Bronchogenic Carcinoma physical examination and management

Bronchogenic Carcinoma physical examination and managementCreated OnMay 29, 2020Last Updated OnMay 29, 2020byadmin You are here: Main Clinical Examination Bronchogenic Carcinoma physical examination and management < All Topics Table of Contents Physical examination: General examination Finger Clubbing (HPOA) Face Facial swelling (SVC syndrome) Cushingnoid face (ectopic ACTH) Neck Raised JVP Eyes Ptosis (Pancoast tumor) Miosis (Pancoast tumor) Papillaedema Jaundice Hand Upper extremities edema Legs Lambert-Eaton myasthenic syndrome (gradual proximal lower extremity weakness) Spine Back pain (metastasis) Look for signs and symptoms of regional spread SVCO Hoarseness (recurrent laryngeal nerve palsy) Phrenic nerve palsy (elevated diaphragm and worsening dyspnea) Brachial nerve root compression (horner syndrome) Dysphagia (esophageal compression) Dyspnea (airway compression) Systemic examination (Right Bronchogenic carcinoma) Inspection Decreased movement on right side Palpation Tracheal centrally located Apex normal Chest expansibility reduced Vocal fremitus increased at tumor area Percussion Dull Auscultation Breath sound reduced/absent Vocal resonance reduced No added sound Abdominal Examination Inspection: Look for abdominal distension (ascites due to carcimatosis) Look for hepatomegaly and sign of jaundice (liver metastasis) Neurological examination Sign of spinal cord compression decreased sensation in the lower half of the body, decreased strength, loss of bowel control, and urinary incontinence or retention. Investigations: Imaging Chest xray Mass lesion: however only visible if >1cm diameters spiculate, cavitating or smooth edge Pleural effusion: commonly unilateral and large Mediastinal widening or hilar adenopathy: if LN involvement Splayed carina, hilar enlargement or paratracheal shadowing Slow resolving consolidation– due to recurrent lung infection Lung collapse Reticular shadowing Tumor spread through LN: lymphangitis carcinomatosis (unilateral & spiking of dyspnoea) If bilateral- need prompt ix for primary site (breast, colon, stomach) Normal– Doesn’t rule out tumour 2. CT scan– metastasis of disease (include liver and adrenal glands) 3. PET scan– extend of mediastinal nodal involvement which not visualize on CT Blood investigations FBC- anemia LFT- liver metastasize Hypercalcaemia Hyponatraemia Assessment fitness for treatment **To confirm diagnosis- need BIOPSY! Methods of biopsy: Bronchial/transbronchial biopsy- using fibreoptic bronchoscopy For centre lung lesions Percutaneous aspiration or biopsy by CT guided For peripheral lung lesions Risk of pneumothorax- 10%, mild haemoptysis <5% Endobronchial US guided biopsy- fine needle aspiration For mediastinal nodes involvement Staging for bronchogenic carcinoma- TMN staging Tumor T1: <3cm T2: 3-7cm T3: >7cm T4: any size that invades mediastinum, heart, great vessels, tracheal, recurrent laryngeal nerve, esophagus, carina, vertebral body Nodes N0: no lymph node involvement N1:ipsilateral bronchopulmonary/hilar N2: ipsilateral mediastinal/carina N3: contralateral mediastinal/hilar/supraclavicular Metastasis M0: no metastasis M1: distant metastasis Treatment: Surgery (eg: lobectomy)- in early stage of NSCLC (stage I II, selected IIIA with curative intent Radiotherapy for cure Using high dose radiotherapy or CHART (cont. hyperfractionated accelerated regimens) In patient with adequate lung function, early stage NSCLC (stage I & II) Complication- but cause no problem Radiation pneumonitis- acute infiltration confined to radiation area & occurring within 3 months of radiotherapy (10-15% cases) Radiation fibrosis- fibrotic changes not precisely confined to radiation area & occurring within 1 year of radiotherapy Using stereotactic radiotherapy or radiofrequency ablation In patient with significant CVS or RS co-morbidities and early stage I disease. Radiotherapy for symptoms Palliation of symptoms from lung cancer- respond favourably for short term Also given at end of chemotherapy to consolidate treatment in SCLC Chemotherapy Palliative care- for tracheobronchial narrowing causing disabling SOB, intractable cough, complications (infection, haemoptysis, RS failure) Can do neodymium-Yag (Nd-Yag) laser, endobronchial irradiation (brachytherapy) or tracheobronchial stent NSCLC- early stage (I, II, IIIa) Surgery (lobectomy) + radiotherapy ±...

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