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Ali was later found out to have
1. Bronchogenic Carcinoma ( lung cancer)
  1. classified into
    1. Neuroendocrine cells
      1. Small Cell Lung Cancer (SCLC)
    2. Epithelial cells
      1. Non-small Cell Lung Cancer (NSCLC)
        includes
        Squamous cell carcinoma
        Large cell carcinoma
        Adenocarcinoma
        Histology
        Gland-forming adenocarcinoma, which on IHC will show TTF-1 positivity which is se- en in majority of pulmonary adenocarcinomas
        Histology
        Composed of solid groups of large anaplastic malignant cells. Cells typically have large nu- clei, prominent nucleoli, and a moderate amo- unt of cytoplasm.
        Histology
        Well differentiated squamous cell carcinoma showing nests of squ- amous cells with central areas of keratinization
        Desmosomes
        Desmosomes
        squamous cell nests (pearls) with central keratinization
        X-ray
        left lung opacity (central lung mass)
        Gross
  2. Treatment
    1. The commonest used chemotherapy combination for small cell is:
      1. Cisplatin and etoposide
      2. CAV (cyclophosphamide, doxorubicin, vincristine)
      3. GemCarbo (gemcitabine and carboplatin)
      4. For relapsed disease:
        ACE (doxorubicin, cyclop- hosphamide and etoposide)
      5. Topotecan:
        for people whose SCLC has relapsed after treatment, but only if they are not able to have doxorubicin
    2. Chemotherapy for non-small cell lung cancer (NSCLC)
      1. NSCLC is not as sensitive to chemotherapy as SCLC.
        Surgery or radiotherapy are the main treatments.
        Chemotherapy may be given before or after surgery or radiotherapy
        Chemotherapy with either:
        Gemcitabine, paclitaxel, docetaxel or vinorelbine
        Together with a platinum drug (carboplatin or cisplatin) should be the first choice for people with advanced NSCLC stage 3 and 4
  3. Multistep carcinogenesis
    1. Smoking
    2. Environmental exposure
    3. Genetics
  4. Local Effects
    2. Cough (75%)
      1. Weight loss (40%)
        Chest pain (40%)
        Dyspnea (20%)
        Others : Hemoptysis, Loss of appetite, Obstructive symptoms
  5. Systemic effects
    1. Paraneoplastic Syndromes:
      1. Cushing's syndrome (ACTH)
        Inappropriate ADH secretion
        Hypercalcemia (PTH)
        Acromegaly (GH)
        Lambert-Eaton mysthenic syndrome
        Peripheral neuropathy (sensory)
        Hematologic abnormalities (leukemoid reaction, DIC, migratory thrombophlebitis)
        Hypertrophic pulmonary osteoarthropathy (clubbing of the fingers)
  6. Etiology
  7. Diagnosis
    1. Medical History
      1. Physical Examination
        Chest x-ray
        CT scan
        Low dose spiral CT
        PET scan
        Sputum cytology
        Guided needle biopsy
        Thoracoscopy
        Bronchoscopy
        Bronchoscopy is a test to view the airways and diagnose lung disease. It may also be used during the treatment of some lung conditions.
Ali's Chief complain was
1. Hemoptysis
  1. definition
    1. The expectoration of blood or bloodstained sputum. With massive hemoptysis the main priorities are to secure the airway and initiate emergency resuscit- ative measures before establishing a diagnosis.
2. Percussion showed
  1. Pleural effusion
    1. Abnormal values
    2. Normal contents of pleural fluid

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	Erstellt von Menna Emam vor mehr als 6 Jahre