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Carcinoma of the Bronchus (Symptoms (Dyspnoea, Chest pain, Haemoptysis,…
Carcinoma of the Bronchus
Epidemiology
Accounts for 13% of all new cancer cases
Accounts for 27% of cancer deaths
Second most common cancer in the UK
Incidence is increasing in women
Only 5% are cured
Risk Factors
Iron oxides
Chromium
Asbestos
Arsenic
Smoking - causes 90% of lung cancers (passive as well)
Radiation (radon gas)
Types
Non-Small Cell
Adenocarcinoma - 27%, most commonly associated with asbestos, local and distant mets
Large cell - 10%, mets early, poorly differentiated
Squamous - 35%, local spread is common, mets occur late
Prognosis: 50% 2 year survival with no mets, 10% with mets
Small Cell
Arises from endocrine cells (Kulchitsky cells)
Often secretes polypeptide hormones resulting in paraneoplastic syndromes e.g. production of ACTH, Cushing's syndrome
20%
Early widespread mets, poor prognosis
Symptoms
Dyspnoea
Chest pain
Haemoptysis
Cough
Recurrent pneumonia
Lethargy
Anorexia and weight loss
Signs
Hypertrophic pulmonary osteoarthropathy (HPOA)
Supraclavicular or axillary nodes
Clubbing
Chest Signs
Pleural effusion
Collapse
Anaemia
Met Signs
Confusion
Fits
Bone tenderness
Focal CNS signs
Hepatomegaly
Peripheral neuropathy
Cerebellar syndrome
Proximal myopathy
Cachexia
Complications
Metastatic
Bone: bone pain, anaemia, raised calcium
Liver
Brain
Adrenals: Addison's
Non Metastatic
Cerebellar syndrome
Fits
Proximal myopathy
Confusion
Neuropathy
Local
SVC obstruction
Rib erosion
Phrenic nerve palsy
Pericarditis
Recurrent laryngeal nerve palsy
AF
Endocrine
SIADH, ACTH (Cushing's) from small cell tumours
PTH from squamous cell tumours
Ectopic hormone secretion
Investigations
Fine needle aspiration or biopsy of lymph nodes
CT to stage tumour (TNM staging)
Cytology of sputum and pleural fluid
Bronchoscopy: to asses operability and histology samples
Chest X-ray: Peripheral nodule, hilar enlargement, lung collapse, pleural effusion, bony secondaries
Bone scan if suspected mets
Low sodium
Treatment
Small Cell
May respond to chemo but will relapse
Usually disseminated at presentation
Palliation
Endobronchial therapy
Pleural drainage
SVC stent for SVC obstruction
Drugs: analgesia, steroids, antiemetics, bronchodilators, anti-depressants
Radiotherapy for bronchial obstruction, SVC obstruction, haemoptysis
Non Small Cell
Radical radiotherapy for stage I/II/III
Chemo + radiotherapy for advanced disease: platinum regimens and monoclonal antibodies
Excision of tumour with no mets - stage I/II = lobectomy
Other Lung Tumours
Hamartoma: rare, benign
Mesothelioma
Bronchial adenoma: slow growing, rare