Bronchiogenic carcinoma is highly recommended in the proper diagnosis of all respiratory disorders. Malignancy can mimic practically all common pulmonary diseases such as tuberculosis, Pneumonia, Lung abscess, atelectasis, localized emphysema, Pleural effusion etc. Just how will we give a detailed or differential diagnosis to single it?
bronchogenic carcinoma
Investigations
Radiological findings: Radiological findings might be protean. The presence of a circular or irregular shadow in a symptomatic patient may be the only finding. The classical circular shadow is named lesion. In more advanced cases, the lesion may be more extensive. Hilar glands are enlarged. The development may undergo central cavitation and the resulting abscess shows thick and ragged walls. The existence of hilar adenopathy should suggest the malignant nature from the lesion. Existence of diaphragmatic paralysis plus a hilar mass should highly recommend the potential of bronchogenic carcinoma. Other features like collapse, consolidation, localized emphysema, and pleural and pericardial effusion can also be present. Special procedures for example tomography, selective pulmonary angiography, isotope scan can help further. A single peripherally placed "coin shadow" in the lung may be caused by primary or secondary neoplasms, tuberculosis, fungal infections or old scars.
bronchogenic carcinoma
Sputum examination: Hemoptysis exists most of the time and also the sputum is usually referred to as "currant jelly". Malignant cells might be detected in the sputum by examining after methylene blue staining which is confirmed by Papanicolaou's method. Other diagnositc procedures include bronchoscopy, needle biopsy of palpable lymph nodes within the neck and axilla and scalene fat pad biopsy. The best scalene node ought to be biosied in the event of lesions with the right lung and the left lower lobe. The left scalene node should be biopsied for left upper lobe neoplasms. Mediastinoscopy and biopsy of abnormal nodes is really a more rewarding procedure. Whenever a solitary pulmonary nodule (coin shadow) is detected and diagnosis isn't evident, the patient should be followed up to determine the progress from the lesion. In general, malignant lesions possess a doubling period of 5 weeks to Eighteen months. Faster growth is an indication of inflammatory lesions. Calcification is at favor of non-malignant lesions though this is not always true. When there is strong suspicion of malignancy, diagnostic thoracotomy is indicated.
Treatment
Management depends on the stage from the tumor on diagnosis, histological type and presence of complications. Treatment may consist of surgery, irradiation and chemotherapy.
Surgery
Once the primary is small , is detected before clinical manifestations develop where there are not any metastases, surgical procedures are ideal. Contraindications to surgery include infiltration of the trachea, carina, superior vena cava, recurrent laryngeal nerve paralysis and pleural effusion. Presence of mediastinal nodes and distant metastases are contraindications to surgery. Surgical results are less satisfactory in those cases who have developed symptoms.
Radiotherapy
Radical radiotherapy is preferred in selected cases. In practices, within the most cases radiotherapy is given as a palliative measure in inoperable cases with local spread or distant metastases. Several recent advances in radiotherapy techniques for example split dose radiotherapy, utilization of radio-sensitizers, as well as the availability of modern radiation equipment like linear accelerator, betatron, neutron beams and meson beams make radiotherapy far better with less hazards. In some centers, radiotherapy is also used prophylactically to the brain to avoid the creation of metastases.
Chemotherapy
It really is suggested for 90% of patients with bronchogenic carcinoma. The option of drugs is dependant on the tumour histology, facilities for supportive therapy, and tolerance by the patient. Chemotherapy may be used since the sole modality of treatment in advanced cases or as a possible adjunct to surgery and radiotherapy. Popular chemotherapeutic agents are methotrexate, cyclophosphamide, vincristine, CCNU, adriamycin and cisplatin.
Prognosis
Since most of the cases are diagnosed late inside the disease, overall prognosis in bronchogenic carcinoma is poor. Asymptomatic subjects detected by investigations have the best prognosis. Next in line are subjects with symptoms referable towards the primary tumour having a amount of under sex months. Metastases in CNS and liver confer a poor outcome. Small cell carcinomas possess a poorer prognosis since metastases develop early. In the most patients only palliative therapy is possible. 5 year survival figures for squamous cell carcinoma change from 40-50% for stage I to under 10% for stages III and above.
