Pulmonology Book

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Lung CancerAka: Lung Carcinoma, Bronchogenic Carcinoma, Small Cell Lung Cancer

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  1. See Also
    1. Non-Small Cell Lung Cancer
  2. Epidemiology
    1. Lung cancer is the top U.S. cause of cancer death
    2. Exceeds deaths from combination of 3 cancers
      1. Colon Cancer
      2. Breast Cancer
      3. Prostate Cancer
    3. Incidence: 172,000 in U.S. in 1999
    4. Mortality: 158,000 in U.S. in 2006
  3. Pathophysiology
    1. Hematogenous seeding occurs at 1-2 mm
    2. Earliest detection of Tumor by CT Chest: 2 mm
    3. Tumor 1 cm size shed 3 to 6 million cells daily
  4. Risk Factors
    1. Tobacco abuse (Relative risk 10-30)
      1. Women: Tobacco directly linked in 90% of cases
      2. Men: Tobacco directly linked in 79% of cases
      3. Passive Smoke Exposure
    2. Asbestos Exposure
      1. Relative risk in non-smokers: 6
      2. Relative risk in smokers: 60
    3. Other associated environmental exposures
      1. Radon Gas
        1. Major and emerging factor in pathophysiology of lung cancer
      2. Arsenic
      3. Chromium
      4. Nickel
      5. Vinyl chloride
      6. Ionizing radiation
    4. Comorbid lung disease
      1. Chronic Obstructive Lung Disease
      2. Idiopathic Pulmonary Fibrosis
      3. Tuberculosis
  5. Types
    1. Small Cell Lung Cancer (20% of lung cancer)
    2. Non-Small Cell Lung Cancer (75% of lung cancers)
      1. Squamous Cell Carcinoma
      2. Adenocarcinoma
      3. Large cell carcinoma
  6. Symptoms (present in 90% at time of diagnosis)
    1. Constitutional symptoms
      1. Fatigue
      2. Anorexia
      3. Weight loss
    2. Cardiopulmonary symptoms
      1. Chest Pain (50%)
      2. Cough (75%)
      3. Dyspnea (60%)
      4. Hemoptysis (35%)
  7. Presentations: Intrathoracic spread (40% at diagnosis)
    1. Nerve injury
      1. Recurrent laryngeal nerve paralysis (Hoarseness)
      2. Phrenic nerve lesion
        1. Left diaphragm elevated
        2. Dyspnea
      3. Brachial Plexus Injury
        1. Presents as Horner Syndrome
        2. Associated with Pancoast's tumor
    2. Chest wall invasion
      1. May present as Pleuritic Chest Pain
    3. Pleural Effusion
    4. Esophageal obstruction
    5. Superior Vena Cava Obstruction
  8. Presentations: Extrathoracic spread (33% at diagnosis)
    1. Long bone or vertebral pathologic Fractures
    2. Supraclavicular Lymphadenopathy
    3. Liver metastases (liver transaminases rarely increased)
    4. Brain metastases (10%)
    5. Spinal column
    6. Lymph nodes
    7. Adrenal glands
  9. Presentation: Paraneoplastic Syndromes (10% at diagnosis)
    1. Hypercalcemia
    2. Syndrome of inappropriate antidiuretic hormone
    3. Cushing's Syndrome
    4. Hypertrophic pulmonary Osteoarthropathy (Clubbing)
    5. Lambert-Eaton myasthenia syndrome
  10. Diagnosis
    1. Non-invasive measures
      1. Sputum Cytology
        1. Test Sensitivity for central tumors: 71%
        2. Test Sensitivity for central tumors: 50%
    2. Less invasive measures
      1. Pleural Effusion Thoracentesis
      2. Excisional Biopsy (if node accessible)
      3. Bronchoscopy with bronchial samples and biopsy
        1. Indicated for central tumors
        2. Test Sensitivity for central lesions: 88%
        3. Test Sensitivity for peripheral lesions: 70%
      4. Transthoracic needle aspiration
        1. Indicated for peripheral lesions
        2. Test Sensitivity for peripheral lesions: 90%
    3. Thoracotomy
      1. Indicated for non-small cell carcinoma
      2. Lesion amenable to surgery
  11. Staging
    1. Non-Small Cell Lung Cancer
      1. See Non-Small Cell Lung Cancer for staging
    2. Small cell lung cancer
      1. Limited: Lesion confined to ipsilateral chest
      2. Extensive: Metastases beyond ipsilateral chest
  12. Labs: Evaluation for metastases
    1. Complete Blood Count
    2. Serum electrolytes
    3. Serum Calcium
    4. Liver Function Tests
  13. Imaging: Evaluation for metastases
    1. Chest CT and abdominal CT
    2. PET Scan (enhances staging by Chest CT)
  14. Diagnostics: Pulmonary Function Tests
    1. Initial Testing
      1. FEV1
      2. DLCO
    2. Second-line testing (indicated for DLCO or FEV1 <80%)
      1. Cardiopulmonary Exercise testing
      2. Arterial Blood Gas sampling
    3. Predictors of high morbidity and mortality
  15. Prevention
    1. Tobacco Cessation
      1. Tobacco exposure is the predominant cause of lung cancer
    2. Lung cancer screening does not change mortality
      1. Annual Chest CT screening might predispose to cancer
      2. Screening in U.S. would cost: $12 billion/year
      3. Routine lung cancer screening is not recommended
  16. Prognosis
    1. Five year survival 14% regardless of screening

