bronchogenic carcinoma
 | Bronchiogenic carcinoma should be considered within the proper diagnosis of all respiratory disorders. Malignancy can mimic almost all common pulmonary diseases such as tuberculosis, Pneumonia, Lung abscess, atelectasis, localized emphysema, Pleural effusion etc. Just how will we offer 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 within an symptomatic patient will be the only finding. The classical circular shadow is called lesion. In additional 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 and also a hilar mass should highly recommend the potential for bronchogenic carcinoma. Other functions like collapse, consolidation, localized emphysema, and pleural and pericardial effusion can also be present. Special procedures for example tomography, selective pulmonary angiography, isotope scan may help further. Just one peripherally placed "coin shadow" within the lung could be caused by primary or secondary neoplasms, tuberculosis, fungal infections or old scars. bronchogenic carcinoma Sputum examination: Hemoptysis exists oftentimes as well as the sputum is usually described as "currant jelly". Malignant cells might be detected within 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 in the neck and axilla and scalene fat pad biopsy. The proper scalene node should be biosied within the of lesions of 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 can be a more rewarding procedure. When a solitary pulmonary nodule (coin shadow) is detected and diagnosis isn't evident, the patient ought to be accompanied to determine the progress from the lesion. Generally, malignant lesions have a doubling period of 5 weeks to Eighteen months. Faster growth is an indication of inflammatory lesions. Calcification is within favor of non-malignant lesions though this is not always true. When there is strong suspicion of malignancy, diagnostic thoracotomy is indicated. Treatment Management is dependent upon the stage with the tumor on diagnosis, histological type and presence of complications. Treatment may contain surgery, irradiation and chemotherapy. Surgery When the primary is small and is detected before clinical manifestations develop and there aren't any metastases, surgical procedures are ideal. Contraindications to surgery include infiltration with the trachea, carina, superior vena cava, recurrent laryngeal nerve paralysis and pleural effusion. Existence of mediastinal nodes and distant metastases are contraindications to surgery. Surgical answers are less satisfactory in those cases who've developed symptoms. Radiotherapy Radical radiotherapy is preferred in selected cases. In practices, inside the most of cases radiotherapy is given like a palliative measure in inoperable cases with local spread or distant metastases. Several recent advances in radiotherapy techniques such as split dose radiotherapy, usage of radio-sensitizers, and the availability of modern radiation equipment like linear accelerator, betatron, neutron beams and meson beams have made radiotherapy far better with less hazards. In some centers, radiotherapy is also used prophylactically towards the brain to prevent the introduction of metastases. Chemotherapy It really is suggested for 90% of patients with bronchogenic carcinoma. A choice of drugs is dependant on the tumour histology, facilities for supportive therapy, and tolerance by the patient. Chemotherapy works extremely well since 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. Prognosis Because most with the cases are diagnosed late within 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 to the primary tumour with a time period of lower than sex months. Metastases in CNS and liver confer a poor outcome. Small cell carcinomas possess a poorer prognosis since metastases develop early. Inside the most of patients only palliative therapy is possible. Five 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 are at least partially preventable by avoidance of smoking. The potential risk of cancer passes down quantitatively with all the decrease in the number of cigarettes smoked plus those that quit smoking completely the improved risk cancer passes down after a period of about 10 years to succeed in that in nonsmokers. Occupational exposure to asbestos, environmental pollutants and radioactive materials needs to be reduced towards the minimum and personnel engaged in these industries should receive personal protection. |
