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1 A 55-year-old construction worker has smoked 2 packs of ciggarettes daily for the past 25 years. He notes swelling in his upper extremity & face, along with dilated veins in this region. What is the most likely cause of the obstruction? A. Aortic aneurysm B. Metastasis C. Bronchogenic carcinoma D. Chronic fibrosing mediastinitis E. Granulomatous disease Answer: C

Answer: Csurgeonshamim.com/lecture pdf/Bronchogenic carcinoma.pdf · 19 TNM staging Primary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor

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Page 1: Answer: Csurgeonshamim.com/lecture pdf/Bronchogenic carcinoma.pdf · 19 TNM staging Primary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor

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A 55-year-old construction worker has smoked2 packs of ciggarettes daily for the past 25years. He notes swelling in his upper extremity& face, along with dilated veins in this region.What is the most likely cause of theobstruction?

A. Aortic aneurysmB. MetastasisC. Bronchogenic carcinomaD. Chronic fibrosing mediastinitisE. Granulomatous disease

Answer: C

Page 2: Answer: Csurgeonshamim.com/lecture pdf/Bronchogenic carcinoma.pdf · 19 TNM staging Primary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor

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BronchogenicCarcinoma

Dr. Muhammad ShamimAssistant Professor, BMU

Page 3: Answer: Csurgeonshamim.com/lecture pdf/Bronchogenic carcinoma.pdf · 19 TNM staging Primary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor

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Introduction

Most common malignancy in men & thesecond most common in women.

There is only a 20% 1-year survival for allcases after diagnosis.

Surgery represents the best chance ofprolonged survival.

Page 4: Answer: Csurgeonshamim.com/lecture pdf/Bronchogenic carcinoma.pdf · 19 TNM staging Primary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor

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Etiology

Cigarette smoking. Atmospheric pollution. Certain occupations radioactive ore chromium mining

Page 5: Answer: Csurgeonshamim.com/lecture pdf/Bronchogenic carcinoma.pdf · 19 TNM staging Primary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor

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Pathology

Many tumors have more than one celltype.

Behavior and prognosis depend largely onthe dominant cell type.

Page 6: Answer: Csurgeonshamim.com/lecture pdf/Bronchogenic carcinoma.pdf · 19 TNM staging Primary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor

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Squamous cell carcinoma (60%)

Common in smokers. Tends to be centrally placed. There is a tendency to cavitate and

metastasise outside the thoracic cavity.

Page 7: Answer: Csurgeonshamim.com/lecture pdf/Bronchogenic carcinoma.pdf · 19 TNM staging Primary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor

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Adenocarcinoma (15%)

More common in females &nonsmokers.

Tends to be sited in the peripheryof the lung.

Often metastasise widely to theliver, brain & adrenals.

It is important to excludesecondary adenocarcinoma fromother sites such as colon, breast& ovary.

Page 8: Answer: Csurgeonshamim.com/lecture pdf/Bronchogenic carcinoma.pdf · 19 TNM staging Primary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor

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Small cell carcinoma

Metastasises widely early in its course. Often associated with ectopic hormone

production & paraneoplastic syndromes.

Page 9: Answer: Csurgeonshamim.com/lecture pdf/Bronchogenic carcinoma.pdf · 19 TNM staging Primary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor

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Alveolar cell carcinoma

Arises in the distal airways.

Page 10: Answer: Csurgeonshamim.com/lecture pdf/Bronchogenic carcinoma.pdf · 19 TNM staging Primary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor

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At the age of 46, an accountant has developedhoarseness due to an inoperable cancer of theleft upper lung lobe. He has smoked heavilysince the age of 14. Which of the followingfeatures of cancer of lung indicates distantspread?

A. HypercalcemiaB. Cushing-like syndromeC. GynecomastiaD. Syndrome of inappropriate secretion of antidiuretic

hormone (SIADH)E. Brachial plexus lesion (Pancoast syndrome)

Answer: E

Page 11: Answer: Csurgeonshamim.com/lecture pdf/Bronchogenic carcinoma.pdf · 19 TNM staging Primary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor

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Clinical featuresPrimary may causes the followings: Persistent cough. Weight loss. Dyspnea. Nonspecific chest pain. Hemoptysis. Clubbing & hypertrophic pulmonary

osteoarthropathy.

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Features of locally advanced &metastatic disease

Severe localized pain. Pancoast’s syndrome. Hemothorax. Hoarseness of voice. Dysphagia. Superior vena caval obstruction. Paraneoplastic syndromes. Hepatomegaly

Page 13: Answer: Csurgeonshamim.com/lecture pdf/Bronchogenic carcinoma.pdf · 19 TNM staging Primary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor

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An asymptomatic 56-year-old man is found onroutine chest x-ray to have a 2-cm nodule-central tumor in the upper lobe of the right lung.The lesion is not calcified. What is the mostappropriate initial step toward making adiagnosis?

