Lung CarcinomaBronchial carcinoma is the commonest malignancy affecting men. It is particularly associated with tobacco smoking and exposure to asbestos. It presents with a multitude of symptoms. Commonly dry cough, weight loss, general malaise and minor haemoptysis in a middle aged or older patient give rise to suspicion of the diagnosis. Chest radiography is mandatory. Tumours commonly spread to the lymph nodes within the chest and the supra-clavicular nodes. Metastases are common within the chest to other parts of the lung. Cerebral, hepatic, skeletal and suprarenal 2nd deposits are also common. In our environment its commonest differential diagnosis is that of Tuberculosis.
Investigation for Ca Lung
Cytology or histology is usually obtained to confirm diagnosis. Central tumours usually produce positive sputum cytology on a good early morning sputum specimen. This is especially useful for patients inoperable on clinical grounds such as inadequate pulmonary function. Cytology from supra-clavicular and mediastinal nodes, or from the tumour obtained by fine needle aspiration biopsy when obviously inoperable, may avoid bronchoscopy. Any patient who appears operable on clinical grounds should be referred for a specialist opinion. If indicated bronchoscopy and computerised tomography with contrast within a thoracic surgical unit would then be performed. Many patients have inappropriate expensive investigations that could be avoided by referral to a specialist unit.