of all lung cancers)

Non Small Cell Lung Cancer (most common ~80%)

SMALL CELL LUNG CANCER
NON-SMALL CELL LUNG CANCER

 1. Squamous cell carcinoma

 2. Adenocarcinoma
 3. Large cell carcinomas
SQUAMOUS CELL CARCINOMA
 Moderate to poor differentiation
 makes up 30-40% of all lung cancers
 more common in males
 most occur centrally in the large bronchi
 Uncommon metastasis that is slow effects the
liver, adrenal glands and lymph nodes.
 Associated with smoking
 Not easily visualized on xray (may delay dx)
 Most likely presents as a Pancoasts tumor
ADENOCACINOMA
 Increasing in frequency. Most common type of
Lung cancer (40-50% of all lung cancers).
 Clearly defined peripheral lesions (RLL lesion)
 Glandular appearance under a microscope
 Easily seen on a CXR
 Can occur in non-smokers
 Highly metastatic in nature
 Pts present with or develop brain, liver,
adrenal or bone metastasis
RISK FACTORS
Smoking is a primary risk factor (87% of pulmonary tumor occur in
smokers)
 Exposure to secondhand smoke
 Previous radiation therapy
 Exposure to radon gas
 Exposure to asbestos and other carcinogens
 Hereditary
 Taking certain dietary supplements
 Exposure to other cancer causing agents in working place
 Multiplicity (<5 nodules increases risk for malignancy)
 Emphysema and pulmonary fibrosis (particularly IPF)
 Neurologic disorders: loss of consciousness, neuromuscular
disorders.
 Lack of immunization
 Trauma, anesthesia and aspiration
PATHOLOGY
Pulmonary tumor
Carcinogens like smoke, occupational and
environmental agents, genetics

Binds with cell’s DNA and damage the cells.

Cellular changes and abnormal cell growth occur

Malignant transformation of pulmonary

epithelial cells.
PATHOLOGY CONT……
Abnormal proliferation of the lung cell. These cells
grow slowly and covers the segmental bronchi and
lobes of the lungs.

Non specific inflammatory changes with

hypersecretion of mucus, desquamation of the cells.

Lesions formation in the lung’s tissues involving the

bronchi, bronchioles or even alveoli.

Bronchogenic carcinoma.
SIGNS AND SYMPTOMS OF LUNG
CANCER
 Sometimes lung cancer does not cause any symptoms and
is only found in a routine x-ray.
 If a person with lung cancer does have symptoms, they will
depend on the location of the tumour in their lung.
 It is also imperative to note that the same symptoms can
be caused by other conditions, so may not necessarily
mean cancer.
 Therefore it is important to consult a doctor when
symptoms are present. 
 Signs and symptoms also depend upon the location, size of
the tumor, degree of obstruction and existence of
metastases
 SIGNS AND SYMPTOMS OF LUNG CANCER

There are two types of signs and symptoms of lung

cancer:

1) Localized – involving the lung.

2) Generalized – involves other areas throughout the

body if the cancer has spread.
CLINICAL FEATURES
pulmonary tumor
 A cough that produces blood or red-colored phlegm (hemoptysis)
 Shortness of breath or difficulty breathing

 Chest pain

 nausea
 Hoarseness or wheezing
 Losing weight without trying

 Bone pain
 Headache, dizziness or limbs that become week or numb

 jaundice
 Swelling of the face, arms or neck
 Frequent upper respiratory infections, like bronchitis or

pneumonia
 Lump on the neck and collar bone
EARLY/LATE SIGNS AND
SYMPTOMS OF LUNG CANCER
Early Signs Late signs

Cough/chronic cough Bone pain, spinal cord

compression
Dyspnea Chest pain/tightness

Hemoptysis Dysphagia

Chest/shoulder pain Head and neck edema

Recurring temperature Blurred vision, headaches

Recurring respiratory Weakness, anorexia,

infections weight-loss, cachexia
Pleural effusion

Liver metastasis/regional
spread
LABORATORY TESTS
 Blood Tests
*CBC-to check red/white blood cell & platelets
-to check bone marrow and organ function

