Download MBBS Pulmonary Medicine Presentations 1 Approach To A Case of Lung Neoplasm Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Pulmonary Medicine 1 Approach To A Case of Lung Neoplasm PPT-Powerpoint Presentations and lecture notes

APPROACH TO A CASE OF LUNG

NEOPLASM AND MEDIASTINAL

TUMOURS

CASE SCENARIO

vA 55 YEAR OLD MALE PRESENTS IN OPD WITH NON RESOLVING RIGHT SIDE

CHEST PAIN WITH ASSOCIATED BREATHLESSNESS ON EXERTION. HE HAS THE

ABOVE SYMPTOMS SINCE LAST 6 MONTHS

vHE ALSO COMPLAINS OF FEVER MODERATE GRADE WITH CHILLS SINCE PAST

7 DAYS

vON FURTHER QUERY HE REVEALS HAVING ONE EPISODE OF BOUTS OF

BLOOD STREAKED SPUTUM AROUND 1 YEAR BACK, WHICH RESOLVED ON

SOME LOCAL MEDICATIONS AND PATIENT DID NOT CONSULT FOR THAT ANY

FURTHER


FURTHER .....

vOCCUPATION: FARMER

vHE HAS NO OTHER COMORBIDITIES, DENIES HAVING TAKEN ATT IN THE

PAST AND CONTACT HISTORY

vFAMILY HISTORY IS NON CONTRIBUTORY

vSMOKING: 10 CIGARETTE/ DAY SINCE 30 YEARS
? PACK YEARS: ?
? SMOKING INDEX: ?
EXAMINATION

GENERAL

SYSTEMIC

?PALLOR: PRESENT

RESPIRATORY

?ICTERUS: ABSENT

DIMINISHED RIGHT SIDE BREATH

SOUNDS ON AUSCULTATION WITH

?CYNOSIS: ABSENT

STONY DULLNESS ON PERCUSSION

?LYMPHADENOPATHY: LEFT

CVS

SUPRACLAVICULAR 1cm

NORMAL

?CLUBBING: PRESENT

ABDOMEN

?PEDAL EDEMA: ABSENT

TENDERNESS IN RIGHT

HYPOCHONDRIAC REGION

CNS
NORMAL

INVESTIGATIONS

vROUTINE BLOOD TESTS: CBC, LFT, KFT
vCHEST RADIOGRAPH [PA]
vECG
vUSG ABDOMEN


CXR (PA)

WHAT DO WE SEE ?

MEDIASTINAL SHIFT ??

RIGHT HILUM ??

RIGHT PLEURAL SPACE ??

DIFFERENTIAL DIAGNOSIS??

1. RIGHT SIDED PLEURAL EFFUSION
2. RIGHT LUNG COLLAPSE
WHAT NEXT??

SE
A

PLEURAL SPACE

ISE

LUNG

E

D

PARENCHYMA AND

AIRWAYS


T
H
H

MEDIASTINUM

RC
A

OTHER SITES

PARANEOPLASTIC

SE

SYNDROMES

INVESTIGATIONS??

?USG THORAX

?THORACOCENTESIS

FLUID FOR CYTOLOGY

DIAGNOSTIC/ THERAEUTIC

AND CELL BLOCK

?CT THORAX

TISSUE FOR HPE AND IHC/

MUTATION ANALYSIS

?BRONCHOSCOPY
CONVENTIONAL/ EBUS GUIDED TBNA/ RADIAL PROBE TBNA


USG THORAX

THORACOCENTESIS

PLEURAL FLUID:
LOOK AT:
1. COLOR
2. TURBIDITY
3. REFILLING
SEND FOR:
1. CYTOLOGY MALIGNANT CELLS
2. CELL COUNT AND DIFFERENTIALS
3. LDH
4. ADA/ ZN SMEAR
5. BIOCHEMISTRY: PROTEINS AND SUGAR


CT THORAX

CT THORAX CONTD.


