Chronic Cough Due to Lung Tumors: Treatment of Cough Caused by Cancer Surgery
Conversely, bronchoscopy usually will not reveal a malignancy when there is little risk for lung cancer (nonsmokers) and normal findings on a plain chest radiograph. Two prospective descriptive studies” have provided information about the role of bronchoscopy in this setting. Chest radiographs had positive predictive values of 36% and 38%, respectively, for airway cancers and a negative predictive value of 100%. Bronchoscopy had positive predictive values of 50% and 89%, respectively, in the two studies, and a negative predictive value of 100%. Bronchoscopy may be indicated to complete the assessment of cough in nonsmokers with normal chest radiograph findings to diagnose bacterial suppurative disease and other nonmalignant airway diseases. However, a patient who smokes cigarettes who has a new cough or a changing character to the cough that persists for months should almost always stimulate a bronchoscopic examination, even when the chest radiograph findings are negative.
In a patient with cough who has risk factors for lung cancer or a known or suspected cancer in another site that may metastasize to the lungs, a chest radiograph should be obtained. Level of evidence, expert opinion; benefit, substantial; grade of recommendation, E/A anti allergy medicine
In patients with a suspicion of airway involvement by a malignancy (eg, smokers with hemoptysis), even when the chest radiograph findings are normal, bronchoscopy is indicated.
Level of evidence, low; benefit, substantial; grade of recommendation, B
Surgery to remove non-small cell lung cancer (NSCLC) is the treatment of choice for patients with stage I and II NSCLC, assuming that comorbid diseases (eg, COPD and heart disease) do not create a prohibitive risk. If cough was caused by a NSCLC that can be surgically removed, clinical experience suggests that the cough will typically cease. However, there are no studies that have systematically addressed the incidence of cough cessation after surgical resection of lung cancer. Palliative, ipsilat-eral to the primary, high intrathoracic vagotomy immediately below the origin of the recurrent laryngeal nerve was reported to substantially alleviate cough in almost all of the 18 patients who underwent exploratory thoracotomy but who had unresectable cancers.
Category: Respiratory Symptoms
Tags: ablative methods, antitussives, brachytherapy, bronchoscopy, chemotherapy, electrocautery, endobronchial treatment, laser, lung cancer, metastatic carcinoma (to lungs), radiation therapy, stents, Surgery