1. Bronchial and lung tumors can be diagnosed through careful clinical evaluation, imaging exams like CT scans, and endoscopic examination. Common types include carcinoid tumors, adenoid cystic carcinoma, and mucoepidermoid carcinoma. 2. Symptoms vary depending on the type and location of the tumor but may include coughing, wheezing, chest pain, and shortness of breath. Treatment options range from surgery to chemotherapy and radiation depending on the cancer's stage and type. 3. Physiotherapy plays an important role both before and after treatment through exercises to improve physical functioning and manage symptoms. Exercise programs aim to preserve independence and quality of life for those with advanced cancer.

1. BRONCHIALAND LUNG TUMORS
PHYSIOTHERAPY IN CARDIOPULMONARY CONDITIONS (BPT402)
JAMIA MILLIA ISLAMIA
New-Delhi
Submitted to- Dr. JAMAL ALI MOIZ (PhD)
Submitted by- SHOAA MAHMOOD
BPT4th YEAR
2020-2021
CPRS

2. BRONCHIAL TUMOR-
Bronchial tumor is a rare type of cancer, that starts in the mucous gland and ducts of the lung airways
(bronchi)or windpipe(trachea), and in the salivary glands.
TYPES OF BRONCHIAL TUMORS:
1. CARCINOID TUMORS-affect hormoneproducingcells and nerve cells. They can form in the
lungs, stomach and intestines.
2. ADENOID CYSTIC CARCINOMA-usually starts in the salivary glands, in the mouth and
throat. It also can affect the trachea, tear glands in the eyes, sweat glands, or women’s uterus, or
breasts.
3. MUCOEPIDERMOID CARCINOMA-happensin the salivary glands. Most cancer of this
type affect the parotid glands in front of the ears.

3. SYMPTOMS:
1. Carcinoid tumor symptoms include:
• Cough, sometimes with blood
• Wheezing
• Shortnessof breath
• Chest pain
• Flushing of the face
• Infections such as pneumonia
2. Adenoid cystic carcinoma symptoms include:
• Lump on the roof of the mouth, underthe tongue, or in the bottomof the mouth
• Troubleswallowing
• Hoarse voice
• Numbness in the jaw, roof of the mouth, face or tongue
• Bump underthe jaw or in front of the ear.

4. 3. Mucoepidermoid carcinoma symptoms include:
• Swelling in the gland near ears, under jaws, and in mouth
• Numbness or weakness of face
• Pain in face
DIAGNOSIS:
• Biopsy
• X-ray
• MRI
Fig. 1- Tracheobronchialtumor

5. TREATMENT:
Removing the lesion with great spare of the functionalparenchyma is the goal of the surgical
treatment.
ENDOSCOPIC TREATMENT:
• Endoscopictreatment are used to ablateendobronchialtumors.
• Repeated endoscopictreatments are required to completelyremove the neoplasticmass.
SURGICAL TREATMENT:
• Aim of surgical treatment is completetumor resection.
• Lesions located in the laryngeal tract, an anterior tranverse collarincision is indicated.
• Neoplasticlesion involving upper tracheacan be approachedby transverse cervical incision.
• Masses localized in the main bronchi, the gold standard is the sleeve resection.

6. LUNG TUMOR-
• Cancerouscells that form in the lining of the lungs.
• It can be in one or both of the lungs.
• Can form canceroustumors which can spread.
RISK FACTORS-
• Tobacco (cigarette smoke) is the primary cause
− Accounts for 90% of all cases
− 25% is from second-handsmoke
• Radon
• Asbestos exposure
• Pollution
• Family history
• Age

7. TYPES OF LUNG TUMOR-
1. Non-small cell lung cancer (NSCLC)-
− Most common type
− About 80-85% are NSCLC
− Grows more slowly
2. Small cell lung cancer (SCLC)-
− Spreads more quickly and aggressively
− Accounts for 15% of cases
− Found mostly in heavy smokers
Fig. 2- Non- small cell lung cancer. Fig. 3- Small cell lung cancer

8. SYMPTOMS-
• Chest pain
• Wheezing
• Fatigue
• Loss of appetite
• Continuouscough
• Coughing up blood
• Shortnessof breath
DIAGNOSIS:
• Biopsy
• CT scan
• X-Ray
• Surgery
• Chemotherapy
• Radiation therapy

9. STAGES AND TREATMENT OF NSCLC:
Stages Description Treatment options
Stage I Tumor of any size found in the lung Surgery
Stage II Tumor has spread to Lymph nodes
associated with the lung
Surgery
Stage III a Tumor has spread to the lymph
nodes in the tracheal area, including
chest wall and diaphragm
Chemotherapy followed by
radiation or surgery
Stage III b Tumor has spread to the lymph
nodes on the oppsite lung or in the
neck
Combination of Chemotherapy and
radiation
Stage IV Tumor has spread beyond the chest Chemotherapy only

