Quit Smoking

Quit Smoking

1. Ali was later found out to have

   • Bronchogenic Carcinoma ( lung cancer)
     • classified into
       • Neuroendocrine cells
         • Small Cell Lung Cancer (SCLC)
       • Epithelial cells
         • 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
     • Treatment
       • The commonest used chemotherapy combination for small cell is:
         • Cisplatin and etoposide
         • CAV (cyclophosphamide, doxorubicin, vincristine)
         • GemCarbo (gemcitabine and carboplatin)
         • For relapsed disease:
           • ACE (doxorubicin, cyclop- hosphamide and etoposide)
         • Topotecan:
           • for people whose SCLC has relapsed after treatment, but only if they are not able to have doxorubicin
       • Chemotherapy for non-small cell lung cancer (NSCLC)
         • 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
     • Multistep carcinogenesis
       • Smoking
       • Environmental exposure
       • Genetics
     • Local Effects
       • Cough (75%)
         • Weight loss (40%)
           • Chest pain (40%)
             • Dyspnea (20%)
               • Others : Hemoptysis, Loss of appetite, Obstructive symptoms
     • Systemic effects
       • Paraneoplastic Syndromes:
         • 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)
     • Etiology
     • Diagnosis
       • Medical History
         • 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.

2. Ali's Chief complain was

   • Hemoptysis
     • definition
       • 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.
   • Percussion showed
     • Pleural effusion
       • Abnormal values
       • Normal contents of pleural fluid

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