Bronchogenic Ca
Bronchogenic Ca
Bronchogenic Ca
SCC
Small cell carcinoma previously known as oat cell carcinoma has the greatest
association with paraneoplastic syndromes. It is very aggressive with a fast
progression. However it is very much chemo sensitive but has a high recurrence
DR R Kanyongo Dept of Cardiothoracic and Vascular Surgery 2015 Page 1
rate. Because of its aggressive nature SCC is usually staged into stages; extensive
disease and limited disease.
Neuroendocrine cells
1. Atypical carcinoid
2. Typical carcinoid
3. Neuroendocrine large cell carcinoma
4. Neuroendocrine small cell carcinoma
Risk factors
Smoking
Asbestos
Occupational exposure to radon, polycyclic aromatic hydrocarbons in dyes
Arsenic
Radiation
Nickel
Chromates
TB scarring
Pathophysiology
Clinical presentation
Cough
Hemoptysis
Chest pain
Dyspnea
Weight loss
Metastatic effects
1. Pancoast tumor; apical lung tumour invading the cervical sympathetic
ganglia causing Horner’s syndrome. Pancoast syndrome occurs when there is
Horner’s syndrome plus invasion of the lower roots of the brachial plexus
Neuroendrocrine symptoms
1. Cushing syndrome
2. Syndrome of inappropriate ADH secretion
3. Hypercalcaemia (secretion of Parathormone like hormone)
4. Hyperglycaemia
5. Hypercalcinotanaemia
6. Hyperthyroidism
7. Carcinoid syndrome
Investigations.
1.CXR ( after FBC and U+E)
2. Bronchoscopy and biopsy/ bronchoalveolar lavage with bronchial Washings for
cytology
3. CT scan chest Abdomen and pelvis ( brain in suspected mets)
Staging
Tx Malignant cells in bronchial secretions, no other evidence of tumour
Tis carcinoma in situ
T0 None evident
T1 <3cm
T2 3cm -7cm tumor or any tumor which is >2cm distal from carina/ any tumor
size with visceral pleural involvement , partial atelectasis from tumor
T3 tumor >7cm tumor involving the chest wall. Tumor less than 2cm from carina
T4 tumor invading heart, aorta and esophagus and other mediastinal structures
presence of malignant pleural effusion
No no nodal involvement
N1 peribrochial nodes ipsilateral hilar nodes
N2 contralateral hila ipsilateral mediastinal and subcarinal lymph nodes
N3 contralateral mediastinal nodes, scalene and supraclavicular nodes
From the TNM classification Bronchogenic cancer can be staged from Stage I -IV
Management will thus depend on the stage of the tumor
* read on the various stages for interest *
In general there is good outcome for surgery for stage I upto stage II b. however
surgery can be performed for tumors upto stage IIIb. Surgery is either a lobectomy
or a pneumectomy. However the cardiopulmonary reserve has to be assessed before
undertaking these operations to assess whether or not a patient will be able to
withstand surgery. Surgery remains the mainstay in treatment of lung cancers.
Radiotherapy can be offered to patients who can not withstand surgery. For
advanced disease chemotherapy is offered.
Prognosis
Overall, the prognosis for lung cancer is poor. The estimated overall 5-year survival
rate for all of the patients with lung cancer is about 16 percent; however, patients
with resected pathologic early stage lung cancer can achieve a 5-year survival rate
of 70 to 80 percent. The type and pathologic stage of lung cancer is the best
predictor for prognosis