Let's take a look at another non-small cell
lung cancer and this time we come to our squamous
cell. A squamous is extremely associated
with smoking. Here once again you tell me again
how many nodule? We can walk through this
quicker now. One nodule, because it’s primary.
This one however is located just like which
one of the other? When compared to the other
two, your small and your adenoma, centrally
located was seen with? Good, small. Squamous
here as well. Hilar mass. What’s hilar means?
Think about the hilum of the lung. So that’s
where you would find it. Arising from the
bronchus associated with cavitation. So if
we’re by the bronchus and such then what
the heck is going on here? Metaplasia took
place, maybe smoking. Up in the bronchi you
have what kind of cells? Columnar, ciliated.
Right. And if you’re going to smoke, how is
the tube going to protect itself?
It first undergoes metaplasia, dysplasia and
then it gives rise to squamous cell cancer.
What is the major paraneoplastic that you’re
going to find here? Your patient is going
to appear as following: “Hey, doc, I’m
coughing out blood, and it’s foamy.”
Next, you find that the patient is telling
" I headache and not feeling too well." Okay. “And
when I go to the bathroom, nothing is coming
out.” Hmm, take a look at calcium levels,
they’re elevated. You take a look at the
PTH levels, severely depressed. Really?
What am I talking about? PTHrP. So, the symptoms
that I gave you, well this is lung cancer,
there is going to be haemoptysis, destruction
of the bronchi and such, hypercalcemia results
in stupor and headache. The hypercalcemia
slows down the GI system, constipation.
And then I also told you PTH levels were low.
Dr. Raj, you just told me it’s a paraneoplastic
and increase in PTH, Oh, yes. I forgot to see
the rP. So, you have an increase in PTHrP, you
have an increase in calcium. Tell me where
this related peptide is coming from? RP.
It’s coming from that nodule that was located
centrally, by the mediastinum. Right. And
where is your PTH coming from? Oh yes, that's
right. By the thyroids. So
therefore, if you have hypercalcemia, what
is it going to tell these parathyroids to
do? Shut down PTH. Low PTH, increase PTHrP,
Histology, whenever you hear squamous,
what are you thinking about? Those lovely
keratin pearls, right? You’re always thinking
about those squamous. Maybe perhaps
you gave your loved ones keratin pearls. I’m
joking, it’s not very nice. And then you
have intercellular bridges. That also is your
squamous. You gotta have fun a little bit,
right? Just say maybe perhaps you’re thinking
about giving your, you proposed to your
loved one with a signet ring. Oh, Dr. Raj,
stop it. Okay, I will. Move on.