BRONCHOSCOPY

BRONCHOSCOPY

CONVENTIONAL

EBUS GUIDED TBNA

RADIAL EBUS

[ENDOBRONCHIAL/

[CENTRAL AND

TBLB/ CRYOBIOPSY]

MEDIASTINAL]

[PERIPHERAL]

WORKUP

METASTASIS

SEARCH

ABDOMEN

CNS

THYROID

BONE

FEMALES

GENITAL

ORGANS

MALES

PROSTATE
TNM GRADING

STAGING


WHAT NEXT??

HISTOPATHOLOGY AND ROLE OF

MUTATION ANALYSIS

IMUNOHISTOCHEMISTRY

EGFR, ALK1, ROS 1, KRAS, PDL 1 ANTIBODY

ADENOCARCINOMA: TTF 1, NAPSIN A

{SENSITIVITY=80%}

WHY??

SQUAMOUS: p40 {MOST SENSITIVE

CERTAIN THERAPEUTIC IMPLICATIONS,

AND SPECIFIC}

LIKE

OTHERS= p 63 AND ck 5/6

? PEMETREXED IS EFFECTIVE FOR

ADVANCED ADENOCARCINOMA

BEST COMBO= TTF1 AND p40/ p63

?BEVAIZUMAB IS CONTRAINDICATED IN

SQUAMOUS CELL CARCINOMA

?NIVOLUMAB EFFECTIVE FOR

ADVANCED SQUAMOUS CELL

CARCINOMA


MANAGEMENT: GENERAL CONDITION



TYPES OF LUNG CANCER WHO 2015 CLASSIFICATION

EPITHELIAL

METASTATIC

MESENCHYMAL

ECTOPIC

LYMPHOHISTOCYTIC


MEDIASTINAL TUMOURS






ETIOLOGY AND RISK FACTORS
SIGNS AND SYMPTOMS

vOCCASIONALLY INCIDENTAL FINDING

vSYMPTOMS DEPEND UPON LOCATION OF TUMOR IN LUNG

vSIGN AND SYMPTOMS ALSO DEPEND UPON SIZE, DEGREE OF

OBSTRUCTION AND METASTASIS

SIGNS AND SYMPTOMS (CONTD.)

THERE ARE 4 TYPES OF SIGNS AND SYMPTOMS OF LUNG CANCER:
1) LOCALIZED ? INVOLVING THE LUNG.

2) GENERALIZED ? INVOLVES OTHER AREAS THROUGHOUT THE

BODY IF THE CANCER HAS SPREAD.

3) PARANEOPLASTIC SYNDROMES

4) THORACIC ONCOLOGY MEDICAL EMERGENCIES
LOCALIZED SIGNS AND SYMPTOMS

1. COUGH
2. BREATHING PROBLEMS, SOB, STRIDOR
3. CHANGE IN PHLEGM
4. LUNG INFECTION, HEMOPTYSIS
5. HOARSENESS, HICCUPS
6. WEIGHT LOSS
7. CHEST PAIN AND TIGHTNESS
8. PANCOAST'S SYNDROME
9. HORNER'S SYNDROME
10. PLEURAL EFFUSION
11. SUPERIOR VENA CAVA SYNDROME
12. FATIGUE

GENERALIZED SIGNS AND SYMPTOMS

1. BONE PAIN
2. HEADACHES, MENTAL STATUS CHANGES OR NEUROLOGIC

FINDINGS

3. ABDOMINAL PAIN, ELEVATED LIVER FUNCTION TESTS,

ENLARGED LIVER, GASTROINTESTINAL DISTURBANCES

(ANOREXIA, CACHEXIA), JAUNDICE, HEPATOMEGALY

4. WEIGHT LOSS
5. ENDOCRINAL , METABOLIC AND VASCULAR CHANGES
THORACIC ONCOLOGY MEDICAL EMERGENCIES

1. SUPERIOR VENA CAVA OBSTRUCTION
2. TUMOR AND PULMONARY EMBOLISM
3. TUMOR LYSIS SYNDROME
4. HYPERCALCEMIA
5. PERICARDIAL TAMPONADE
6. MASSIVE PLEURAL EFFUSION

THANK YOU