So what are the classic presentations? Okay, So
if you have somebody who is got lung cancer
in a central place around one of the major
bronchi and they may present with cough and
if that tumor is eroding into the bronchus
they may bleed a little bit into the bronchus
and have hemoptysis as well. Occasionally
that hemoptysis is fatal and that leads the tumor
to erode into an artery that bleeds so fast, that
the patient would die with massive hemoptysis.
However if you've got a mass, which is in the periphery
of the lung not so near to the main bronchus,
then actually it can remain pretty asymptomatic
for a very long period of time. These tumors
tend to be picked up by x-ray surveillance
rather than by presenting with symptoms.
The other presentation of tumor which is
affecting a bronchus is that it can block that
bronchus and of course what we call lobar
collapse. So that could be the right lower lobe,
as shown in this picture, it could be the right
upper lobe, could be the entire lung.
This patient will present with an x-ray showing
a lung collapse and breathlessness as they
develop over a period of few weeks. When the
lung hasn’t quite collapsed but has significant
obstructions of bronchus and the patient on
examination may have a wheeze over that area
which is a monophonic wheeze. It has a one
node which is quite different to the wheeze
you get in an asthma which is polyphonic with
multiple nodes. The reason why it has a monophonic
wheeze is that there is only one area of obstruction,
so there is any node of determinant flow that occurs
in that area. And of course partial obstructions
in airways makes the body’s ability to clear
the distal lung of infection or bacteria that
get into that area much weaker and therefore
patients can present with pneumonia. So a
smoker presenting with pneumonia, we have
to be aware that it might the evidence of
central obstruction due to a tumor that is otherwise
unknown. As I have mentioned, an important
symptoms for patients presenting with lung
cancer are systemic systems. That is weight
loss, loss of appetite, general malaise and
fatigue. If you have those symptoms, then
you must consider cancers as potential diagnosis.
Other patients themselves may look cachexic
because of the weight loss they look particularly
thin. Clubbing is also a very common sign
in lung cancer and is significantly present
in many patients with squamous cell cancer.
So just to take these potential presentations
and give you free potential examples of this.
This is a patient who has been coughing. They
have coughed up blood. Because of that somebody
has done a bronchoscopy. When they looked down on
the bronchoscopy, they can see is a tumor
blocking the upper lobe bronchus and the chest
x-ray shows collapses of the upper lobe. So that's a
central tumor which is causing partial collapse
of the lung and hemoptysis.
This next patient presents with the pain in
the arm and the reason why they got pain in
the arm is that they have an apical tumor
which is eroding into the brachial plexus
which is so called as Pancoast tumor. So it is
quite a different presentation, although its still
a tumor on the left hand side.
In this third presentation, another
tumor of the right hand side. Actually you
can just about see there is a very small
shadow, visible underneath the ribs there
and this is an asymptomatic cancer. It's far
too small to be actually causing symptoms in
a peripheral position but it was picked up on
a chest x-ray that was done for other reasons.
This is a very common presentation for lung
cancers which is asymptomatic abnormality
identified on x-ray done for other reasons.