Bronchial carcinoma

Bronchial carcinoma

• Malignant tumour of bronchial tree

Epidemiology

• Most common malignancy (32000 deaths/year in UK)
• Third most common cause of death in UK

Cell types

• Small cell (20-30%)
• Non-small cell
• Squamous (40%)
• Large cell (25%)
• Adenocarcinoma (10%)
• Bronchoalveolar cell (1-2%)

Aetiology

• Smoking (including passive)
• Squamous
• Urban > rural
• Occupational
• Adenocarcinoma
• Asbestos, coal, chromium, arsenic, petroleum products and oils. radiation

Clinical features

• Often no clinical signs
• Clubbing
• Supraventricular nodes (small cell)
• Signs of:
• Pleural effusion or collapse
• Unresolved chest infection
• Chronic lung disease (e.g. asbestosis)
• Symptoms:
• Cough
• Chest pain
• Haemoptysis
• Chest infection
• Others (malaise, breathlessness etc)

Spread of bronchial carcinoma

• Direct
• Pleura and ribs
• Erosion of ribs and involvement of lower brachial plexus nerves in apical tumours (Pancoast's tumour)
• Sympathetic ganglion (Horner's syndrome - small pupil and poptosis)
• Recurrent laryngeal nerve palsy with unilateral vocal cord paralysis. (hoarseness, bovine cough)
• Spinal cord compression
• Oesophagus (dysphagia)
• SVC obstruction (headache, facial congestion, fixed distended veins)

• Metastatic
• Bones (spinal cord compression can complicate)
• Liver
• Brain
• Adrenal glands (usually asymptomatic)

Non-metastatic extrapulmonary manifestations

• Ectopic hormone production, adrenocorticotrophic hormone (ACTH), e.g. (small cell)
• Neurological, e.g. myasthenic syndrome
• Hypertrophic pulmonary osteoarthropathy (HPOA)
• Vascular/thrombotic/haematological
• Cutaneous, e.g. dermatomyositis

Investigations

• Chest X-ray
• Blood tests
• Hyponatraemia
• Polycythaemia
• Anaemia
• CT scan and PET scanning for staging
• Bronchoscopy biopsy (proximal lesions) or percutaneous biopsy (peripheral lesions)

Management

• Multidisciplinary team approach
• Surgery
• Only 5-10% of cases suitable
• For non-small cell
• Radiotherapy
• Particularly for squamous cell
• Can be useful for symptom control
• Used for SVC obstruction
• Chemotherapy
• Combination chemotherapy
• Particularly useful for small cell
• Also used for non-small cell

Prognosis

• 55-67% 5-year survival for those with local disease only
• 23-40% 5-year survival for those with locally adanced disease
• 1-3% 5-year survival for those with advanced disease