*Blood Chemistry Test-to assess how organs

are functioning such as liver and kidney
 Biopsy-to determine if the tumor is cancer or not
-to determine the type of cancer
-to determine the grade of cancer (slow
or fast)
RADIOLOGICAL
 CXR
 CT Scans
 MRI
 Sputum cytology
 Fibreoptic bronchoscopy
 Transthoracic fine needle aspiration
BIOPSY
ENDOSCOPY
 Bronchoscopy
 Mediastinoscopy
 VATS (video assisted thoracoscopic surgery)
BRONCHOSCOPY
MEDIASTINOSCOPY
TMN STAGING SYSTEM FOR LUNG
CANCER
T= Tumors : tumor size,
(local invasion)

N= Node : node involvement

(size and type)

M= Metastasis : general
involvement in organs and
tissues
LUNG CANCER STAGING
CONTINUED
 T: Tx, T0, Tis, T1-T4
(T3-tumors greater
than 7cm, T4 is a
tumor of any size)
 N: N0, N1, N2, N3
 M: M0, M1a, M1b
MEDICAL MANAGEMENT
 The three main cancer treatments
are:
*surgery (lung resections)
*radiation therapy
*chemotherapy
 Other types of treatment that are
used to treat certain cancers are
hormonal therapy, biological
therapy or stem cell transplant.
 LUNG RESECTIONS
 Lobectomy: a single lobe of lung is removed
 Bilobectomy: 2 lobes of the lung are removed (only
on R side)
 Sleeve resection: cancerous lobe is removed and
segment of the main bronchus is resected
 Pneumonectomy: removal of entire lung
 Segmentectomy: a segment of the lung is removed
 Wedge resection: removal of a small, pie-shaped
area of the segment
 Chest wall resection with removal of cancerous lung
tissue: for cancers that have invaded the chest wall
COMPLICATIONS
 Primary bronchial carcinoma
 Tuberculoma
 Hydatid cyst
COMPLICATIONS CONT….
Pulmonary tumor
 Pleural effusion
 Tumor obstructs superior vena cava
 Ectopic hormone production

• Mimics the bodies own hormones

• ADH (anti diuretic hormone) = SIADH (syndrome
of inappropriate ADH) no urine output
• ACTH (Adrenocorticotrophic hormone) = Cushing
syndrome
 Atelectasis and Pneumonia
 Metastasis (brain, bone, lung, liver, lymph nodes)
CONT….
Pulmonary tumor
 lung cancer histology is divided into two main
types: small-cell (neuroendocrine) lung cancer
(SCLC), which may tend to disseminate early in
their development and non-small-cell lung
cancer (NSCLC), which are more likely to be
diagnosed in a localized form.
 SCLC is an aggressive neuroendocrine tumor. It
is staged in the same way as NSCLC and stage 1
tumors may benefit from surgery. For non-
operable cases, disease is split into limited-or-
extensive-stage disease.
POST-OP COMPLICATIONS FOR
THOSE WITH LUNG CANCER
 Airway obstruction, dyspnea, hypoxemia, respiratory
failure
 Anesthesia side effects (N/V)
 Bleeding (hypotension, cardiogenic shock)
 Cardiac dysthymias, CHF, fluid overload
 Fever, sepsis
 Pneumonia
 Pneumothorax
 Pulmonary embolus
 Wound dehiscence
 Prolonged hospitalization
 Death
EDUCATING THE PATIENT

 Inform the patient what to expect, from administration of

anesthesia to thoracotomy and the likely use of chest
tubes and a drainage system postoperatively.
 Tell the patient about the administration of oxygen
postoperatively and the possible use of a ventilator.
 Explain the importance of frequent turning to promote
drainage of lung secretions.
 Instruct the proper use of an incentive spirometry and how
to perform diaphragmatic and pursed-lip breathing
techniques.
 Teach the patient to splint the incision site with hands, a
pillow or a folded towel to avoid discomfort
PROGNOSTIC FACTORS
 The best estimate on how a patient will do based
on:
*type of cancer cells
*grade of the cancer
*size or location of the tumor
*stage of the cancer at the time of diagnosis
*age of the person
*gender
*results of blood or other tests
*a persons specific response to treatment
*overall health and physical condition
GROUP MEMBERS
1. Azedi Precious Mwanza 19713015
2. Faith .M. Phiri 19713062
3. Getrude Chola 19713052
4. Joseph Chipulu 19113086
5. Musonda Sweaven Chilondoma 19713057
6. Precious Mbasela 19713024
7. Nancy Makani 19713070
8. Vincent Kapya 19713065