SMOKING AND LUNG CANCER

[Music] patient Wilfred Ayers talks to surgeon DeeDee Monroe so mr. Ayers if this proves to be a cancer of the lung your outlook or your prognosis is almost 100% nil for any length of time and with operation and complete removal of the tumor and the tumor bearing area you have a reasonably good outlook but then once it's completed the only thing to do is to go back to your job and live with optimism and quit smoking and quit smoking Wilfried heirs will walk these streets again but- the cigarette and - a lung in a week he will have a major operation which we will see and which may save his life last year in north america 50,000 people died from cancer of the lung a disease which has become a major killer only since the smoking of cigarettes has become epidemic many more thousands died of coronary heart disease or we're disabled by chronic bronchitis emphysema and other illnesses which medical men the world over say can be related directly to the smoking of cigarettes almost a hundred and fifty years ago Charles lamb wrote for thy sake tobacco I would do anything but die medical men say too many people are doing just that [Music] [Music] history history of heavy smoking very good the number of years would you care to make give any opinion as to the relationship between his smoking and the fact that he appears now with the proven bronchogenic carcinoma of the squamous cell variety I definitely feel that it did have a relationship to this morning but I don't think we can prove it I think there is no question that prolonged cigarette smoking is responsible I presume for carcinoma certainly these people get carcinoma and the logical assumption is the responsibility of the cigarettes now what in the cigarette smoking is responsible for it I don't think we can say at all whether or not it's tar or some other product of combustion is not at all clear but I think the association is clear and I think that it is certainly more than adequate to be acted upon in in advising people whether or not to smoke and you will be the first one I'm sure will agree that there are other deleterious effects of smoking that perhaps haven't got the fatality of a cancer the lung but from an economic point of view and from the point of view of disabling a person they're equally as important and I'm talking particularly about the chronic bronchitis and the emphysema those people coronary artery disease seems to have some association certainly there are some cases where this appears to be clear-cut there is a time-honored association with burgers disease there is no doubt that there are a number of areas of medicine where you can get this deleterious between the disease and smoking I've done the stupidest thing I've lived a cigarette before Brecker having anything three and four cigarettes but since I get out of bed which is I think is uh no good to anybody and my wife says to me several times she says why ever don't you stop suppose inhale my smoke yes what was the symptom or the reason that motivated you to seek the advice of a doctor in the first place well I for a pastor and nine months when I went to see dr. Ali's I had a streak of blood on my phlegm saying here's futile he must be done that so I thought well this has gone far enough and my wife said why don't you go and see the doctor so I said I will I'll make up my mind one of these days I didn't know what I was involving myself in this is important yes I should say about nine months ago and when did you go to the doctor it was a months ago just a month ago so you waited eight man I waited eight months why well I thought it was a blood vessel I'd broken and when I coughed that it wasn't I put these x-rays up here not specifically for you to completely understand them but to give you a rough idea of what your problem is now if you look at this x-ray here you will see that you have a shadow which is generalized in the upper part of the left lung and if you compare this to the right lung you'll see that there's a difference in the degree of penetration on both sides what this represents is that you have a complete obstruction to with you mr. Ayers the thing that we're all concerned about this day is the fact that this could very likely be a tumor that's obstructing your airway this tumor is undoubtedly likely to be a malignant tumor and in other words it's to be a cancer and if it proved to be a cancer the only satisfactory treatment is to remove it completely this will mean that you will lose your left lung and the other lung is good isn't it oh a spar as we know it's an excellent excellent condition so that that is one reason why I think that the left lung should come out I little did I know till I came in here that I had only a lung and a half or less all right mr. Aris we'll carry on with the bronchoscope examination tomorrow and after that there will be no further delay if it's indicated we'll take you to surgery yes now mr. Ayers we're going to carry out this bronchoscopy procedure that I explained to you yesterday and this is the instrument and the light is on the end of this hollow and we put this through your ear tree and this is just a simple diagram of your ear tree with the lung at the side I'll pay no attention to this side this is your left lung yes and this is the part that is involved in other words this part of your lung which is your upper lobe is collapsed because there's something plugging the airway going into it right here you have a bird's eye view so to speak of the air tree as we look sideways through a special instruments that's actually a miniature periscope that we can look at a right angle and these