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Clinical Manifestations
Lung cancer gives rise to signs and symptoms caused by local tumor growth, invasion or obstruction of adjacent structures, growth in regional nodes through lymphatic spread, growth in distant metastatic sites after hematogenous dissemination, and remote effects of tumor products ,para neoplastic syndromes
Central or endobronchial growth of the primary tumor may cause cough, hemoptysis, wheeze and stridor, dyspnea, and postobstructive pneumonitis with fever and productive cough. Peripheral growth of the primary tumor may cause pain from pleural or chest wall involvement, dyspnea on a restrictive basis, and symptoms of lung abscess resulting from tumor cavitation.
Regional spread of tumor in the thorax by contiguous growth or by metastasis to regional lymph nodes may cause tracheal obstruction, esophageal compression with dysphagia, recurrent laryngeal nerve paralysis with hoarseness, phrenic nerve paralysis with elevation of the hemidiaphragm and dyspnea, and sympathetic nerve paralysis with Horner's syndrome presenting enophthalmos, ptosis, miosis, and ipsilateral loss of sweating. Other problems of regional spread include superior vena cava syndrome from vascular obstruction; pericardial and cardiac extension with resultant tamponade, arrhythmia, or cardiac failure; lymphatic obstruction with resultant pleural effusion; and lymphangitic spread through the lungs with hypoxemia and dyspnea. In addition, lung cancer can spread trans bronchially, producing tumor growing along multiple alveolar surfaces with impairment of gas exchange, respiratory insufficiency, dyspnea, hypoxemia, and sputum production. Thrombotic disease complicating cancer is usually a poor prognostic sign. Cutaneous manifestations such as dermatomyositis and acanthosis nigricans are uncommon (1%), as are the renal manifestations of nephrotic syndrome or glomerulo nephritis. Diagnosis and Staging. Screening
Most patients with lung cancer present with advanced disease, raising the question of whether screening would detect these tumors at an earlier stage when they are theoretically more curable. The role of screening high-risk patients for example current or former smokers greater than 50 years of age for early stage lung cancers is debated. Establishing a Diagnosis of Lung Cancer
Once signs, symptoms, or screening studies suggest lung cancer, a tissue diagnosis must be established. Tumor tissue can be obtained by a bronchial or transbronchial biopsy during fiberoptic bronchoscopy; by node biopsy during mediastinoscopy; from the operative specimen at the time of definitive surgical resection; by percutaneous biopsy of an enlarged lymph node, soft tissue mass, lytic bone lesion, bone marrow, or pleural lesion; by fine-needle aspiration of thoracic or extrathoracic tumor masses using CT guidance. Investigations:
• Complete history and physical examination
• Determination of performance status and weight loss
• Complete blood count with platelet determination
• Measurement of serum electrolytes, glucose, and calcium; renal and liver function tests
• Electrocardiogram
• Skin test for tuberculosis
• Chest x-ray
• CT scan of chest and abdomen
• CT or MRI scan of brain and radionuclide scan of bone if any finding suggests the presence of tumor metastasis in these organs
• Fiber optic broncho scopy with washings, brushings, and biopsy of suspicious lesions
• X-rays of suspicious bony lesions detected by scan or symptom
• Barium swallow radiographic examination if esophageal symptoms exist
• Pulmonary function
• Biopsy of accessible lesions suspicious for cancer if a histologic diagnosis
Dr Guptha, Director for the dermatology billing services
cardiology billing services
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