Tumors of the lungs can be benign or malignant. A benign tumor is not life threatening. Practically all tumors of the lungs are malignant. Malignant means there is unregulated and uncontrolled growth of cells with direct spread to adjacent organs and by the blood and lymph spread to distal areas. By far, the commonest malignant tumor of the lungs is a bronchial carcinoma and a major risk factor is smoking and chronic exposure to carcinogenic chemicals or dusts. Cancer or carcinoma of the lungs is a very serious health issue worldwide. In the developed world, the United Kingdom for example, it is responsible for far more male deaths than any other cancer. In the United States it is the leading cause of death from cancer in both men and women. Because of these worrisome statistics there are moves and legislation to ban smoking in public places in a number of developed countries. Most cases of cancer of the lung begin in the larger bronchus, where they may cause partial or complete obstruction of the bronchus depending on the extent of spread of the disease. The malignant tumor usually spread to adjacent areas like the mediastinum, pleura and chest wall by direct invasion. It spreads to the hilar region, mediastinal and supraclavicular lymph nodes by the lymphatic s. The commonest site of spread by the blood is to the brain, liver and bones. The symptoms and signs of lung cancer depend on the anatomical location of the malignant tumor and the extent of the disease, and are classified into groups. A. Local effects of tumor in bronchus. 1. Chronic cough, usually goes ignored because it is taken as normal by most smokers 2. Coughing up blood (hemoptysis) or blood streaks in sputum. This should always be investigated. 3. Bronchial narrowing of air passage results in shortness of breath and stridor 4. Distal collapse of lungs results in dyspnea (difficuly or discomfort inbreathing) and mediastinal shift to the affected side. Clinical exam will reveal respiratory distress and unequal air entry on auscultation and absent or diminished breathing at affected site. 5. Weight loss. Spread to mediastinum may cause 1. Hoarse voice and coarse cough due to pressure on laryngeal nerve. 2. Headaches and pulsatile veins in neck due to compression of superior vena cava. Distended collateral veins on anterior chest wall. 3. Difficulty swallowing due to compression from esophagus 4. Invasion into the pericardium can result in pericardial effusion which is blood stained. Arrhythmia may also develop. Spread to pleura and chest wall result in: 1. Blood stained pleural effusions. Of note the pleural effusion in bronchogenic carcinoma is not always due to the tumor but also as a result of infection. 2. Chest wall pain 3. Pain in the inner aspect of the arm. Spread to lymph nodes: 1. Bronchial narrowing can result from compression by the enlarged lymph nodes, with the associated symptoms listed earlier. 2. The lymph nodes are palpable and may become painful. Distant spread by blood to brain will result in weakness, headache and visual disturbances. Memory impairment or loss is also common. Spread to the bones can cause bone pain and pathological fractures. Spread to the liver can result in its enlargement and development of jaundice. The prognosis for lung cancer is generally poor because in most instances the disease is diagnosed in advanced or late stages. From a real practical stand there are 3 key things to always bear in mind that can go a far way in making an early diagnosis. They are, 1. Chronic smoking 2. Chronic cough (in principle any cough persisting for more than a month should be investigated). 3. Chronic pain. Any case of persistent cough, or protracted pain especially in a chronic smoker and the elderly should always be investigated to exclude or confirm and make the early diagnosis of lung cancer. This will go a far way in improving survival rates in lung cancer patients.
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