Bronchogenic Carcinoma

An error report! a mistake because of an information I didn't know , large cell (not adeno- or small cell )carcinomas are particularly may be associated with B-HCG secretion leading to gynaecomastia , I don't know why ? So it's gross memorization I believe!

Just to highlight important points in Bronchogenic carcinomas,

1-   Most common cause of death from cancers with life expectancy rates between less than 5 to 8 years

2-   No screening tests available

3-   In more than 90% of cases,  there is a direct correlation between smoking and bronchogenic carcinomas also exposure to asbestos (shipyards , boilers ,pipes, foundaries )always strggling to remember places  particularly pipes and boilers don’t know why ?!!

4-   4 pathological types

A-   Centrally located:

1-    Squamous cell carcinomas: forming cavitations , and as any cavity associated with Hypecalcemia but this time because it secretes PTH-rP, spreads locally to mediastinum and hilar L.N.

2-    Small cell carcinomas : neuroendocrinal cells , small cell (obviously) , secretes ADH associated with SIADH, so expect decreased serum osmolarity , hypervoelemic hyponatremia and increased urine osmolarity, spreads through blood to liver, bones and brain, also associated with “Lamber-eaton” syndrome

         b- peripherally located :

1-    Large cell carcinomas : peripherally located , cavitations No hypercalcemia , in exchange you find increase B-HCG production , metastasisi :Distant

2-    Adenocarcinomas: they are peripherally located ,feature to distinguish they aren’t commonly associated with smoking , they are directly related to Asbestos exposure (remember pipes and boilers) and since Asbestos , always pleural so pleural effusions are common compilactions ( I have seen a case like this before, really devastating condition)

Remember Asbestos are associated with mesotheliomas)

5-   Bronchogenic carcinomas are associated with with the following symptoms Dyspnea cough , hemoptysis , loss of weight , sufficient to trigger investigation yet not specific enough to diagnose , so consider elderly and smoking or history of asbestos exposure as a warning sign !!!

6-   Diagnosis: frustrating to remember !

   Centrally located tumours can be diagnosed by “sputum cytology” and bronchoscopy some of which may need needle aspiration biopsy which is also good in peripherally located lesions , yet open lung biopsy may be needed

7-   Treatment : unless the tumour is localized , consider chemo- or radiotherapy and palliative measures

8-   Localized” small cell” tumors with no spread to mediastinum or hilar l.N can be resected followed by management with VP 16 ?!!(EToposide !!!!! and platinum) why ??

9-   Other types with CAP : ) cyclophosphamide (nephrogenic D.I-yes it’s a small world- adrianmycin and platinum)