Prophylaxis
Bronchogenic carcinoma reaches least partially preventable by avoidance of smoking. The risk of cancer boils down quantitatively using the reduction in the quantity of cigarettes smoked as well as in those that give up smoking completely the increased risk cancer boils down over time of approximately A decade to succeed in that in nonsmokers. Occupational experience of asbestos, environmental pollutants and radioactive materials should be reduced towards the minimum and personnel involved in these industries should receive personal protection.
bronchogenic carcinoma
Investigations
Radiological findings: Radiological findings might be protean. The presence of a circular or irregular shadow in a symptomatic patient may be the only finding. The classical circular shadow is named lesion. In more advanced cases, the lesion may be more extensive. Hilar glands are enlarged. The development may undergo central cavitation and the resulting abscess shows thick and ragged walls. The existence of hilar adenopathy should suggest the malignant nature from the lesion. Existence of diaphragmatic paralysis plus a hilar mass should highly recommend the potential of bronchogenic carcinoma. Other features like collapse, consolidation, localized emphysema, and pleural and pericardial effusion can also be present. Special procedures for example tomography, selective pulmonary angiography, isotope scan can help further. A single peripherally placed "coin shadow" in the lung may be caused by primary or secondary neoplasms, tuberculosis, fungal infections or old scars.
bronchogenic carcinoma
Sputum examination: Hemoptysis exists most of the time and also the sputum is usually referred to as "currant jelly". Malignant cells might be detected in the sputum by examining after methylene blue staining which is confirmed by Papanicolaou's method. Other diagnositc procedures include bronchoscopy, needle biopsy of palpable lymph nodes within the neck and axilla and scalene fat pad biopsy. The best scalene node ought to be biosied in the event of lesions with the right lung and the left lower lobe. The left scalene node should be biopsied for left upper lobe neoplasms. Mediastinoscopy and biopsy of abnormal nodes is really a more rewarding procedure. Whenever a solitary pulmonary nodule (coin shadow) is detected and diagnosis isn't evident, the patient should be followed up to determine the progress from the lesion. In general, malignant lesions possess a doubling period of 5 weeks to Eighteen months. Faster growth is an indication of inflammatory lesions. Calcification is at favor of non-malignant lesions though this is not always true. When there is strong suspicion of malignancy, diagnostic thoracotomy is indicated.
Treatment
Management depends on the stage from the tumor on diagnosis, histological type and presence of complications. Treatment may consist of surgery, irradiation and chemotherapy.
Surgery
Once the primary is small , is detected before clinical manifestations develop where there are not any metastases, surgical procedures are ideal. Contraindications to surgery include infiltration of the trachea, carina, superior vena cava, recurrent laryngeal nerve paralysis and pleural effusion. Presence of mediastinal nodes and distant metastases are contraindications to surgery. Surgical results are less satisfactory in those cases who have developed symptoms.
Radiotherapy
Radical radiotherapy is preferred in selected cases. In practices, within the most cases radiotherapy is given as a palliative measure in inoperable cases with local spread or distant metastases. Several recent advances in radiotherapy techniques for example split dose radiotherapy, utilization of radio-sensitizers, as well as the availability of modern radiation equipment like linear accelerator, betatron, neutron beams and meson beams make radiotherapy far better with less hazards. In some centers, radiotherapy is also used prophylactically to the brain to avoid the creation of metastases.
Chemotherapy
It really is suggested for 90% of patients with bronchogenic carcinoma. The option of drugs is dependant on the tumour histology, facilities for supportive therapy, and tolerance by the patient. Chemotherapy may be used since the sole modality of treatment in advanced cases or as a possible adjunct to surgery and radiotherapy. Popular chemotherapeutic agents are methotrexate, cyclophosphamide, vincristine, CCNU, adriamycin and cisplatin.
Prognosis
Since most of the cases are diagnosed late inside the disease, overall prognosis in bronchogenic carcinoma is poor. Asymptomatic subjects detected by investigations have the best prognosis. Next in line are subjects with symptoms referable towards the primary tumour having a amount of under sex months. Metastases in CNS and liver confer a poor outcome. Small cell carcinomas possess a poorer prognosis since metastases develop early. In the most patients only palliative therapy is possible. 5 year survival figures for squamous cell carcinoma change from 40-50% for stage I to under 10% for stages III and above.
Prophylaxis
Bronchogenic carcinoma reaches least partially preventable by avoidance of smoking. The risk of cancer boils down quantitatively using the reduction in the quantity of cigarettes smoked as well as in those that give up smoking completely the increased risk cancer boils down over time of approximately A decade to succeed in that in nonsmokers. Occupational experience of asbestos, environmental pollutants and radioactive materials should be reduced towards the minimum and personnel involved in these industries should receive personal protection.