Radiological Investigations & Presentations Involved in Bronchial Carcinoma

This is the commonest cancer in males and second commonest cancer in females after breast cancer.

It is also the most preventable cancer as over 90% is directly related to cigarette smoking.

For practical purposes lung cancer can be divided into small cell lung cancer, comprising about 20% and non-small cell lung cancer, comprising 80 percent.

In non-small cell lung cancer surgery should be considered in all cases although only one quarter of patients will be operable and only one quarter of them will be cured.

Radiotherapy may provide useful palliation in inoperable patients and very good symptom relief in metastatic disease. Chemotherapy is still experimental in non-small cell lung cancer and its role is not yet established.

In small cell lung cancer the disease has almost always disseminated by the time of diagnosis and surgery is thus inappropriate. As opposed to non-small cell lung cancer.

This tumour is very chemosensitive and radiosensitive and the majority of patients will respond to combination chemotherapy (e.g., mitomycin, ifosfamide and cisplatin) with good relief of symptoms and modest prolongation of life.

A small proportion of limited small cell lung cancer patients will be cured. In patients with extensive disease, who are incurable, single agent etoposide orally or intravenously is a possible alternative to combination chemotherapy.

As in non-small cell lung cancer, radiotherapy can provide very useful palliative relief.. This is the most common malignant tumour in the western world and is now the third most common cause of death in UK after heart disease and pneumonia.

Mortality rates worldwide are highest in Scotland, closely followed by England and Wales. In the UK, 35000 people die each year from bronchial carcinoma with a male to female ratio of 3.5 : 1.

Although the rising mortality from this disease has leveled off in men, it continues to rise in women, accounting for 1 in 8 of all deaths from malignant disease in women, second only to carcinoma of the breast.

The strength of the association between cigarette smoking and bronchial carcinoma overshadows any other aetiological factors, but there is a higher incidence of bronchial carcinoma in urban compared with rural areas.

Even when allowance is made for cigarette smoking. Passive smoking (the inhalation of other people’s smoke by non smokers) increases the risk of bronchial carcinoma by a factor of 1.5.

Occupational factors include exposure to asbestos, and an association is also claimed for workers in contact with arsenic, chromium, iron oxide, petroleum products and oils, coal tar, products of coal combustion, and radiation.

Tumours associated with occupational factors are mostly adenocarcinomas and appear to be less related to cigarette smoking.

Chest X-Ray:

This is the most valuable screening test for bronchial carcinoma. It is relatively insensitive test, however, since the tumour mass needs to be between 1 and 2 cm in size to be recognized reliably. CT scanning can identify small tumour masses, but is at present too time consuming and expensive to replace the chest X-ray.

About 70 per cent of all bronchial carcinomas arise centrally, the rest peripherally (particularly adenocarcinomas). At the time of clinical presentation the chest X-ray will demonstrate over 90 percent of carcinomas.

A small proportion arise within the main bronchus or trachea or else present with metastatic or non-metastatic complications but with no detectable mass on the chest X-ray.

Bronchial carcinoma can appear as round shadows on a chest X-ray. Characteristically the edge of the tumour has a fluffy or spiked appearance, though sometimes it may be entirely smooth with cavitations, particularly when the tumour is epidermoid in type.

Carcinoma can also cause collapse of the lung. Carcinoma causing partial obstruction of a bronchus interrupts the mucociliary escalator, and the bacteria are retained within the affected lobe.

This gives rise to the so called secondary pneumonia that is commonly seen on a chest X-ray of a patient presenting with bronchial carcinoma.

The hiliar lymph nodes on the side of the tumour are frequently involved in carcinoma of the lung. A large pleural effusion may also be present. Carcinoma can spread through the lymphatic channels of the lung to give rise to lymphangitis carcinomatosa; this is usually unilateral and associated with striking dyspnoea.

The chest X ray shows streaky shadowing throughout the lung. This appearance may be seen in both lungs, particularly when it is due to metastatic spread, usually from tumors below the diaphragm (the stomach and colon) and from these breast.

 

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