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

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TUMOURS

CASE SCENARIO

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

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CHEST PAIN WITH ASSOCIATED BREATHLESSNESS ON EXERTION. HE HAS THE

ABOVE SYMPTOMS SINCE LAST 6 MONTHS

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vHE ALSO COMPLAINS OF FEVER MODERATE GRADE WITH CHILLS SINCE PAST

7 DAYS

vON FURTHER QUERY HE REVEALS HAVING ONE EPISODE OF BOUTS OF

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BLOOD STREAKED SPUTUM AROUND 1 YEAR BACK, WHICH RESOLVED ON

SOME LOCAL MEDICATIONS AND PATIENT DID NOT CONSULT FOR THAT ANY

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FURTHER


FURTHER .....

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vOCCUPATION: FARMER

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

PAST AND CONTACT HISTORY

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vFAMILY HISTORY IS NON CONTRIBUTORY

vSMOKING: 10 CIGARETTE/ DAY SINCE 30 YEARS
? PACK YEARS: ?

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? SMOKING INDEX: ?
EXAMINATION

GENERAL

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SYSTEMIC

?PALLOR: PRESENT

RESPIRATORY

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?ICTERUS: ABSENT

DIMINISHED RIGHT SIDE BREATH

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SOUNDS ON AUSCULTATION WITH

?CYNOSIS: ABSENT

STONY DULLNESS ON PERCUSSION

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?LYMPHADENOPATHY: LEFT

CVS

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SUPRACLAVICULAR 1cm

NORMAL

?CLUBBING: PRESENT

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ABDOMEN

?PEDAL EDEMA: ABSENT

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TENDERNESS IN RIGHT

HYPOCHONDRIAC REGION

CNS

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NORMAL

INVESTIGATIONS

vROUTINE BLOOD TESTS: CBC, LFT, KFT

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vCHEST RADIOGRAPH [PA]
vECG
vUSG ABDOMEN

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CXR (PA)

WHAT DO WE SEE ?

MEDIASTINAL SHIFT ?

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RIGHT HILUM ?

RIGHT PLEURAL SPACE ?

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DIFFERENTIAL DIAGNOSIS?

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

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SE
A

PLEURAL SPACE

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ISE

LUNG

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E

D

PARENCHYMA AND

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AIRWAYS


T

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H
H

MEDIASTINUM

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RC
A

OTHER SITES

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PARANEOPLASTIC

SE

SYNDROMES

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INVESTIGATIONS?

?USG THORAX

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?THORACOCENTESIS

FLUID FOR CYTOLOGY

DIAGNOSTIC/ THERAEUTIC

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AND CELL BLOCK

?CT THORAX

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TISSUE FOR HPE AND IHC/

MUTATION ANALYSIS

?BRONCHOSCOPY

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CONVENTIONAL/ EBUS GUIDED TBNA/ RADIAL PROBE TBNA


USG THORAX

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THORACOCENTESIS

PLEURAL FLUID:
LOOK AT:
1. COLOR

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2. TURBIDITY
3. REFILLING
SEND FOR:
1. CYTOLOGY MALIGNANT CELLS
2. CELL COUNT AND DIFFERENTIALS

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3. LDH
4. ADA/ ZN SMEAR
5. BIOCHEMISTRY: PROTEINS AND SUGAR

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CT THORAX

CT THORAX CONTD.

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BRONCHOSCOPY

BRONCHOSCOPY

CONVENTIONAL

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EBUS GUIDED TBNA

RADIAL EBUS

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[ENDOBRONCHIAL/

[CENTRAL AND

TBLB/ CRYOBIOPSY]

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MEDIASTINAL]

[PERIPHERAL]

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WORKUP

METASTASIS

SEARCH

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ABDOMEN

CNS

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THYROID

BONE

FEMALES

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GENITAL

ORGANS

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MALES

PROSTATE
TNM GRADING

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STAGING


WHAT NEXT?

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HISTOPATHOLOGY AND ROLE OF

MUTATION ANALYSIS

IMUNOHISTOCHEMISTRY

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

ADENOCARCINOMA: TTF 1, NAPSIN A

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{SENSITIVITY=80%}

WHY?

SQUAMOUS: p40 {MOST SENSITIVE

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CERTAIN THERAPEUTIC IMPLICATIONS,

AND SPECIFIC}

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LIKE

OTHERS= p 63 AND ck 5/6

? PEMETREXED IS EFFECTIVE FOR

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ADVANCED ADENOCARCINOMA

BEST COMBO= TTF1 AND p40/ p63

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?BEVAIZUMAB IS CONTRAINDICATED IN

SQUAMOUS CELL CARCINOMA

?NIVOLUMAB EFFECTIVE FOR

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ADVANCED SQUAMOUS CELL

CARCINOMA

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MANAGEMENT: GENERAL CONDITION

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TYPES OF LUNG CANCER WHO 2015 CLASSIFICATION

EPITHELIAL

METASTATIC

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MESENCHYMAL

ECTOPIC

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LYMPHOHISTOCYTIC


MEDIASTINAL TUMOURS

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ETIOLOGY AND RISK FACTORS
SIGNS AND SYMPTOMS

vOCCASIONALLY INCIDENTAL FINDING

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vSYMPTOMS DEPEND UPON LOCATION OF TUMOR IN LUNG

vSIGN AND SYMPTOMS ALSO DEPEND UPON SIZE, DEGREE OF

OBSTRUCTION AND METASTASIS

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SIGNS AND SYMPTOMS (CONTD.)

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

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2) GENERALIZED ? INVOLVES OTHER AREAS THROUGHOUT THE

BODY IF THE CANCER HAS SPREAD.

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3) PARANEOPLASTIC SYNDROMES

4) THORACIC ONCOLOGY MEDICAL EMERGENCIES
LOCALIZED SIGNS AND SYMPTOMS

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1. COUGH
2. BREATHING PROBLEMS, SOB, STRIDOR
3. CHANGE IN PHLEGM
4. LUNG INFECTION, HEMOPTYSIS
5. HOARSENESS, HICCUPS

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6. WEIGHT LOSS
7. CHEST PAIN AND TIGHTNESS
8. PANCOAST'S SYNDROME
9. HORNER'S SYNDROME
10. PLEURAL EFFUSION

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11. SUPERIOR VENA CAVA SYNDROME
12. FATIGUE

GENERALIZED SIGNS AND SYMPTOMS

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

FINDINGS

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3. ABDOMINAL PAIN, ELEVATED LIVER FUNCTION TESTS,

ENLARGED LIVER, GASTROINTESTINAL DISTURBANCES

(ANOREXIA, CACHEXIA), JAUNDICE, HEPATOMEGALY

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

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

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6. MASSIVE PLEURAL EFFUSION

THANK YOU