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CARCINOMA OF THE LUNGS

By Dr. T. VISHNU MURTHY
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The direct and indirect effects of lung cancer can produce a variety of anatomic,clinical, and other manifestations.

  1. Pulmonic Manifestations
  2. Extrapulmonic Manifestations
  3. Systemic Manifestations
  4. Metastatic Manifestations
  5. Extrathoracic Manifestations

PULMONIC MANIFESTATIONS: Irritation of bronchial mucosa by tumour or by inflammation adjacent to the tumour may cause a change in pattern of a chronic cough or may produce a wholly new cough, Hemoptysis of bright red blood, flecks of blood or rusty sputum by due to vascular invasion or to pneumonia developing behind the tumour. Occasionally, the tumour may occlude enough of a large bronchus to make the patient notice a respiratory wheeze.

An obstructed bronchial lumen may cause retention of secretion, predisposing to parenchymal infection. If the lumen is completely obstructed, the distal parenchyma may become atelectatic. Although roentgenographically apparent atelectasis may be asymptomatic, parenchyma that is infected or inflamed may produce all the classic clinical, bacteriologic, and roentgenographic manifestations of phenomena. With conventional treatment of the pneumonia, the patient may have a conventional symptomatic and bacteriologic response, but the roentgenogram may fail to clear because of the underlying neoplasm. In this circumstance, the unresolved pneumonia becomes the clue that leads to further tests and discovery of the tumour. A lung abscess can sometimes be produced at the site of such a pneumonia, although an alternative cause of lung abscess is necrosis of the interior of a large tumour.

As a parenchymal manifestations, dyspnea is the direct result of metastasis when the tumour either replaces large amounts of parenchymal tissue or more commonly invades the pleural surface, causing an effusion that reduces space available for ventilation. In many other circumstances, however, dyspnea may be indirect, occurring because

  1. parenchymal inflammation extending to the pleura initiates a pleural effusion,
  2. primary tumour may locally obstruct the tranches or carina,
  3. the amount of secondary parenchymal information or atelectasis may be great enough to impair ventilation in a patient whose respiratory reserve had been reduced-by chronic lung disease or by poor cardiac compensation-before the tumour developed.
EXTRA PULMONIC MANIFESTATIONS:

The many possible extrapulmonic manifestations of lung cancer include systemic features, which are often indirect and metastatic features, which are due to direct spread of tumour to the affected site.

SYSTEMIC MANIFESTATIONS:

Anorexia may occur indirectly because of persistent infection, pain, or other discomforts of the pulmonic features just cited. With decreased food intake, the patient may then loose weight and become easily fatigued. Alternatively, however anorexia and other digestive disturbances can be the direct result of hepatic peritoneal or other intra-abdominal metastasises.

When a patient with lung cancer has an endocrine problem resulting from a decrease in hormone, the cause usually destruction of the glandular site by metastasis. An increase in hormone may represent one of the functional “ endocrinopathies “ that can produce adrenal hyper function, inappropriate antidiuresis hypercalcemia, or the carcinoid syndrome. The hypersecretive endocrine problems can often occur without metastasis and can sometimes be the first evidence of the tumour.

The weakness often associated with lung cancer was long regarded only as a nonspecific systemic effect until the discovery in recent years that many instances of weakness were due to neurologic lesions, occurring without metastasis and presumably caused by a secretory product of the tumour. The lesions can be include cortical cerebellar degeneration, peripheral neuropathies, encephalomyelitis, and various myopathic syndromes.

METASTATIC MANIFESTATIONS:

Hoarseness occurs when tumour impinges on the mediastinal portion of the recurrent left laryngeal nerve. The subsequent paralysis of the left vocal cord is demonstrated at laryngoscopy or bronchoscopy.

The superior ( vena cava ) syndrome can be produced by metastases in mediastinal nodes. Lung cancer today is the most common cause of the suffusion and brawny edema that occur in the face, neck, or upper arms as a consequence of compression or invasion of the superior vena cava.

Involvement of the esophagus by lung cancer in the mediastinum can produce the same clinical pattern of dysphagia noted in esophageal carcinoma Although myocardial involvement is rare in lung cancer, direct invasion of the pericardium is more common. Neoplastic cells found in a bloody pericardial effusion may sometimes be the evidence of the cancer.

Carcinoma arising in the apex of the lung—superior sulcus tumour ( Pancoast tumour ) — can invade adjacent bone or the nerve bundles that pass through the thoracic inlet. Involvement of the first or second rib can produce local pain; involvement of the bronchial plexus can produce sensory or motor disturbances in the arm; and involvement of the sympathetic nerve chain can produce Horner’s Syndrome on the affected side.

EXTRA THORACIC MANIFESTATIONS

Cancer of the lung can metastasise for any structure or the body. The brain has been a distant metastatic site so commonly that pulmonary examination is often performed to exclude metastasis from a lung cancer in any adult suspected of having a primary brain tumour.

Among the other diverse extra thoracic metastatic manifestations of lung cancer are pathologic fractures of bone, the development of multiple cutaneous nodules, enlargement of the liver, hypoadrenalism caused by metastatic replacement of the adrenal glands, diabetes mellitus resulting from destruction of the pancreas gastrointestinal bleeding from metastasis to small bowel, jaundice from metastasis to periportal nodes, ascites from peritoneal invasion, and various peripheral neurologic manifestations from metastasis to vertebrae or to spinal card.

The occurrence rate of cancer of the lung is difficult to estimate and the opportunity to establish a correct diagnosis has sharply increased in recent years with the frequent use of chest roentgenograms and with availability of such diagnostic techniques as bronchoscopy , biopsy of affected structures, cytologic examination of sputum and other fluids. These better methods of diagnosis lead to the detection of many cases of cancer today that might have been unrecognised years ago.

Patients referred to medical centers for specialised modes of therapy, such as thoracic surgery, high voltage radiotherapy, new chemotheraputic agents, may not reflect the true distribution of lung cancer in that community or in other regions. Certain cancers formerly regarded as metastatic have been called primary in the past few decades, after pathologists recognised that nonbronchogenic lung cancers can arise periodically and disseminate widely to other parts of the body.

For all these reasons, cancer of the lung is diagnosed more frequently than ever before. The epidemiologic significance of the increase is difficult to evaluate, but the clinical significance of this increased occurrence rate is that lung cancer is now perhaps the most commonly recognised form of carcinoma in man.

TREATMENT

According to Ayurvedic treatment we diagnose the patient in four types

  1. Pulse test,
  2. Urine test,
  3. Walking test,
  4. Eyes Movement, then we prepare medicine with herbal medicinal plants by individual formula and it can be healed without chemotherapy and radiotherapy. And you can visit website www.nectarhealth.org