When infection occurs distal to a tumour, however, it frequently persists or relapses. For this reason failure of a pneumonia to resolve is a common presentation of bronchial carcinoma. In bronchial carcinoma general symptoms such as lethargy, anorexia and weight loss frequently signify disseminated disease. The most important sites of secondary spread are liver, bone and brain, but virtually all parts of the body can be affected. Diagnosis Carcinoma of the bronchus is so common and has such a variety of symptoms and signs that it should be considered in mist heavy smokers.
Diagnosis is usually straightforward and the first important investigation is a chest X-ray.
In a smoker, clubbing, haemoptysis, persistent chest infection or weight loss demand an immediate X-ray of the chest. In addition to confirming the diagnosis, a knowledge of tumour cell type affects treatment. Similarly, cytology of pleural fluid will usually confirm a diagnosis of malignancy. In a small number of patients, surgical biopsy is necessary to establish a diangosis. In considering surgery, assessment for mediastinal spread is critical.