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Lung Cancer Case Discussion?

Mesothelioma causes, treatment and diagnosis discussion

Lung Cancer Case Discussion?

Postby Wynwode » Tue Mar 03, 2015 12:21 am

i`m a 2nd year medical student and i`m gonna have a case discussion this wednesday. i know how to explain some of the signs and symptoms but i just hope that maybe someone can actually explain for me about them in more details so that when i'm asked, i wont be so blurrrrrreeedd like i always do=p.

here is the case:

A 55 year old man, heavy smoker (40 cig/day for 30 years) presented with cough, hemoptysis, right sided chest pain, and progressive shortness of breath for the last 3 months. Recently he noticed that he is passing large amounts of urine with increased frequency of urination day and night and he became constipated. Also he has pain and swelling around the wrist and ankle joints and over the last 3 months he has poor appetite and lost 10 kg of body weight (from 60 kg to 50 kg). 20 years ago this gentleman was in Germany and worked for 5 years in ship building

Physical examination showed a thin, emaciated patient who looks in pain. His respiratory rate was 26/minute. He has clubbing in his fingers and toes with painful swelling around both wrists and ankles. Examination of the chest showed decreased movement of the right side in comparison with the left side, the trachea was shifted to the right side, there was a dull percussion note over the right upper zone anteriorly with absent breath sounds.

Investigations showed hemoglobin of 10 gm/ dl. Blood sugar, renal function, and liver function tests were normal. Serum calcium was 2.8 mmo1/1.

Chest x-ray showed collapse consolidation in the right upper lobe, and x-ray of the wrists and ankles showed periostial elevation with new bone formation.

Bronchoscopy showed a tumor obstructing the right upper lobe bronchus, biopsy was taken and histopathology revealed squamous cell carcinoma.

Topics for discussion:

Explain the reasons behind each of the following physical sign and/or symptom:

Hemoptysis, chest pain, shortness of breath, passing large amounts of urine, constipation, swelling of joints, clubbing of fingers, tracheal shifting the right, dull percussion note over upper chest, x-ray findings of wrist and ankle joints (new bone formation).

i know you'll need a lot of typing here,but please, i really dont have anyone to ask except the doctors who are so busy in the hospital=(
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Lung Cancer Case Discussion?

Postby Archer » Tue Mar 03, 2015 7:57 pm

Asbestos is common in shipbuilding as a fire retardant and insulator.
Accumalation in the lungs causes asbestosis and chronic lung damage.
It also increases the risk of lung cancer, in this case, SCC.
However, smoking alone can do it too, which he has a history of.
The combination is even more potent at causing lung cancer.

Hemoptysis can be caused by the tumor invasion of vessels, collapse of lung.
Chest pain from tumor invasion, lung collapse, tracheal shifting.
Clubbing of fingers is due to chronic hypoxia from the cancer and presumed asbestosis.
Tracheal shifting is due to volume loss on the collapsed lung and shifting of trachea.
Dull percussion due to consolidation and collapsed lung.

The other problems mainly relate to hypercalcemia of malignancy which is due to increased osteoclast activity in the bone with metastases.
Also, some SCC's can produce PTH related peptide, which also causes bone resorption.
High calcium causes constipation, polyuria and nocturia.
Also can cause renal/ureteral stones which may cause urinary issues.
The Xray findings are related to metastases or a result of disordered calcium levels. The body is both breaking down bone through PTH related mechanisms or through osteolytic metastases, and also laying it down due to high calcium levels, causing abnormal appearing bone.
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