Bronchiogenic carcinoma should be considered within the 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. Now how are we able to offer a detailed or differential diagnosis to single it out?
Radiological findings: Radiological findings might be protean. The presence of a circular or irregular shadow within an symptomatic patient will 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 as well as the resulting abscess shows thick and ragged walls. The presence of hilar adenopathy should suggest the malignant nature of the lesion. Presence of diaphragmatic paralysis plus a hilar mass should highly recommend the potential for bronchogenic carcinoma. Additional features like collapse, consolidation, localized emphysema, and pleural and pericardial effusion may also be present. Special procedures for example tomography, selective pulmonary angiography, isotope scan might help further. An individual peripherally placed “coin shadow” within the lung may be brought on by primary or secondary neoplasms, tuberculosis, fungal infections or old scars.
Sputum examination: Hemoptysis occurs oftentimes as well as the sputum is normally described as “currant jelly”. Malignant cells might be detected inside the sputum by examining after methylene blue staining and this can be confirmed by Papanicolaou’s method. Other diagnositc procedures include bronchoscopy, needle biopsy of palpable lymph nodes in the neck and axilla and scalene fat pad biopsy. The proper scalene node needs to be biosied within the of lesions with the right lung and also the left lower lobe. The left scalene node should be biopsied for left upper lobe neoplasms. Mediastinoscopy and biopsy of abnormal nodes can be a more rewarding procedure. When a solitary pulmonary nodule (coin shadow) is detected and diagnosis just isn’t evident, the individual ought to be followed up to see the progress from the lesion. Generally speaking, malignant lesions have a doubling time of 5 weeks to 1 . 5 years. More rapid growth is suggestive of inflammatory lesions. Calcification is at favor of non-malignant lesions though this is not always true. If you have strong suspicion of malignancy, diagnostic thoracotomy is indicated.
Management depends on happens with the tumor on diagnosis, histological type and presence of complications. Treatment may consist of surgery, irradiation and chemotherapy.
Once the primary is small, and is detected before clinical manifestations develop and there are not any metastases, surgical treatment is 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 answers are less satisfactory in those cases who’ve developed symptoms.
Radical radiotherapy is preferred in selected cases. In practices, inside the majority of cases radiotherapy emerges being a palliative measure in inoperable cases with local spread or distant metastases. Several recent advances in radiotherapy techniques such as split dose radiotherapy, use of radio-sensitizers, and the option of modern radiation equipment like linear accelerator, betatron, neutron beams and meson beams make radiotherapy more efficient with less hazards. In a few centers, radiotherapy is also used prophylactically towards the brain to stop the development of metastases.
It really is suggested for 90% of patients with bronchogenic carcinoma. The choice of drugs is founded on the tumour histology, facilities for supportive therapy, and tolerance by the patient. Chemotherapy works extremely well because the sole modality of treatment in advanced cases or being an adjunct to surgery and radiotherapy. Popular chemotherapeutic agents are methotrexate, cyclophosphamide, vincristine, CCNU, adriamycin and cisplatin.
As most with the cases are diagnosed late inside the disease, overall prognosis in bronchogenic carcinoma is poor. Asymptomatic subjects detected by investigations possess the best prognosis. Next in line are subjects with symptoms referable towards the primary tumour with a duration of under sex months. Metastases in CNS and liver confer an undesirable outcome. Small cell carcinomas use a poorer prognosis since metastases develop early. Within the majority of patients only palliative therapy is possible. Five year survival figures for squamous cell carcinoma change from 40-50% for stage I to lower than 10% for stages III and above.
Bronchogenic carcinoma reaches least partially preventable by avoidance of smoking. The chance of cancer comes down quantitatively with the decrease in the quantity of cigarettes smoked and in those who stop smoking completely the increased risk cancer comes down over the years of about 10 years to succeed in that in nonsmokers. Occupational contact with asbestos, environmental pollutants and radioactive materials ought to be reduced to the minimum and personnel engaged in these industries should receive personal protection.