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so what are the classic presentations
okay so if you have somebody who is got
lung cancer in a central place or on one
of the late major bronchi the name may
present with cough and if that tumors
are rolling into the bronchus they may
bleed a little bit into the bronchus and
have him OPS's as well occasionally that
hemoptysis is fatal in that the tumor
erodes into an artery that bleeds so
fast that the patient will die with
massive hemoptysis however if you've got
a mass which is in the periphery of the
lung not near a main bronchus then
actually it can remain pretty a systemic
for a very long period of time and these
tumors tend to be picked up by x-ray
surveillance rather than by presenting
the symptoms the other presentation for
a tumor which is acting a bronchus is
that it can block that bronchus and
cause what we call lobar collapse so
that could be the right lower lobe as
shown in this picture it could be the
right upper lobe could be the entire
lung or could this patient will present
for an x-ray showing lung collapse and
breathlessness there's a divert over a
period of a few weeks when the lung
hasn't quite collapsed but is the
there's significant obstruction to the
bronchus and the patient on examination
may have a wheeze over that area which
is a monophonic wheeze it has one note
which is quite different to the weeds
you get in asthma which is polyphonic
with multiple notes and the reason why
it's a monophonic wheeze is that there
is only one area of obstruction so
there's only one note of determinant
flow occurs in that area and of course
partial structure main Airways makes the
body's ability to clear that airway at
the distal lung of infection or bacteria
that get into the area much weaker and
therefore patients can resent with
pneumonia so a smoker presenting with
pneumonia we have to be aware that that
might be evidence of a central
obstruction due to a tumor that's
otherwise unknown
as I've mentioned an important range of
symptoms for patients presenting with
lung cancer are systemic symptoms that
is weight loss loss of appetite general
malaise and fatigue and if you have
those symptoms then you must consider
cancer as a potential diagnosis and the
patient's themselves may look Coquet
sick because of the weight loss they
look at particularly thin clubbing is
also a very common sign in lung cancer
and is a significant significantly
present in many patients with squamous
cell cancer so just to take these
potential presentations and give you
three potentially explanation of three
potential examples of this this is a
patient who has been coughing they've
coughed up blood because of that
somebody's done a bronchoscopy and when
they looked down a bronchoscopy what
they can see is a tumor blocking the
upper lobe bronchus and the chest x-ray
shows collapse of that upper lobe so
that's a central tumor which is causing
partial collapse of the lung and
hemoptysis this next patient presents
with pain in the arm and the reason why
they've got pain in the arm is that they
have an apical tumor which is eroding
into the brachial plexus which is a
so-called Pancoast tumor so it's quite a
different presentation although it's
still an upper lobe tumor on the right
hand side and this third presentation
another ruffalo tumor on the right hand
side actually you can just about see
there's a very small shadow under
visible underneath the ribs there and
this is an asymptomatic cancer it's far
too small to be actually causing
symptoms in a in that peripheral
position but it was picked up on a chest
x-ray that was done for other reasons
and this is a very common presentation
for lung cancers which is an
asymptomatic abnormality identified on
an x-ray done for other reasons
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