BRONCHOGENIC CARCINOMA

Prof.Lazarus Yusufu

Introduction

• Commonest primary malignant lung tumour
• Globally commest male cancer,2nd common in females.
• Still rare in Africa,incidence on the rise,due to cigarette smoking

and atmospheric pollution

• 40 years
• Arsenic,asbestos,nickel,metalliciron,iron oxides,radioactive subs.

exhaust fumes,coal tar,fumes,benzopyrene,chromate&petroleum

products.

Gross types

• 3 main macroscopic types

main bronchus tmours(main bronchi)

peripheral tumours(surface of the lungs)

pancoast tumour:{pulmonary sulcus tumour or superior sulcus

tumour}on the apex,affects the brachial plexus&cervical

sympathetic nerve(stellate ganglion)

This results in what is called Pancoast Syndrome

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Microscopic types

• Sq.cell(epideremoid) 50%,central,near the hilum,slow&late metastasis
• Anaplastic ca,small cell/oat cell 15%,large cell 5%
• Adenocarcinoma 20%,peripheral,young females,non-smokers,poorly

differenciated,rapid growth + early mets,seen more in the young

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Metastasis

• Direct spread/local; mediastinum,pleura,chest wall or pericardium
• Lymphatics;hillar l.nodes,subcarinal or paratracheal chain of l.nodes
• Blood stream;liver,brain,bones,adrenal glands,skin

Clinical features

• Symptoms as a result of
• 1.primary tumour/bronchopulmonary symptoms 68%
• 2.metaststes/secondaries 13%
• 3.non-metastatic extrapulmonary manifeststion 14%
• 4.incidental abnormal routine chest X-RAY 5% +- weight loss

1.

• cough,productive,persistent
• haemoptysis ~50% of patients
• dyspnoea ~50% of patients,dysphagia,hoarseness,SVC synd,

pancoast synd

• chest pain;dull,fever,wheezing,stridor,recurrent pneumonia

2.

• extrathoracic

brain-hemiplegia,epileptiform fits,head aches,vomiting

bone-bone pains,pathological #s,of long bones,vertebrae,pelvis

• skin-subcut,nodules

3.

• hypertrophic pulmonary osteoarthropathy,joint pain,swelling finger

clubbing

• carcinomatous neuropathy-proximal muscles,myaesthenis myopathy

sensory neuropathy,corticocerebellar degeneration

• endocrine manifestation-cushing’s synd,gynaecomastia,

hypogycaemia,inappr.ADH secretion

• skin-dermatomyositis,acanthosis nigrans,scleroderma
• vascular-migratory thrombophlebitis,spontan.vascular thrombosis

4.Incidental findings

• 5% symptomless,but chest x-ray shows shadows suggestive of ca.

non-specific symptoms of weight loss,malaise,anorexia are initial

symptoms 15 -20%

Investgations

• C X-RAY
• Bronchoscopy +_ biopsy/washings
• Ultrasonography
• Oesophagoscopy
• Mediastnoscopy+ biopsy
• Ba.swallow
• Lung biopsy/Pleural biopsy-needle or high speed drill,using VAT(video

assisted thoracoscopy)

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• Tomography
• CTScan whole body
• MRI

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Diagnosis

• 75% +ve histology on sputum abd pleural examination
• 25% only presumption,or diagnosis is by exclusion or explorooratory

thoractomy

• Surgical removal offers the best prospects for cure
• Radiotherapy rarely for cure,for palliative treatment
• Cytotoxic chemotherapy,cisplatin/carboplatin,etoposide,irinotecan
• Immunotherapy;intrapleural BCG inj. to stimulate immune response
• Laser beams,thru flexible bronchoscope

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