What is Prognosis in Bronchial Carcinoma

Bony metastases are common, giving rise to severe pain and pathological fractures.

There is frequent involvement of the liver. Secondary deposits in the brain present as a change in personality, epilepsy or a focal neurological lesion. Carcinoma of the bronchus is a cause of secondary deposits in the adrenal gland.

Non-Metastatic extra pulmonary manifestations:

Although approximately 10 percent of small cell Tumours are thought to produce ectopic hormones at some stage, clinically important extra pulmonary manifestations are relatively rare apart from finger clubbing.

Hypertrophic pulmonary osteoarthropathy (HPOA) occurs in approximately 3 percent of all bronchial carcinomas, particularly squamous cell carcinomas and adenocarcinomas.

Symptoms include joint stiffness and severe pain in the wrists and ankles, sometimes associated with gynaecomastia. X-rays show the characteristic proliferative periostitis at the distal ends of long bones, which have an onion skin appearance.

HPOA is invariably associated with clubbing of the fingers. It may regress after resection of the lung tumour or as a result of vagotomy at thoracotomy.

Metastases in the lung are very common and usually present as round shadows 1.5 – 3 cm in diameter. They may be detected on chest X ray in patients already diagnosed as having carcinoma. The primary is usually in the

- Kidney
- Prostate
- Breast
- Bone
- Gastrointestinal tract
- Cervix or ovary

They nearly always develop in the parenchyma and are often relatively asymptomatic even when the chest X ray shows extensive pulmonary metastases.

It is rare for metastases to develop in the bronchi, when they may present with haemoptysis. Carcinoma, particularly of the stomach, pacreas and breast, can involve mediastinal glands and spread along with lmphatics of both lungs (lymphangitis carcinomatosa), which can lead to progressive and severe breathlessness.

On the chest X ray, bilateral lymphadenopathy is seen together with streaky basal shadowing fanning out over both lung fields. Occasionally a pulmonary metastasis may be detected as a solitary round shadow on chest X ray in an asymptomatic patient.

The commonest primary tumour to do this is renal carcinoma. The differential diagnosis includes:

- Primary bronchial carcinoma
- Tuberculoma
- Benign tumour of the lung
- Hydatid cyst

Single pulmonary metastases can be removed surgically but, as CT scans usually show the presence of small metastases undetected on chest X ray, surgery is seldom performed.

The overall prognosis in bronchial carcinoma is very poor. Less than 10 percent of patients survive five years after diagnosis. The best prognosis is with well-differentiated squamous Tumours, which have not metastatised and are amenable to surgical treatment.

A bronchial adenoma may produce symptoms over several years. Recurrent haemoptysis due to the vascularity of tumour is common as is recurrent broncho pulmonary infection distal to bronchial obstruction caused by the adenoma.

Very rarely, and usually when metastatic spread has occurred, the bronchial adenoma may give rise to the carcinoid syndrome. The physical signs are usually those of collapse.

The tumour may be suspected if the patient is young and symptoms have been present over a prolonged period; but confirmation of the diagnosis can only be made by bronchoscopy, biopsy and histology.

Treatment is by resection of the pulmonary lobe or segment containing the tumour along with the bronchus from which it arises. Occasionally when surgical resection is not possible local removal of the tumour tissue from the bronchial from which it arises.

Occasionally when surgical resection is not possible local removal of tumour tissue from the bronchial lumen or laser therapy may be an alternative.

| Clinical Symptoms (Physical signs) in Bronchial Carcinoma | Radiological Investigations & Presentations Involved in Bronchial Carcinoma | Non Meta-static extra-pulmonary manifestations of bronchial carcinoma | Surgical, radiotherapic, chemotherapy & laser therapy involved in Bronchial Carcinoma Treatment | Pathological Treatment in Bronchial Carcinoma | Bronchial Carcinoma - Causes and Prevention |

 

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