Question

a 67 y.o. female patient who presents with c/o dyspnea and a chronic cough for weeks. She is a smoker since she was a teenager. This is a follow-up visit after testing has been completed. Testing completed included:

Pulmonary Function Testing which show a definite blockage in her airflow;

A Chest X-Ray which shows a lesion

Bronchoscopy washings which showed malignant cells.

Histology is a squamous cell carcinoma

Her diagnosis is bronchogenic lung cancer.

1. Why did this patient have a blockage in her airflow?

2. Did her lung cancer metastasize from cancer in another location in her body, or did it arise in her lungs?

3. Why did she develop dyspnea?

4. The lining of the bronchi are normally pseudostratified columnar epithelium, not squamous cell. Why did this patients cancer develop from squamous cells?

This patient is scheduled for surgery, followed by radiation therapy and chemotherapy. Surgery will remove the bulk of the tumor, and the radiotherapy is expected to shrink the remaining tumor cells. The chemotherapy is aimed at mnetastatic liver tumors that were discovered. The patient has stopped smoking.

5. Why did the APN order a liver scan when it was discovered that the patient had bronchogenic carcinoma?

6. Why did the cancer metastasize before she had enough signs and symptoms to see out her physician?

7. Have survival rates for patients with this type of cancer improved or not in recent years with treatment? If so what are the latest survival rates published?

8. What educational information should be shared with this patient?

Answer 1

1- direct blocked by tumor, pulmonary tissue invasion, lymphatic invasion etc

2- secondary lung cancer metastasis from adrenal,bone, brain , breast and other organ

But in this patient history of chronic smoking and sqamous cell carcinoma are mostly primary in lung

3- dysnea- due to direct obstruction of air flow, pulmonary invasion, pulmonary embolism, lymphatic obstruction

4- pseudo stratified columnar epithilium - 1st metaplasia due to smoking

Due to metaplasia change in squamous epithilium

Than dysplasia and change in cancer cell