Lung tumours

Carcinoma of the bronchus

• Accounts for 20% of all cancers and 27% of all cancer deaths

Risks

• Cigarette smoking
• Asbestos
• Chromium
• Arsenic
• Iron oxides
• Radiation

Histology

• 30% squamous
• 30% adenocarcinoma
• 25% small cell
• 15% large cell
• Alveolar carcinoma – very rare 1%

Symptoms

• Cough, haemoptysis, dyspnoea, chest pain, recurrent or slowly resolving pneumonia, anorexia, weight loss

Signs

• Cachexia, anaemia, clubbing, HPOA (Hypertrophic pulmonary osteoarthropathy causing wrist pain), supraclavicular or axillary LN
• Chest signs – none or consolidation, collapse, pleural effusion
• Metastases – bone tenderness, hepatomegal, confusion/fits, cerebellar syndrome, proximal myopathy, peripheral neuropathy

Complications

• Local
  • Recurrent laryngeal nerve palsy
  • Phrenic nerve palsy
  • SVC obstruction
  • Horner’s syndrome (Pancoast tumour)
  • Rib erosion
  • Pericarditis
  • AF
• Metastatic;
  • Brain
  • Bone – pain, anaemia, raised Ca+
  • Liver
  • Adrenals (Addison’s)
  • Endocrine
  • Ectopic hormone secretion – SIADH, ACTH by SCC, PTH by Squamous carcinomas
• Non-metastatic neurological
  • Confusion
  • Fits
  • Cerebellar syndrome
  • Proximal myopathy
  • Neuropathy
  • Polymyositis
  • Eaton-Lambert syndrome
• Other;
  • Clubbing
  • HPOA
  • Dermatomyositis
  • Acanthosis nigricans
  • Thrombophlebitis migrans

Tests

• Cytology
• CXR – peripheral circular opacity, hilar enlargement, consolidation, lung collapse, pleural effusion, bony secondaries
• FNA or biopsy of peripheral lesions or superficial LN
• Bronchoscopy – histology and assess operability
• CT/PET – staging

Treatment

• Non-small cell tumours
  • Excision for peripheral tumours with no metastatic spread
  • Curative radiotherapy is an alternative
  • Chemotherapy and radiotherapy for more advanced disease
• Small cell tumours
  • Chemotherapy
• Palliation – radiotherapy, SVC stent, endobronchial therapy, pleural drainage, pleurodesis

Prognosis

• Non-small cell – 50% 2 year survival without spread
• Small cell – 3 mth survival with no treatment, 1yr if treated

Other lung tumours;

• Bronchial adenoma – rare slow growing, 90% are carcinoid tumours
• Hamartoma – rare benign, on CT looks like a lobulated mass with flecks of calcium
• Mesothelioma

DDX for coin lesions on a CXR;

• Malignancy                               ?   Abscesses

• Granuloma                                ?   Carcinoid tumour
• Pulmonary hamartoma ?   AVM
• Cyst                                         ?   Foreign body
• Skin tumour – seborhoeic wart