Bronchogenic Carcinoma (C0007121)

Definition (MSH)A cancer of the lung, so-called because it arises from the epithelium of the bronchial tree. It is not a histologic designation despite the name.
Definition (CSP)group of carcinomas of the lung, arising from the epithelium of the bronchial tree.
Definition (NCI)A lung carcinoma arising from the bronchial epithelium. (NCI05)
ConceptsNeoplastic Process (T191)
MSHD002283
EnglishBC - Bronchogenic carcinoma, bronchial cancer, Bronchial carcinoma, Bronchial Carcinomas, Bronchiogenic Carcinoma, Bronchogenic Carcinoma, Bronchogenic Carcinomas, Bronchogenic Lung Carcinoma, bronchus cancer, Bronchus carcinoma, CA - Cancer of bronchus, CA - Carcinoma of bronchus, Cancer of bronchus, CARCINOMA BRONCHIOGENIC, Carcinoma of bronchus
Spanishcarcinoma broncogeno, carcinoma bronquial
Parent Conceptsrespiratory system cancer (C0814136), Carcinoma (C0007097), Lung Neoplasms (C0024121), Carcinoma of lung (C0684249)
SourcesAOD, CSP, CST, DXP, MSH, MTH, NCI, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Small cell carcinoma of lung (C0149925)

Definition (MSH)An anaplastic, highly malignant, and usually bronchogenic carcinoma composed of small ovoid cells with scanty neoplasm. It is characterized by a dominant, deeply basophilic nucleus, and absent or indistinct nucleoli. There are admixtures of small cell lung carcinoma with other types of lung cancer. Small cell carcinomas are distinguished by their distinctive biological features, response to chemotherapy and radiotherapy, and by their nearly universal tendency to develop overt or subclinical metastases, which frequently eliminates surgery in most patients. (From Stedman, 25th ed; Holland et al., Cancer Medicine, 3d ed, p1286-7)
Definition (CSP)radiosensitive tumor composed of small, oval, undifferentiated cells that are intensely hematoxyphilic and typically bronchogenic.
Definition (NCI)A type of lung cancer in which the cells appear small and round when viewed under the microscope.
Definition (NCI)A highly aggressive subtype of lung carcinoma characterized by the presence of malignant small cells and necrosis. Metastatic disease is usually present at the time of diagnosis. (NCI05)
ConceptsNeoplastic Process (T191)
MSHD018288
EnglishLung Oat Cell Carcinoma, Lung Small Cell Neuroendocrine Carcinoma, Oat cell carcinoma of lung, Oat Cell Carcinoma of the Lung, oat cell lung cancer, Oat Cell Lung Carcinoma, PULMONARY SMALL CELL CARCINOMA <OAT CELL>, PULMONARY SMALL CELL CARCINOMA OAT CELL, Reserve Cell Carcinoma, Reserve Cell Carcinomas, Round Cell Carcinoma, Round Cell Carcinomas, SCCL, SCLC, SCLC - Small cell lung cancer, SCLC1, SMALL CELL CANCER OF THE LUNG, Small Cell Carcinoma, Small cell carcinoma of lung, Small Cell Carcinoma of the Lung, Small Cell Carcinomas, Small Cell Lung Cancer, Small Cell Lung Carcinoma, Small Cell Neuroendocrine Carcinoma of Lung, Small Cell Neuroendocrine Carcinoma of the Lung
Spanishcarcinoma de celulas en grano de avena de pulmon, carcinoma de celulas pequenas de pulmon, carcinoma pulmonar de celulas en grano de avena, carcinoma pulmonar de celulas pequenas
Parent ConceptsCarcinoma (C0007097), Lung Neoplasms (C0024121), Carcinoma, Neuroendocrine (C0206695), Oat cell carcinoma (C0262584), Carcinoma of lung (C0684249), High Grade Lung Neuroendocrine Neoplasm (C1708364), Malignant neoplasm of lung (C0242379), adult solid tumor (C0280099), Small cell carcinoma of lung (C0149925), Carcinoma of lung parenchyma (C0345957)
SourcesCOSTAR, CSP, DXP, MSH, MTH, NCI, NDFRT, OMIM, PDQ, QMR, RAM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Carcinoma of lung (C0684249)

Definition (NCI)A carcinoma originating in the lung. Lung carcinomas usually arise from the epithelium that lines the bronchial tree (bronchogenic carcinomas), and are classified as small cell or non-small cell carcinomas. Non-small cell lung carcinomas are usually adenocarcinomas, squamous cell carcinomas, or large cell carcinomas. Metastatic carcinomas to the lung are also common, and can be difficult to distinguish from primary tumors. -- 2004
ConceptsNeoplastic Process (T191)
EnglishCancer of Lung, Cancer of the Lung, CARCINOMA LUNG, Carcinoma of lung, Carcinoma of the Lung, Lung Cancer, Lung carcinoma, PULMONARY CARCINOMA
Parent ConceptsMalignant Neoplasms (C0006826), Lung diseases (C0024115), Carcinoma (C0007097), Malignant neoplasm of lung (C0242379)
SourcesCOSTAR, CST, MTH, NCI, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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