Lung Cancer and Tumors: Presentation

00:00 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.

00:37 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.

00:57 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.

01:13 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 range of 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.

02:46 So just to take these potential presentations and give you free potential examples of this.

02:54 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.

03:14 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.

03:30 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.

03:49 This is a very common presentation for lung cancers which is asymptomatic abnormality identified on x-ray done for other reasons.