The Inoperable Bronchogenic Carcinoma: 4 case reports and literature review

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
The Inoperable
Bronchogenic Carcinoma:
Four Case Reports
Prof. Abdulsalam Y Taha
College of Medicine
University of Sulaimani
2022 1

2. Introduction
 Bronchogenic carcinoma (BGC) is a
highly fatal and very common cancer
in both genders affecting smokers
and even non-smokers. Surgery, the
best therapy for this cancer, is
unfortunately not an option for a
great number of patients with
inoperable BGC (IBGC). The term
(Inoperable) is used to describe
tumors which are beyond surgery for
either a technical factor (non-
resectable) or a medical factor. 2

3. The Cases
 Four cases with inoperable bronchogenic
carcinoma (IBGC) admitted to the
Department of Thoracic Surgery,
Sulaymaniyah Teaching Hospital,
Sulaymaniyah, Region of Kurdistan, Iraq
on different times after 2003 are
presented herein. Reasons of
inoperability of BGC are discussed here
besides presentation of the 4 cases.
3

4. Case 1 Left BGC with left phrenic
nerve palsy (elevated
hemidiaphragm)
4
Clubbing of Fingers
Courtesy of Prof. Abdulsalam Y Taha
Courtesy of Prof. Abdulsalam Y Taha

5. Case 2 Left Pancoast Tumor in a
37-years Old Man
5
Courtesy of Prof. Abdulsalam Y Taha

6. Case 2…
6
Courtesy of Prof. Abdulsalam Y Taha

7. Case 2: Severe left shoulder pain
and left apical pulmonary opacity
7
Courtesy of Prof. Abdulsalam Y Taha

8. Case 2…
8
Courtesy of Prof. Abdulsalam Y Taha
Courtesy of Prof. Abdulsalam Y Taha

9. Case 2: Diagnostic left thoracotomy
for incisional biopsy followed by deep
X-ray therapy
9
Courtesy of Prof. Abdulsalam Y Taha

10. Case 3: IBGC in a 78-years old
man presented with productive
cough and SOB for a few
months
10
Courtesy of Prof. Abdulsalam Y Taha

11. Case 3: RLL collapse
consolidation 11
Courtesy of Prof. Abdulsalam Y Taha

12. 12
Stagnant secretions
in RMB
RMB tumor
involving carina
funnel shaped bronchus
after aspiration of secretions
stenosis of RUL
bronchus intermedius tumor
Courtesy of Prof.
Abdulsalam Y Taha
Courtesy of Prof.
Abdulsalam Y Taha
Courtesy of Prof.
Abdulsalam Y Taha Prof.
Abdulsalam

13. Case 4: A 70-years old man with IBGC (small
cell lung cancer, skin and adrenal glands
metastases)
13
Courtesy of Prof. Abdulsalam Y Taha

14. Case 4: Skin Nodule
14
Courtesy of Prof. Abdulsalam Y Taha

15. Case 4: Left hilar mass on CXR
15
Courtesy of Prof. Abdulsalam Y Taha

16. Case 4
16
Courtesy of Prof. Abdulsalam Y Taha

17. Case 4: Left hilar mass and LLL collapse
17
Courtesy of Prof. Abdulsalam Y Taha
Courtesy of Prof. Abdulsalam Y Taha

18. Case 4
18
Courtesy of Prof. Abdulsalam Y Taha

19. Case 4: Bilateral adrenal glands
soft tissue lesions (? Metastases)
19
Courtesy of Prof. Abdulsalam Y Taha

20. Case 4: Small-cell lung cancer
20
Courtesy of Prof. Abdulsalam Y Taha

21. Signs of Inoperability in BGC
1. Poor pulmonary reserve.
2. Distant metastases.
3. Small cell lung cancer.
4. Unilateral or bilateral recurrent laryngeal
nerve paralysis.
5. Horner’s syndrome.
6. Phrenic nerve paralysis.
7. Pancoast tumor. 21

22. Signs of Inoperability in BGC…
8. Malignant pleural effusion
9. Chest wall involvement (relative)
10. Involvement of the contralateral lung
11. Involvement of the contralateral
mediastinal lymph nodes (LNs) or the
unilateral or contralateral supraclavicular
LNs (N3 Disease).
12. A tumor within the trachea or involving
the carina or in the main stem bronchus less
than 2 cm from the carina.
13. Superior vena cava (SVC) obstruction
syndrome.
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23. Comment…
 In 1997 study, we found that “95.8% of
Iraqi patients were inoperable. Many
patients had more than one sign of
inoperability. The commonest one was
poor respiratory functions. Some of the
signs were clinical e.g. SVC obstruction,
radiological e.g. rib erosion, while others
were bronchoscopic e.g. vocal cord
paralysis, widened and immobile carina,
carinal tumor and main stem bronchus
close to the carina” [1]. 23

24. Comment…
 The reasons for this high inoperability were 1.
The aggressive nature of the disease so when
the symptoms developed, the tumor was too
advanced 2. The patients usually consulted
doctors too late as respiratory symptoms were
attributed to smoking and chronic bronchitis 3.
There was unfortunately a delay in referral of
patients to bronchoscopy by the physicians; the
patient either received only symptomatic
treatment or misdiagnosed and treated as a
case of pulmonary tuberculosis [1].
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25. Take Home Message
 It is hoped that with smoking cessation, BGC
incidence would decrease. Moreover, patients'
education and physicians' orientation would
ensure earlier patients' consultation and
earlier referral of the patients for diagnostic
bronchoscopy and imaging studies to make the
diagnosis earlier. The increasing use of
thoracoscopic surgery would offer safer surgery
for more patients deemed to be inoperable
before. We aim to get a diagnosis of BGC in our
patients at an earlier stage so that more
“curative” operations would be performed.
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26. Bibliography
[1] Abdul Salam Yaseen Taha. The use of
fiberoptic bronchoscope in the diagnosis
of bronchogenic carcinoma. BJS March
1997;3:31-36
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