Question

Chief Complaint: 68-year-old man with a cough and dyspnea ("shortness of breath") for the past week.

History: Daniel McDonald, a 68-year-old white male with a 40-pack-year smoking history suffered from chronic bronchitis for which he had been on antibiotics for several months. Two weeks ago, he began coughing up a bloody sputum ("hemoptysis"). In the past week he's become increasingly short of breath. A routine chest X-ray revealed two silver dollar-sized opacities on the right side of the carina. Bronchoscopic examination revealed a tumor that was nearly occluding the right mainstem bronchus. A bronchial biopsy revealed the diagnosis: bronchogenic carcinoma.

Explain why this man has bloody sputum ("hemoptysis").

Explain why this man has shortness of breath ("dyspnea").

If you examined the cancerous tissue under the microscope, how might the cells differ in appearance from normal bronchial epithelium?

How might this type of cancer metastasize (i.e. spread to other parts of the body)? In other words, by which routes might the cancer cells reach other organs?

Why is the surgical removal of a lung cancer so ineffective in halting the disease?

Answer 1

Bronchogenic carcinoma is the most common malignant tumour of lung .
Bronchogenic means genesis or arising from Bronchus

Answer 1) Bronchial artery supply the blood to Lungs .In bronchogenic carcinoma if the growth is central or endobronchial ( around bronchus )then the blood vessels get erroded by tumour cells and this result in rupture of blood vessels and Haemoptysis ( Blood in Sputum )

Answer 2 )Regional spread of tumor in the thorax (by contiguous growth or by metastasis to regional lymph nodes) may cause tracheal obstruction and result in shortness of breath( Dyspnea) .Endobronchial growth of tumour cause bronchial obstruction ans Dyspnea .

Answer 3) Bronchogenic cancer differs from Normal bronchus in such atypical cells are seen ,increased mitosis seen,Nucleuscytoplasmic reversal seen .

Bronchogenic cancer have many variants in histolgy specimen
1) Squamous cell carcinoma --->Presence of Keratin .It is P40 and P63 positive .

2) Adenocarcinoma ---> made up of Mucin glands .On immunohistochemistry ( IHC) --> Thyroid transcription factor positive

3) Small cell carcinoma --->Neurosecretory granules seen .Salt and Pepper chromatin ,Basophilic stain ( Azzo Pardi effect ) Diagnostic on IHC is Chromogranin positive .

4) Large cell crcinoma
5 ) Mixed

Answer 4)
Cancer cells spread through
1) Direct spread ---> Invades Pleura ,Chest wall etc

2) Lymphatic spread --->Reaches mediastinal group of lymph nodes compressing trachea ,Bronchus ,esophagus and Phrenic nerve
Trachea and Bronchus compresion ---> Dyspnea
Oesophagus ----> Dysphagea

3) Haematogenous ----> It reaches through blood to Liver ,Bone and Brain

Answer 5) Bronchogenic cancer is highly aggressive disease characterized by its rapid doubling time, high growth fraction, early disseminated disease, and dramatic response to first-line chemotherapy and radiation. In general, surgical resection is not routinely recommended for patients because Pateints already have occult at the time of Surgery .
Hence surgical removal is ineffective in halting the disease .