Early Detection of Bronchogenic Carcinoma

Abstract

1) In spite of the fact that the mortality of pulmonary resection for bronchogenic carcinoma is now less than 10 per cent, the salvage of patients having this disease is still disappointingly low. Earlier diagnosis is our only means of improving this salvage. 2) In our experience there is a five months' delay between the onset of symptoms and the time the patient presents himself to the physician and a further delay of six months between the visit to the physician and a correct diagnosis. 3) The delay in correct diagnosis is usually due to the making of an incorrect diagnosis. Virus pneumonia and unresolved pneumonia are two diagnoses that are frequently made in patients having this disease. 4) The early bronchogenic carcinoma represents only a change in the bronchial mucosa which obstructs the bronchus. Signs or symptoms of bronchial obstruction should be regarded with suspicion. A localized wheeze and the finding of a region of localized emphysema on the x-ray film are the earliest symptom and sign of bronchogenic carcinoma. Cough is the most common symptom complained of by the patient. In evaluating this symptom the change in the cough history from a hacking cough to paroxysmal type of coughing is the most important factor. 5) X-ray Inspection of the chest is the most valuable diagnostic method in the detection of this disease. Mass radiography Is bringing to light many early lesions in the asymptomatic stage. Mass radiography, however, unless repeated often cannot be the answer to early diagnosis. 6) Bronchoscopy is an excellent diagnostic procedure but when negative does not rule out bronchogenic carcinoma. The examination for neoplastic cells in material coughed up or obtained at bronchoscopy has made it possible to make many more early diagnoses. 7) Exploratory thoracotomy may often be necessary in order to diagnose early bronchogenic carcinoma. Exploratory thoracotomy is safe and should be recommended when there is sufficient evidence to suspect early neoplasm. 8) In our patients it was found that approximately 40 per cent were inoperable at the time they first visited the physician. This disappointing fact is one reason why the salvage rate in this disease is still low. 9) Continued vigilance on the part of the general practitioner and insistence upon accurate diagnoses of lesions appearing within the lung will bring many more patients having bronchogenic carcinoma to the thoracic surgeon at a stage where the lesion can be completely removed.