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CARCINOMA
Growth rapid
adrenals
Cannon ball tumors
Adenoca. –cannon ball
tumors
Microscopic Classifications
Undifferentiated/ anaplastic carcinoma (20-30%)
Highly aggressive type
1)Oat cell variety is most aggressive amongst these
Central location
Spread-lymphatic, disseminates to surrounding tissue
and vascular spread
2)Large cell (giant cell tumors) (1-10%)
Variant of adenocarcinoma
Aggressive tumor - peripherally located
Lymphatic spread not seen
Classification
3) Small cell carcinoma
Located peripheraly
syndrome.
Microscopic Classifications
Bronchoalveolar/ alveolar cell carcinoma
Arises from alveolar cells or typical clara
cells in the bronchioles
Favorable prognosis compared to other
tumors
Spread
Direct extension- mediastinum, pleura,
pericardium,chest wall
Intrabronchial spread-main bronchus tumors
Lymphatic spread-
hilar- subcarinal-paratracheal-supraclavicular-
inferior deep cervical LN
In lungs-peri bronchial and perivascular
spread
Blood spread- adenocarcinomas, oat cell
,giant cell
Clinical Manifestations
Dyspnea
Hemoptysis
Chest pain
Clinical manifestations
Regional spread to hilar and
mediastinal nodes may cause
Invasion of mediastinum-SVC-congestion
of veins of face
Dysphagia due to esophageal compression,
nerve compression,
Horner’s syndrome due to sympathetic
nerve involvement
Elevation of the hemidiaphragm from
•lobar collapse,
•pleural effusion,
•pneumonitis,
•elevation of the hemidiaphragm,
•hilar and mediastinal adenopathy, and
•erosion of ribs or vertebrae due to metastases.
Lung cancer on CT
CT is the most useful in evaluating patients with
pulmonary and mediastinal masses.
It is also useful for detecting multiple metastases.
distant sites
Stage 2-tumor metastasis to ipsilateral hilar LN
B:Chemotherapy
C:Radiation therapy
D:Other therapy
Immunologic therapy,
Laser
Surgery
Surgical removal of primary tumor is the
treatment of choice
Contraindications of operability
Involvement of main bronchus within 1.5 cm of
carina
Invovement of oesophagus, RLN, SVC, phrenic nerve
Trachea compression
Vocal cord involvement
Distant meatstasis
Unfit for operation, poor respiratory reserve, cardiac
disease
Surgery
Radical resections depending on location
of tumor
Radical lobectomy- confined to one lobe
Radical pneumonectomy- involvement of
main bronchus
Other operations include
Local wedge resection and sleeve
resection in cases of poor respiratory
reserve
Surgery