LUNG TUMOURS

Introduction
• Malignant lung tumours ae the commonest cause of death world
wide
• 18% of all cancer related deaths
• Tobacco use is the major risk factor, causal in over 90% of all lung
cancers
• Risk is proportional to amount smoked
• Higher in urban areas
CLASSED
• PRIMARY LUNG TUMOURS
• SECONDARY LUNG TUMOURS
• MIDIASTINAL TUMOURS
PRIMARY LUNG TUMOURS

• Commonest is bronchial carcinoma

• Bronchial Ca arises from the bronchial mucous glands and epithelium
• Common types are
a. Squamous cell
b. Adenocarcinoma
c. Small-cell
d. Large-cell
Clinical features
• Cough usually dry and an early symptom, bovine cough if RLN is involved
• Haemoptysis
• Lung collapse
• Breathlessness
• Chest pain and nerve entrapment
• Superior vena cava syndrome
• Finger clubbing
• Hypertrophic pulmonary osteoarthropathy
• Paraneoplastic features, SIADH, ACTH, HYPERCALCAEMIA, CARCINOID
SYNDROME, GYNAECOMATIA
Investigation
• CXR
• CT
• BRONCHOSCOPY WITH BIOPSY FOR HISTOLOGY
• SPUTM CYTOLOGY
Mx
• Surgical Treatment
• Radiotherapy
• Chemotherapy for small cell tumours, drugs used include;
cyclophosphamide, doxorubicin, vincristine
• Laser therapy and stenting

Prognosis is very poor, one year mortality is about 70%

Well differentiated squamous cell carcinoma has the best prognosis
Secondary Tumours
• Metastases from primary tumours, particularly from midline
structures such as the breast, thyroid, ovaries, testes, uterus

• Usually multiple lesions

• Symptoms are late

• Lymphangitic carcinomatosis
Secondary Tumours
• CXR shows diffuse pulmonary shadowing radiating from the hilar
region.
• CT shows polygonal thickened interlobular septa.

• Opiates may be useful in reducing breathlessness.

• Biopsy for histology and treat accordingly

Tumours of the Mediastinum
Tumour type depends on the part of the mediastinum involved
Usually benign
Mediastinal regions are;
• Superior
• Anterior
• Posterior
• Middle
Superior
• Retrosternal goitre
• Persistent left superior vena cava
• Prominent subclavian artery
• Thymic tumour
• Dermoid cyst
• Lymphoma
• Aortic aneurysm
Anterior
• Retrostenal goitre
• Dermoid cyst
• Thymic tumour
• Lymphoma
• AOTIC Aneurysm
• Germ cell tumor
• Pericardial cyst
• Hiatus hernia
Posterior
• Neurogenic tumour
• Paravetebral abscess
• Oesephageal lesion
• Aotic aneurysm
• Foregut duplication
Middle
• Bronchia Carcinoma
• Lymphoma
• Sarcoidosis
• Bronchogenic cyst
• Hiatus hernia
Diagnosis
• Usually incidentally through CXR
• Symptoms are not common…
• Dermoid cyst may rupture in the bronchus
• Malignant Mediastinal tumours invade and cause compression

• Commonest type of mediastinal tumour is an enlarged metastatic

lymphnode. Others are;
• Lymphoma
• Germ cell tumour
• Malignant thymic tumours
Clinical features
• Depends on the adjacent structures
If close to trachea and main bronchus
• Breathlessness
• Stridor
• Cough
• Lung collapse
Close to oesophagus
• Dysphagia
Close to the phrenic nerve
• Diaphragmatic paralysis
RLN
• Paralysis of the vocal cord with bovin cough
Sympathetic nerve
• Horner’s syndrome
Superior Vena Cava
• SVC Syndroem
Pericardium
• Pericarditis and pericardial effusion
Investigation
• CXR
• CT
• MRI
• Bronchoscopy
• Mediastinoscopy
Mx
• Surgery