Bronchogenic carcinoma

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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104 Bronchogenic carcinoma

Instruction

Examine this patient’s chest.

Salient features

History

• Symptoms related to primary tumour: cough, dyspnoea, haemoptysis, postobstructive pneumonia)

• Symptoms related to mediastinal spread:

• Hoarseness with left-sided lesions (caused by recurrent laryngeal nerve palsy)
• Obstructive of the superior vena cava with right-sided tumours or associated lymphadenopathy
• Elevation of the hemidiaphragm from phrenic nerve paralysis
• Dysphagia from oesophageal obstruction and pericardial tamponade.

• Symptoms related to metastases:

• Sites include liver, brain, pleural cavity, bone, adrenal glands, contralateral lungs and skin
• Initial presentation with symptoms from a metastatic focus is particularly common with adenocarcinoma.

• Paraneoplastic syndrome:

• Pain or arm in legs caused by hypertrophic osteoarthropathy
• Symptoms of hypercalcaemia caused by squamous cell carcinoma
• Neurological syndromes.

• Systemic effects: anorexia, weight loss, weakness and profound fatigue.

• History of smoking

Examination

Patient 1

• Clubbing and tar staining the fingers

• Dull percussion note at the apex with absent breath sounds.

Look for Horner syndrome and wasting of the small muscles of the hand.

Patient 2

• Signs of pleural effusion on one side.

Patient 3

• Signs of unilateral collapse or consolidation of the upper lobe on one side.

Note: If you suspect bronchogenic carcinoma, always look for clubbing, tar staining, cervical lymph nodes and radiation marks, and comment on cachexia.

Diagnosis

This patient with marked clubbing and large pleural effusion (lesion) probably has bronchogenic carcinoma (aetiology) and is very short of breath because of the large effusion (functional status).

Questions

How may patients with bronchogenic carcinoma present?

• Cough (in 80%), haemoptysis (70%) and dyspnoea (60%); loss of weight, anorexia

• Skeletal manifestations: clubbing (in 30%)

• Local pressure effects: recurrent laryngeal palsy, superior vena caval obstruction, Horner syndrome

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