10. STAGES AND TREATMENT OF SCLC:
• Limited Stage
– The cancer is confined to one area of the chest
– Include nearby lymph nodes
– Treated with radiation therapy and chemotherapy
• Extensive Stage
– A tumor has spread beyond the lung
– Accounts for 70% of SCLC
– Treated with chemotherapy only
COMMON SIDE EFFECTS RESULTING FROM TREATMENT:
• Pain
• Cough
• Fatigue
• Nausea, vomiting
• Diarrhea, constipation
• Hair loss
• Loss of appetite
• Weight gain or loss

11. PHYSIOTHERAPY MANAGEMENT
PREHABILITATION:
• Prehabilitationis exercise delivered prior to surgery or treatment.
• Prehabilitationcan be used in-
1. Operablepatients to maximise their physical status prior to the insult of surgery and reduce
postoperative morbidity
2. Inoperablepatientsto improve their physical status enough for them to become operable.
PERIOPERATIVE MANAGEMENT:
• Aims to treat PPCs, prevent musculoskeletal sequelae, facilitate early and safe discharge home.
• Physiotherapyprinciplesinclude-
1. Early mobilisation commenced on the first postoperative day.
2. Sitting out of bed and supportedcoughing.
3. Shoulder/thoraciccage exercises are prescribed after removal of the intercostal catheter.
4. Reduce pain
5. Function improvement in short term.

12. POSTOPERATIVE MANAGEMENT:
Day-1 postoperative:
• Sit out of bed in ward chair.
• Ambulate greater than or equal to 20m on ward.
• Teach supported cough with towel wrap
• Commence respiratory physiotherapy if indicated.
Day-2 postoperative:
• Ambulate greater than or equal to 50m on ward.
• Encourage supported cough.
• Commence or continue respiratory physiotherapy if indicated.
Day-3 postoperative:
• Review by physiotherapist only if patient requires ongoing mobility assistance or respiratory
physiotherapy.
Once intercostalcatheters are removed:
• Teach upper limb and thoracic mobility range of motion exercises.
• Physiotherapy completes a discharge mobility assessment and provide any discharge planning as
required for safety.

13. EXERCISE FOLLOWING TREATMENT:
• Exercise following surgery or treatment aims to restore physical status and to maximize function,
physical activity, psychological status and health related quality of life in the long term.
• Majority of studies includeboth aerobic (ground walking, treadmill or stationary cycle) and
resistance training components.
• Other componentssuch as breathingexercises, dyspnoeamanagement, balanceexercises and
stretches are used occasionally.
• Generally exercise programs are supervised, run for 8 to 12 weeks (range 4 to 14 weeks) and occur
in an outpatientsetting, although inpatient and home based programs have also been used.
• The exercise program should be individually tailored to the patient.
• Careful pre-exercise screening and assessment, and monitoringthroughoutthe exercise program is
advised.

14. EXERCISE IN ADVANCED DISEASE:
• Exercise for peoplewith advanced lung cancer aims to prevent deterioration in physical and
psychological status and maximize independence.
• A combined exercise program of aerobic and resistance exercise can be given to inpatientsas well
as outpatients.
• Neuromuscularelectrical stimulation may be an option for patients with severe symptoms that limit
exercise performance.
• Adherenceto an exercise training is an important issue in advanced lung cancer. Adherenceto the
exercise training sessions is higher for supervised hospital-based training .
• Telerehabilitationposes a potentialalternative model of deliver, where patient exercise at home
while being monitored and supervised by health professionalslocated elsewhere.
• Palliative care is important in advanced lung cancer, which focus on management of breathlessness
with breathingtraining, relaxation techniquesand activity pacing.
• Assistance with mobilisation, provision of gait aids and function-directedexercises are indicated.

15. SUMMARY:
• Careful clinical evaluation, imaging and endoscopicexamination are essential for the confirmation
of bronchialand lung tumors.
• Early diagnosis may allow to perform parenchyma saving surgeries, avoiding the functional
problems related to extensive lung resection.
• Aerobic exercise result in improvement in functional capacity but not health related qualityof life.
• Improvement in muscle strength are observed in peoplewho undergo resistance training exercises.
• Exercise is also associated with reduced cancer symptoms, anxiety and depression.
• There is rapid functional declinein the advanced stage of lung cancer, maintenanceis a positive
result.
• Growing evidence suggests that exercise following surgery/treatment is associated with
improvement in physical and physiological outcomes.

16. REFERENCES:
• Physiotherapymanagement of lung cancer, Journal of physiotherapy, Catherine. L. Granger, 2016.
• Epidermiology, etiology and prevention, Clin Chest Med, 2011.
• Clinico-radiological characteristicsof tracheobronchialtumors, Stevic R. et al, 2012.
• Endobronchial tumor in children:unusual findings in recurrent pneumonia.Madafferi. S. e5 al,
2015.
• World health organization.Cancer fact sheet number 297.