Bronchial Carcinoma

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• most common malignancy in western countries

Types

• Squamous cell
  • 30%
  • slow-growing
  • metastasises late
  • clubbing
  • HPOA
  • hypercalcaemia
• Small cell
  • 20%
  • fast growing
  • metastasises usually present at diagnosis
  • SIADH / ectopic ACTH
• Adenocarcinoma
  • 40%
  • larger proportion of non-smokers tumours

Risk Factors

• asbestos
• passive smoking
• radon gas
• tuberculosis
• chronic obstructive pulmonary disease
• air pollution
• coal tar fumes
• nickel
• chromium
• iron oxide
• arsenic
• previous lung cancer

Presentations

• Local symptoms
  • worsening cough
  • haemoptysis
  • chest pain
  • breathlessness
  • pneumonia
• Local Invasion
  • hoarse voice
  • stridor
  • Pancoast tumour
    • invasion of C8/T1
• Metastatic
  • back pain
  • bony pain
  • headache
• Non-metastatic
  • thirst
  • Polyuria
  • leg weakness
  • sensory disturbance
  • lethargy

Past Medical History

• Chronic Obstructive Airways Disease
• TB
• pulmonary fibrosis
  • associated with adenocarcinoma

ROS

• looking for mets & non-metastatic complications
• complications of treatment

SH

• smoking habit
  • inc. passive
• occupational exposure
  • asbestos
  • chromium
  • nickel

Examination

• General
  • cachetic
  • breathless
  • muscle wasting
• Hands
  • tar stains
  • clubbing
• Neck
  • lymphadenopathy
• Face
  • Horner's syndrome
  • Hoarse voice
  • SVC obstruction
• Respiratory
  • pleural effusion
  • lobar collapse
  • consolidation
  • radiotherapy marks
  • operation scars
• Abdominal
  • hepatomegaly
  • ascites
• CNS
  • papilloedema
  • myopathy
• Other
  • hypercalcaemia
  • hyponatraemia
  • ectopic ACTH
  • hypertrophic pulmonary osteoarthropathy (3%)
  • polymyositis
  • dermatomyositis
  • Lambert-Eaton myasthenic syndrome
  • thrombophlebitis migrans
  • acanthosis nigricans
  • dementia

Investigations

• FBC
• LFTs
• Calcium
• Sodium
• CXR
• Sputum cytology
• Bronchoscopy / Pleural aspiration / Pleural biopsy
• Pulmonary function Tests
• CT thorax
• Finding mets
  • USS abdomen
  • bone scan
  • CT brain

Management options

• surgery
  • 20% suitable
• radiotherapy
  • best in squamous cell carcinoma
  • 'operable' tumour not resected
  • palliation
    • pain
    • haemoptysis
    • severe dyspnoea
• chemotherapy
  • small cell carcinoma only
• palliative care
• psychosocial support

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