Download Etiology

Bronchogenic Carcinoma
(Lung Cancer)
Respiratory department
Definition
Bronchogenic
carcinoma refers
to the malignant tumor which
grows in the bronchus.
Originating from mucus or
gland of bronchus.
Incidence and mortality

Bronchogenic carcinoma has increased
remarkable in incidence and mortality
during half of the century and has become
the most frequent visceral malignant
diseases of men.The mortality of lung
cancer hold the first place among all kinds
carcinomas.
Etiology

The cause of lung cancer is unknown.It is believed
that there are following related factors.

1. Excessive cigarette smoking:Smoking
index(Brinkman Index) is equal to cigarettes per
day smoking time(years).

Passive smoking is also a carcinogen factor.
Etiology

2.Atmospheric pollution.It was found that
carcinogenic factor is benzpyrene .

3.Occupational factors.

4Radioactivity in the atmosphere .

5.Diets and Nutrition.

6.Chronic irritation.

7.Genetic factors.
Pathology And Classification

1. According to the position of tumor arising
from ,it can be divided into two types .

Central type:Tumor arises from main
bronchus, lobar and segmental bronchus .
Peripheral type : Tumor arises beyond
segmental bronchus .
Pathology And
Classification

2.According to cytology,it is convenient to
classify into four kinds of types.
 (1).Squamous cell carcinoma.
 (2).Small cell anaplastic carcinoma.
 (3).Large cell anaplastic carcinoma.
 (4).Adenocarcinoma(including alveolar
cell carcinoma).
Pathology And
Classification
 According
to the different principles
of management,it is divided into two
types.
 SCLC:small
cell lung carcinoma.
 NSCLC:non
small cell lung carcinoma.
Clinical features

There are no symptoms of early lung
cancer in some patients.
 Symptoms caused by lung cancer are nonspecific:perhaps an audible wheeze or a
slight cough,symptoms of infection
(fever ,purulent sputum) , of obstruction
(wheezing,dyspnea), or ulceration of
bronchial mucosa (hemoptysis).
Clinical features

1.Respiratory symptoms.

(1).Cough:
 (2).Hemoptysis:
 (3).Dyspnea.:

(4).Wheeze or stridor:

(5).Chest pain :

(6).Fever:
Clinical features
 2.Symptoms
caused by the near
organs or tissue involved by tumor.

(1).Dysphagia.

(2).Hoarseness.

(3).Pleural effusion due to invasion of the
pleura.
Clinical Features

(4).Horner’s syndrome.It is caused by
invading the cervical sympathetic ganglia
on the involved side the pupil is small ptosis
of the up eyelids,retraction of the eyeball
and no sweat of the face.

(5)Cardiac effusion
Clinical fetures

(6).Superior vena caval syndrome. Due to
obstruction of the superior vena caval,the
patient may have noticed that his collar is
tight, the neck is enlarged and the jugular
vein and the veins of anterior chest wall are
distension and edema of the face.
 3.Symptoms caused by metastasis.liver,
skeleton,brain, supra clavicle lymph nodes.
Clinical fetures

4.Paraneoplastic syndrome.Because tumor cell
can secrete ectopic hormone，antigen or
enzyme the patients with Lung Cancer
sometimes may have some paraneoplastic
syndrome Including:
 (1) Collagen tissue disorder such as finger
clubbing , hypertrophic pulmonray
osteoarthropathy 。
Clinical features

(2)Endocrine disorders including Cushing’s
syndrome ,syndrome of inappropriate
antiduretic hormone secretion(SIADHS),

(3) Neuropathic or myopathic disorders
including polyneuritis ,cerebellar
degeneration,mental abnormalitis etc

(4) others.
Radiographic Findings

The appearance on the x-ray film depends
on the position ,size and stage of the tumor
1.Peripheral type :It may be various such
as infiltrative or nodular, lobulated or
umbilicus sign,liner protrusions from the
shadow into the surrounding lung,
cavitation which is often eccentric
irregular in the inner wall owing to the
necrosis of the neoplasm.
Radiographic Findings

2 Central type
 (1) Direct appearance :Unilateral
enlargement of the hilar shadow due to
the tumor itself or enlarged lymph nodes.
 (2) Indirect appearance :Including local
emphysema;obstructive pneumonia
either lobal or segmental; obstractive
atalectasis (collapse) lobe or segment.
Advantage of CT:

(1) Some small lesion, lesion behind of
cardiac or blood vessel,and pathology
located in apical of lung can be found by
CT which can’t be found by chest x-ray.