openings here which speed air into this upper lobe are plugged and the object of this is to put down the bronchoscope we turn your head to the side to line it up and we have it lying in here the main airway going to the entire left lung and then we look sideways into this left upper lobe bronchus and we observe directly with the human eye exactly what the condition and the nature of that air tube is and this is the object of the examination I don't think it'll bother you very much we'll do it on a local anesthesia will freeze your throat and I think you'll find it very easy okay in dr. mundo your tongue will get sick I will be a little difficult to swallow for yourself does it be an indication that you start to get rosin [Applause] we're ready to uh alright I'll just lie down sir fine thank you just raise your head sir raise your head now put it down I don't think you'll find this examination all upset at all so just write what size of this number seven eight that's fine just to cut your tongue sir and just relax nice and easy nice and easy that's it no problem there tall flow could I have the portably scope please all right now we're right in your main airway now mr. Ayers and we're looking down into your main airway and we can see the two divisions now we have these little telescopic instruments that I was talking to you about then we've got this through the hollow tube and we're looking on the interior of your airway and we can see a very nicely I'll have a right-angle scope now and now we're going to put in the telescope this that's a miniature periscope so we can look sideways and with this instrument we're able to see side branches directly you're doing very well mr. ears there's no problem here at all and there will soon be finished this off your head just swing your feet over the side now did we bother you very much yeah well we've determined that your rape line looks very clear and the your left the main part of your left airway is fine and that our suspicions that the left upper lobe the airway was blocked has been confirmed yeah and so this is plugged and it's plugged by a tumorous growth so our next job now is to fix you up and to get rid of this and we'll proceed with that next week sure okay mr. Ayers [Applause] not all smokers have the reasons to stop that Wilfred Ayers has but not all who developed cancer have the warnings he had either cancer is a silent killer and more often than not does not proclaim its onset and doctors now urge that those who smoke have x-rays twice a year too many smokers come with their problems too late when surgery or radiation or other treatments cannot cure them breathing tests help determine how he will function on only one lung smoking no keep going keep blowing keep blowing as much as you can I really understood in his oxygen uptake this is really when I'm visa v1 long against the other easy the capacity of each separate lung can be plotted on a spirometer that's all he calculated sure we just want one against the other anyways because I want to in case have to cover the whole thing I think we better get more Demerol don't you this is the moment of truth but there bang on you know that thing's in there real tight I know okay it's a good differential spirometry physical examination was essentially unremarkable apart from the fact that there was a gross abnormality in the iris point respiratory sounds in his left upper chest suggesting the collapse of his left upper lobe the rest of the physical examination was negative and the chest x-ray was grossly abnormal he's had extensive investigations now many of which are of little interest because they're essentially normal including electrocardiograph and his pulmonary function studies in extremely healthy-looking man and I think almost clinically you could tell that he wouldn't present a risk to surgery and I think it's his only chance for a possible cure of his disease he has no evidence of cardiovascular disease none whatsoever may we see the x-rays now the geological findings are such that they indicate an obstruction in in the left upper lobe rompers would you call the remainder of as long normal the remainder of his left lung dis no his right lung shows no evidence of any disease we took a biopsy from this tumor medicine dr. Bellin condors around eh yes well the biopsy showed that squamous cell carcinoma there's no doubt about it and no-step dermatology elsewhere that would suggest extraterrestrials are the pulmonary function studies will be more helpful in making sure that he has enough reserve to withstand the sort of surgery that Katrina who heals up the Oh sir yeah vital capacity does maximum breathing capacity time vital capacity and pulmonary diffusing capacity with carbon monoxide uptake the opinion of the pulmonary function consultant was in summary the findings reported above are reasonably good for a male in this age group of the flow rates are perhaps a little bit down not as much as I would expect with his long history of smoke that is diffusing capacity was normal I wouldn't consider these a contraindication to any to a pneumonectomy dr. Pollock any color I agree with dr. Monroe one with the general course of the discussions and I think in this case operation is a best way to proceed as a result of the anesthetic you pile up secretions in your chair and it's difficult for you to cough and the breathing exercises can make this simpler for you so let's just check them again you don't have to feel coughing after the operation mr. here because I'll be supporting your incision so it's just let's practice again with the breathing in and short breath in Long breath out