A 56 Year Old Man, Chronic Smoker Complains Of Worsening Cough And Weight Loss

A 56 year old man who is a chronic smoker as well as have a past history of chronic bronchitis comes to the clinic with a complain of worsening cough over the last month. The cough is productive of 2 teaspoonfuls of  yellowish mucus, with streaks of blood. Patient has noticed dysnpnea on exertion as well as fatigue, decreased appetite and a weight loss of 12 pounds during the last 2 months. he has no history of recent travel or exposure to tuberculosis patient. .

The X Ray of his chest is shown below:

What is the diagnosis?
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Lung Cancer.

Case Discussion:

Lung cancer

Lung cancer also known as bronchogenic carcinoma is the most common cause of cancer in men, and the 6^th most frequent cancer in women worldwide. It is the leading cause of cancer mortality worldwide in both men and women and accounts for approximately 20% of all cancer deaths 

Epidemiology

The major risk factor is cigarette smoking which is implicated in 90% of cases.  Other risk factors include asbestos or exposure to certain other harmful chemicals.

Clinical presentation

Patients with lung cancer may be asymptomatic in up to 50% of cases. Cough and dypnoea are rather non-specific symptoms that are common. 

Central tumors may result in haemoptysis and peripheral lesions with pleuritic chest pain.

Pneumonia, pleural effusion, wheeze, lymphadenopathy are not uncommon. Other symptoms may be secondary to metastasis (brain, liver, bone) or to paraneoplastic syndromes.

Pathology

The term bronchogenic carcinoma is somewhat loosely used to refer to primary malignancies of the lung that are associated with inhaled carcinogens and includes four main histological subtypes. These are broadly divided into non small-cell carcinoma and small cell carcinoma as they are differ clinically in terms of presentation, treatment and prognosis:

• Non small cell lung cancer (80%)
  • Squamous cell carcinoma (35%)
    • strongly associated with smoking
    • most common carcinoma to cavitate
    • poor prognosis
  • Adenocarcinoma (30%)
    • more common in women
    • more common in non-smokers
    • peripheral
  • Large cell carcinoma (15%)
• Small cell carcinoma (20%)
  • strongly associated with smoking
  • early metastasis 
  • most common primary lung malignancy to cause paraneoplastic syndrome and superior vena cava obstruction
  • worst prognosis

Treatment and prognosis

Treatment and prognosis varies not only with stage, but also with cell type. In general, surgery, chemotherapy, and radiotherapy are offered according to stage, resectability, operability, and functional status.