A. Fibreoptic bronchoscopyB. Bone scanC. ThoracotomyD. Observation at follow-up examination in 6 monthsE. Mediastinoscopy

Answer: A

Page 14: Answer: Csurgeonshamim.com/lecture pdf/Bronchogenic carcinoma.pdf · 19 TNM staging Primary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor

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Diagnostic investigations Chest radiography

Pleural effusion, lobarcollapse, raisedhemidiaphragm.

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Computerisedtomography (CT)Shows the tumor &its extensions,mediastinal lymphnodes, & hepaticmetastasis.

Sputum cytology

Page 16: Answer: Csurgeonshamim.com/lecture pdf/Bronchogenic carcinoma.pdf · 19 TNM staging Primary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor

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Bronchoscopy

Flexible or rigidbronchoscopy.

Biopsy is hazardous in: bleeding disorders systemic anticoagulation pulmonary hypertension

Complications include Bleeding Pneumothorax Laryngospasm arrhythmia.

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Other biopsy techniques

Percutaneous needle biopsy underradiological control.

Mediastinoscopy or mediastinotomy Advisable on all patients who have

enlarged mediastinal lymph nodes (>1 cm)on CT.

Thoracoscopy & biopsy Open lung biopsy

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TNM stagingPrimary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor Tis Carcinoma in situ T1 Tumor upto 3 cm, within visceral pleura & distal

to lobar bronchus. T2 Tumor >3 cm or invading visceral pleura, or within

lobar bronchus but 2 cm distal to carina. T3 Any size, with extension to chest wall, or within main

bronchus within 2 cm of carina. T4 Any size, involving mediastinum or its contents,

vertebral body or carina or malignant pleural effusion.

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Nodes (N) N0 N1 Peribronchial or ipsilateral hilar nodes, or both. N2 Ipsilateral mediastinal & subcarinal nodes. N3 Contralateral mediastinal or hilar, ipsilateral or

contralateral scalene or supraclavicular nodes.Distant metastasis (M) M0 M1

Page 21: Answer: Csurgeonshamim.com/lecture pdf/Bronchogenic carcinoma.pdf · 19 TNM staging Primary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor

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After undergoing a percutaneous needlebiopsy, a 49-year-old electrical engineer isfound to have small cell carcinoma. Chest x-rayshows a lesion in the peripheral part of the rightmiddle lobe. The patient should be advised toundergo which of the following?

A. Right lobectomyB. Right pneumonectomyC. Excision of lesion & postoperative radiotherapyD. Combination chemotherapyE. Radiotherapy

Answer: D

Page 22: Answer: Csurgeonshamim.com/lecture pdf/Bronchogenic carcinoma.pdf · 19 TNM staging Primary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor

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Treatment Tumours graded T2, N1, M0 or less have a better

prognosis when treated surgically.

Page 23: Answer: Csurgeonshamim.com/lecture pdf/Bronchogenic carcinoma.pdf · 19 TNM staging Primary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor

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Surgical management

Principle of surgery is to remove all cancer(the primary and the regional lymph nodes)but to conserve as much lung as possible:

1. Lobectomy2. Segmentectomy or simple wedge excision.3. Pneumonectomy. This procedure is reserved for either

centrally placed tumours involving the mainbronchus or those that straddle the fissure.

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Page 25: Answer: Csurgeonshamim.com/lecture pdf/Bronchogenic carcinoma.pdf · 19 TNM staging Primary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor

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Thoracoscopic lungresection Lung biopsy &

treatment ofrecurrentpneumothorax arethe most frequentindications.

Pneumonectomy,lobectomy &empyema drainageare all possible.

Page 26: Answer: Csurgeonshamim.com/lecture pdf/Bronchogenic carcinoma.pdf · 19 TNM staging Primary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor

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Complications of lung resection

Bleeding. Respiratory infection. Persistent air leak. Bronchopleural fistula. Hypoxaemia.

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Page 28: Answer: Csurgeonshamim.com/lecture pdf/Bronchogenic carcinoma.pdf · 19 TNM staging Primary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor

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Other treatment modality

Radiotherapy Chemotherapy

Page 29: Answer: Csurgeonshamim.com/lecture pdf/Bronchogenic carcinoma.pdf · 19 TNM staging Primary tumor (T) TX Tumor proven by cytology but not visualized. T0 No evidence of primary tumor

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Survival The 5-year survival rate is less than 2%

if no treatment is offered at the time of diagnosis andipsilateral lymph nodes are involved.

15-30% 5-year survival Those with mediastinal lymph nodes discovered and

removed at thoracotomy.

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Thank you!