and calm there is little hope among medical men that those who now smoke will stop despite new medical knowledge that much lung damage can be reversed by stopping they only hope that examples like mr. Ayers will cause non-smokers not to begin the way I look at it it's a must-do doctor mono and how the doctors have told me and I put myself into their hands company I mean he told me once that he said he a little while back there that it he didn't get too much chance for my life you see you're not I didn't have something done I've heard that there's lots of individuals going around with one life as a matter of fact there's a lady I know very well through daily contact sometimes in a store you see and she only has one line I think it you can't tell any differently she's got one or a half a dozen maybe I could recommend that you try to rest as much as you can and to relax as much as you can when I start to come to from the anesthetic you call it yeah yeah am I likely to get into a tantrum like it mad no no no no you were weak I had that experience once they plugged the ether over here and I was asleep the seven o'clock came round about midnight the same man that was wounded you know for my neck and let's talk about 12 of them and I was cursing everybody around me funny mr. Ayers there is nothing to that yeah I just had my little dab there cuz I won't want to cause any commotion like that you know in my I'm not going to say that H actually done by smoking you know what I mean I had left it to the doctors to lose and then but when I was told not to smoke I have not caught man I should have taken my dearly beloved wife's advice years ago and cut down on this smoking you know sometimes you get into a little bit of a some Andrew I mean you get into a jam and first thing you will do is pick up cigarette you keep smoking and smoking and smoking you know when you're told that you haven't done you got that the the prospects in life is not very far ahead of me you know then you should up and take notice because life is sweet by pressures 130 the air we're injecting the pentose all in the intravenous now then you will just fall off to sleep very quietly very pleasantly you may notice the little peculiar taste or smell something like onions or garlic there now that lady only the right lung left lung is excluded from the airway blood pressure is 120 now you let the respirator the automatic respirator take over control of ventilation now we're ready to position the patient for the surgery this is help to help position his legs properly please eat it up now alright we're about to make the incision dr. Brenda everything all right this particular patient will and other the take out a rib to facilitate the closure issues remaining 19 I hold this now to the second rib that 2/3 the four that's five this rib is riding high [Applause] something [Applause] [Applause] you hold that money boy [Applause] [Applause] the large man it's got to come that's not me by chance to me gonna come but it's not not the most favorable situation Thank You distance to be confined to the phone are you happy that the author's doesn't seem to be it was clear it's clear it's not involved and there's nothing in the mediastinal area up above which is to remain leopardi and maybe the sure people aren't even gonna say well we just have to work away but we get to think their toes all right we're just about for just about ready to sever the lungs now what I have in my hand here at its the air to the other edge is going the other lung branches there this is a soft clamp it's gentle to the tissues and will clamp the air tube like so now I'm just giving a nice please I think we should set that a little further down Robinson Palin I almost ever the connections here and as we do doctor the ferry keeps cutting a nose there we are here's what we've been asked for this morning is remove that line containing the tumor mass which I have in my fingers here dr. Beale and we'll take this and demonstrate but all the big vessels and everything that come off the stairs are all tied off here this isn't the important side of course the side is next to the heart now let's cut the lawn completely so that we can have a good view of this neoplasm or tumors we start from the upper lobe and we'll go down to the base of the lung here is the tumor in the upper lobe occupying almost half of it it's not a very large tumor just I would say medium-sized it is a hard white mass that you can see here the rest of the tissue is soft and spongy and this tumor is very hard it is fairly well demarcated and the definite prognosis can be established only after microscopic examination the operation is all over yeah try to keep your eyes open now will you take a deep breath for deep and trying to give us a smile oh sure Wilfred Ayers has opened his eyes again on a world that wears a cigarette in its face where he will have to live with temptations that confront a smoker wherever he looked sin listens where persuasion filters out of the mind of the beholder the consciousness of the harms that medicine now definitely attributes to cigarettes a world whose governments are split between the revenues they gain from cigarettes and the responsibility they feel for the health of their people's a world that seems to have no ready answer to the question of how far laws should go in curbing the rights of people to make their own choices and take their own consequences a world where the young are taking ever earlier to a habit that Public Health Association's have estimated will claim the lives of millions who are now school children before they reach the age of 70 [Music] [Music]