Chief Complaint: 68-year-old man with a coughand dyspnea (\"shortness of breath\") for the past week.

History: Daniel McDonald, a 68-year-old whitemale with a 40-pack-year smoking history suffered from chronicbronchitis for which he had been on antibiotics for several months.Two weeks ago, he began coughing up a bloody sputum (\"hemoptysis\").In the past week he's become increasingly short of breath. Aroutine chest X-ray revealed two silver dollar-sized opacities onthe right side of the carina. Bronchoscopic examination revealed atumor that was nearly occluding the right mainstem bronchus. Abronchial biopsy revealed the diagnosis: bronchogeniccarcinoma.

Questions:

Top of Form

1. Define the term \"bronchogenic carcinoma.\"

2. Ninety percent of all cancers arise from epithelial tissue.Why do you suppose this is?

3. Describe the structure of the bronchial epithelium.

4. What is the \"mucociliary escalator\"?

5. This man has a long history of infectious bronchitis. Whywould this chronic smoker be especially susceptible to infectionsof the bronchi?

6. Explain why this man has bloody sputum (\"hemoptysis\").

7. Explain why this man has shortness of breath (\"dyspnea\").

8. If you examined the cancerous tissue under the microscope,how might the cells differ in appearance from normal bronchialepithelium?

9. How might this type of cancer metastasize (i.e. spread toother parts of the body)? In other words, by which routes might thecancer cells reach other organs?

10. Why is the surgical removal of a lung cancer so ineffectivein halting the disease?