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Dr. Acromion:

Thank you Dr. Habib they say; 'Almost doesn't count.' It gave me the opportunity to refresh my knowledge on cancer.
I would kindly request you shade some light on this again, sorry for keeping you on the case; Is there any information in this case that proves that the cancer actually starts from the bronchus and not from the lungs or neighbouring structures while keeping in mind that even metastasis from other areas can lead to distortion of the normal anatomy of the bronchus?

Dr.Habiib:
 Thank you very much again and again Dr. Acromion.

When we making cases there is roles any word of the case is has a meaning so that what helps as diagnosis.
Also there is basic  clinical cases and advanced ( postgraduate clinical cases), in basic clinical cases we make simplify to be clear more and more and we list parts of investigations, on other you are doctor we don`t to be like others you must use a mind, so we make tricks to not reach answer easy.

On back to your opinion :

Let`s us to focus about metastasis:

   Metastasis: is a development of secondary malignant cancer implants, discontinuous with primary tumor.
Can occur in many routes; the most common of which lymphatics and vascular spread.
The most common sites are:  Lung, LIVER, and BONE BRAIN (2L AND 2B)

What does make metastasis in lung?

It is a malignant, makes hemorrhage and necrosis here is important we see clinically in the person dyspnea (difficult of breathing) so if we make case must see this word and if you are in your clinic you must see this problem in your patient.
In our case there is no word says there is difficult of breathing.

ON OTHER HAND DISTORTION OF VOICE:

There is many other factor can make alteration of voice so we use alteration not hoarse of voice.
This disease may lead to chances of voice:
1. Laryngeal nodule (laryngeal polyp or singer disease.
2. Squamous cell carcinoma of larynx.
3. Spread of cancer line bronchogenic.
4. And many other diseases like thyroid diseases.

Dr. Acromion:
Dr. Habiib, aad ayaad u  mahadsantahay, I appreciate.

Dr.Habiib:
My dear Dr. Acromion thank you.
 Our goals of cases is to make refreshment every one of our dear members to make updating of his knowledge day after, to comfort when he deals  our patient if we don't make this we will shock  when we will meet cases which is reality serous that makes confuse what we will make.
 
  FOR FATHER UNDERSTANDING:
LUNG METASTASIS:
 Origin:
Metastasis tumors of lung are common and may derive from:
1. Carcinomas (e.g. thyroid, breast, kidney, placental, G.I.T).
2. Melanoma.
3. Sarcomas.
4. Lymphoma.
HOW TO REACH THE LUNG?
 They reach the lungs though the blood spread.
 
1.BREAST, SKIN AND KIDNEY tumors: Tumor emboli derived this organs draining by systemic veins (vena cava) → Lung metastasis.
2.Tumors of G.IT: Tumor emboli derived from this organs drained by portal vein  → liver metastasis, futher spread from the liver gives rise of emboli that reach hepatic vein and consequently to the inferior vena cava  → Lung metastasis.

OR THEY REACH THE LUND RETROGRADE LYMPHATIC SPREAD IN CASE OF BREAST CANCER.

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