(2) Lymph nodes along hilar or
mediastina can be found by CT.
Fig1 Atelectasis,Right upper lobe
Fig3
Mass With Fuzzy,Right Upper LObe
Fig4 Mass In right
Lobe,Lateral portion
Fig5 Cavitating Bronchial Carcinoma
Examination of sputum

Cytologic examination of bronchial
secretions(or sputum)may reveal exfoliated
malignant cells recognizable to the
pathologist who is specially trained for such
work.The sputum must to be fresh, send on
time, repeat(4-6 times)..
Bronchoscope

Bronchoscope may verify the existence of
tumor , of Central type, and cytologic
diagnosis of lung cancer should be obtained
though FBC

.Blind biopsy may be help to the diagnosis
of the tumor beyond the range of
bronchoscope vision
Fig 1 Normal Trachea
Fig 2 Normal Carina
Fig 3 Squamous Cell
Carcinoma, Trachea
Fig 4 Adenocarcinoma
Left Lingular Bronchus
Fig 5 Adenocarcinoma
Right Truncal Intermedus
Fig 6 Extrinsic Pressure
Trachea
Lung Biopsy

1.Biopsy with fiberoptic bronchoscope;
2.Transthoracic neddle biopsy with CT
directed or B type ultrasonic;
 3.Biopsy with thoracoscopy ;
 4.Biopsy with medistinoscopy;
 5.Exploratory thoracotomy.
Diagnosis

1.Symptom -free: General investigation of high
risk group (male,morn than 40 years old,cigarette
consumption 20/per day). Taking a x-ray film and
examining sputum for cancer cell every half year

Early stage of the bronchogenic carcinoma
Refers to the tumor is still located at the
bronchus ,no invade the hilar lymph nodes,pleura
as well as distant metastases,its diameter is often
<3cm.
Diagnosis
 Diagnosis

procedure:
1. X-ray film(-) and sputum for cytology (-) 
FBC(-) follow up once a month /year.

2. X-ray film(+) and sputum for cytology (+) 
FBC to identify the cancer cell type  CT , MRI
 therapy.
Diagnosis
 Diagnosis

procedure:
3. X-ray film(-) and sputum for cytology (+)
ruling out the tumor of upper respiratory tract
first FBC.

4 X-ray film(+) and sputum for cytology (-)
FBC(-) lung biopsy.
Differential diagnosis

1.Solitary nodule: Tuberculoma, Benign
Tumor

2.Cavitation:Lung Abscess, Tuberculosis,

3. Enlargement of hilar shadow:
Hamartoma

4.Others: Pleural Effusion,Widening Of
Mediatinal.
Treatment






1.Rresection by operation ;
2.Radiotherapy ;
3.Chemotherapy;
4.Immunotherapy ;
5.Traditional Chinese medicine therapy etc.
The therapeutic principle of lung cancer is
comprehensive: rescect the tumor as far as
possible then combine with other treatments ; other
treatments first then operation depending on the
cytologic type, position,size and stage of the tumor.
Treatment
 SCLC:
Ⅰ Chemotherapy , operation.

Ⅱ Chemotherapy,radiotherapy.
 NSCLC:
 Ⅰ Operation.
 Ⅱ Most :operation→chemotherapy

Small parts: radiotherapy.

Treatment
 Ⅲ:

Operation + chemotherapy;
radiotherapy +chemotherapy.
 Ⅳ:
chemotherapy+ radiotherapy(relieve
some symptoms,such as pain, dyspnea,
obstruction etc).