1.What is your diagnosis of this case?
It would be the wise to say as already indicated in the case that the diagnosis is Carcinoma in the upper lobe of the left lung ( Lung cancer).
2. What are the predisposing factors of this case?
The principal predisposing factor is cigarette smoking including second hand smoking, the risk of lung cancer increases with the number of cigarettes each day and the number years smoked. Quitting smoking at any time can significantly decrease one's chances of developing lung cancer in the future.
Exposure to certain chemicals like asbestos, radon gas can increase the risks of Lung cancer.
There is also the so called " non-modifiable risk factors" such as heredity, age , sex and race may play role in lung cancer development.
Certain chronic lung diseases , for example Chronic Obstructive Pulmonary Disease (COPD) may also increase the risks of developing lung cancer.
3. How this cancer spread?
The cancer cells spread via the bloodstream , the lymphatic vessels or by means of direct contact to the adjacent body structures.
4. What are superficial lymph nodes would be enlarged and palpated?
Supraclaviculer lymph nodes are the most important, however a complete physical examinations should include palpation for the anterior cervical, posterior cervical , axillary, tonsilar, submental and submandibular lymph nodes and in advanced stages of the cancer as far as the inguinal region.
5. Clarify the bronchopulmonary segments of the upper lobe of left lung?
Left upper lobe;
1 and 2. Apicoposterior bronchus
3. Anterior bronchus
Lingula
4. Superior bronchus (lingular)
5. Inferior bronchus (lingular)
6.What would be the cause of alteration of voice?
Alteration of the voice also known as hoarse voice is do to compression of the left recurrent laryngeal nerve by the cancerous (pancoast) tumor.
7.What caused distortion carina of trachea?
The growing cancerous tumor compresses and pushes the immediate structures such us the trachea, great blood vessels, mediastinum , th ribs leading to distortion of the carina of trachea.
8.What are the complications of this case?
If the cancer spreads throughout the lungs the level of oxygen in blood drops causing shortness of breath.
Blockage of air way by the tumor may lead to the collapse of the part of the lung that the airway supplies, a condition called Atelectasis,
Accumulation of fluid between the lung and the chest wall...........pleural Effusion may also occur leading to sensation of breathlessness.
The cancer may also encroach into certain nerves in the neck , causing a droopy eyelid , small pupil, Sunken eye and reduced perspiration on one sid of the face..........this is called Horner's Syndrome.
The Esophagus my be affected by the growing cancer causind difficult in swallowin food or pain while swallowing.
The heart may be affected by the lung cancer leading to arrhythmias, reduced blood flow to the heart due to obstruction of the superior vena cava by the tumor causing facial swelling , cyanosis and dilatation of the veins of the face and neck......known as the Superior vena cava syndrome and ultimately heart failure.