CTS1A Tumours and their anatomico-physiologic complications

Case 1
A 50-year-old man presents with weight-loss and a persistent cough with blood-stained sputum.
His wife has noticed an alteration in his voice. He smokes 2 packets of cigarettes a day.
On examination, the left vocal cord is immobile and lies in the adducted position. A PA chest
Xray shows a large mass in the upper lobe of the left lung with an increase in the width of the
medistinal shadow on the left lung.

Questions
1. What are the signs and symptoms in this case?
Signs: immobile left vocal cordlying in adducted position.
Symptom: voice alteration, weight-loss, persistent cough with blood- stained sputum.
2. How can you correlate the alteration in the voice with the rest of the symptoms?
Change in the voice pattern (hoarseness of voice) can be a symptom of lung cancer. This occurs
more commonly with left sided tumors and happens because of the pressure effect of the tumour
on the left recurrent laryngeal nerve. Cigarette smoke contains over 60 known carcinogens,
including radioisotopes from the radon decay sequence, nitrosamine, and benzopyrene.
Additionally, nicotine appears to depress the immune response to malignant growths in exposed
tissue. The blood coughing is due to the force of the tumour on the alveolar capillaries which
might cause them breaking and leak blood. These leak back until they enter the trachea and
blood is coughed subsequentially.
Left main bronchus tumour.
3. What other features would you expect to see in the chest Xray?
-Any nodes on the region of the lung to indicate whether the tumour has metastasized or not.
Enlarged lymph nodes in the lungs (Hilar lymph nodes). Collapsed lung- If the bronchus grows
enough to obstruct bronchus. Pneumonia can be an option. Accumulation of secretion which may
be infectious since they are not moved around, stagnate and cause infection. Fluid stuck in a
particular place gets stagnant. If tumour completely blocks the bronchus, from growing in inside,
air gets trapped, absorbed in circulation since it is 20% O2 and CO2, N2 gets absorbed slowly
therefore lungs gets collapsed since there is no fresh air keeping them open.
4. Would you expect this patient to present with chest pain?
The tumour can cause dull, sharp, or stabbing pain in the chest but it is not always the case. The
tumour can increase the pressure in the mediastinum and compresses other organ and nerves
thus would present with pain. Lung Cancer would present with chest pain when it is at a late
stage since the tumour would have already developed and pressing on a nerve which would
present ith visceral pain.
Cancer may present without pain. Lungs at apex may cause pain in hand and neck.
5. What anatomical characteristics would determine whether a tumour would present with
pain?
It causes pain when it presses on a nerve, blockage of vessels, Bone cancer.
Pain associated with pressur on nerves.
6. Give examples of carcinomas which in your opinion would classically present with pain.
Bone cancer since there is a lot of nervous tissue highly innervated. It has to do with the
expendability of the tissue. Bone not expandable thus tumour starts to grow pressing on
nerves. As it grows it puts a lot of pressure on the tissue. Tumour growing in lungs for
example is spongy with no pain. Tumors in cavities, cause no pain. Ovarian cancer, no
pressure bulid up no pressure on nerves thus no pain felt. Anything which increases space
in brain cause increase intracranial pressure causing head aches.
Spinal cancer
Prostate Cancer
If you have a colon cancer it will be diagnosed last in ascending colon since faeces in ascending
is still liquid thus can tricle past. Descending faeces would be large thus passage obstructed
casuing constipation and bleedin and mucous.

Case2
A 40 year-old woman goes to her doctor because she has noticed a swelling in her neck which
has grown over several months. She is preoccupied now because she has noticed that her neck
looks swollen all over. On examination you see very distended neck veins and a raised SVC
/jugular vein pressure. Person would also have swollen hands.
Questions
1. Can you explain the womans clinical features?
Symptom: Swollen Neck which has grown over several months
Sign: Distended Neck vein and raised SVC pressure
2. What pathology could present in this way?
There may be a tumour in the superior mediastinum which is pressing on the superior
vena cava thus pressure is increased in the SVC. The blood pools in the veins since it is
restricted from going down thus owing to the distended neck veins and bluish neck
appearance. This could include bronchogenic carcinoma including small cell and non-
small cell lung carcinoma, Burkitt lymphoma. Upper lobe tumour Right Or lymphoma
pressing svc inwards.
Swelling in tissues too (hands ex)
Arterial blood coming in, venous blood is stagnant thus high hydrostatic pressure thus
oedemain hand.
3. What is the name of the syndrome?
Superior vena cava syndrome


Case3
A 35-year-old man presents with sudden onset of dropping of the right upper eyelid. On
examination, there is constriction of his pupil and enophthalmos.

Questions
1. What is enophthalmos?
Enophthalmos is the progressive displacement or sinking in of either one of both eyeballs
over any length of time.
2. What is the clinical term for dropping of the upper eyelid?
Eyelid ptosis
3. Can you correlate, using your anatomy, the three clincial signs. What is happening?
Horners syndrome which includes constriction of the pupil, ptosis and enophthalmus. It
is caused by an interruption of the sympathetic nerve supply to the levator palpebrae
superioris.
Dry, red face.

4. What could be the cause of this?
Horners syndrome is a sign of another medical problem such as a stroke, tumor or spinal cord
injury. Cancers of the top part of the lungs (sometimes called Pancoast tumors) may damage a
nerve that passes from the upper chest into your neck which could therefore lead to the Horners
syndrome. Stroke, tumor, or other damage to a part of the brain called the brainstem, Injury to
one of the main arteries to the brain (carotid artery).
Tumour growing in apex of heart starts compressing sympathetic chain against rib thus start
getting a knock out of syonpathetic function.