Early Clinical Features of Bronchogenic Carcinoma: Illustrative Cases

¹ The Department of Laryngology and Broncho-Esophagology (Chevalier Jackson Bronchoscopic Clinic), Temple University, Philadelphia, Pennsylvania.

1) Cases illustrating the various early clinical and roentgenologic manifestations of bronchogenic carcinoma have been presented.

2) The early manifestations of a bronchogenic carcinoma depend chiefly on its point of origin, so that an arbitrary classification based on location offers a logical basis for understanding the mechanism by which the early symptoms, signs and roentgen abnormalities are produced.

3) To avoid confusion with the other common lower respiratory diseases, thorough clinical study appears advisable in the following groups of cases: (a) Those in which chronic pulmonary symptoms (notably cough, blood-streaking or hemoptysis, wheezing) are not adequately explained, (b) Those in which symptoms or abnormal physical findings persist after what has appeared to be one of the common acute lower respiratory infections, (c) Those in which the roentgen examination shows evidence of impaired bronchial drainage (abnormal density of unilateral, lobar or segmental distribution, unless obviously tuberculous in origin with positive sputum) or impaired aeration (obstructive emphysema, atelectasis of a lung, a lobe or a bronchopulmonary segment). In cases where a tumor-like lesion is evident on the roentgenogram, the need for complete study is apparent. The finding of cavitation not clearly tuberculous in origin should of course call for further investigation.

4) Complete study should include, in addition to the roentgen examination, a bronchoscopy, with bacteriologic study of bronchial secretions; cytologic examination is indicated in those cases in which tissue for biopsy is not obtainable at bronchoscopy. In cases where the differential diagnosis includes tuberculosis, examination of sputa or gastric washings and skin-testing are in order. Additional procedures which may be indicated in a given case include bronchography, planigraphic study, bacteriologic and cytologic examination of pleural fluid, aspiration biopsy and occasionally thoracoscopy.

5) Exploratory operation is indicated in cases where there is convincing clinical evidence of bronchogenic carcinoma, even though a proven histologic diagnosis is not obtainable, provided there is no evidence of extrapulmonary invasion or metastasis, and provided the operative risk is not disproportionate.