Pulmonology Book

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Lung Cancer

Aka: Lung Cancer, Lung Carcinoma, Bronchogenic Carcinoma, Small Cell Lung Cancer
  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 EffusionThoracentesis
      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. Management: Cranial Irradiation in Small Cell Cancer
    1. Prophylactic cranial irradiation improves survival
    2. Auperin (1999) N Engl J Med 341:476-84
  16. 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
  17. Prognosis
    1. Five year survival 14% regardless of screening

Small cell carcinoma of lung (C0149925)

Definition (MSH) A form of highly malignant lung cancer that is composed of small ovoid cells (SMALL CELL CARCINOMA).
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.
Definition (NCI) An aggressive (fast-growing) cancer that forms in tissues of the lung and can spread to other parts of the body. The cancer cells look small and oval-shaped when looked at under a microscope.
Definition (CSP) radiosensitive tumor composed of small, oval, undifferentiated cells that are intensely hematoxyphilic and typically bronchogenic.
Concepts Neoplastic Process (T191)
MSH D055752
SnomedCT 254633006, 254632001
English SMALL CELL CARCINOMA OF LUNG, LUNG CARCINOMA, SMALL CELL, LUNG CANCER, SMALL CELL CARCINOMA, LUNG CARCINOMA, OAT CELL, OAT CELL CARCINOMA OF LUNG, PULMONARY SMALL CELL CARCINOMA <OAT CELL>, SCLC1, SCLC, SCCL, SMALL CELL CANCER OF THE LUNG, small cell carcinoma of lung (diagnosis), small cell carcinoma of lung, Small Cell Lung Cancer, Oat Cell Carcinoma of Lung, Oat Cell Lung Cancer, Carcinoma, Small Cell Lung, Small Cell Lung Carcinoma, Small cell lung cancer stage unspecified, Small cell carcinoma of the lung, LUNG CANCER SMALL CELL, SMALL CELL CARCINOMA, PULMONARY SMALL CELL CARCINOMA OAT CELL, Small Cell Lung Carcinoma [Disease/Finding], small cell lung cancer (SCLC), cancer cell lung oat, cancer cell lung small, small cell carcinoma, small cell lung carcinoma, lung cancer oat cell, oat cell carcinoma of lung, oat cell cancer, sclc, small cell carcinoma of the lung, Oat cell carcinoma of lung, SCLC - Small cell lung cancer, Small cell lung cancer, Oat cell carcinoma of lung (disorder), Small cell carcinoma of lung (disorder), lung cancer, small cell, oat cell lung cancer, small cell lung cancer, Lung cancer, small cell, Small cell carcinoma of lung, Lung Oat Cell Carcinoma, Lung Small Cell Neuroendocrine Carcinoma, Oat Cell Carcinoma of the Lung, Oat Cell Lung Carcinoma, Small Cell Carcinoma of Lung, Small Cell Carcinoma of the Lung, Small Cell Neuroendocrine Carcinoma of Lung, Small Cell Neuroendocrine Carcinoma of the Lung
Italian Cancro a piccole cellule polmonare, stadio non specificato, Cancro a piccole cellule polmonare, Carcinoma a piccole cellule del polmone, Carcinoma del polmone a piccole cellule, Tumore del polmone a piccole cellule, Cancro del polmone a piccole cellule
Dutch kleincelcarcinoom van de long, kleincellige longkanker, kleincellige longkanker stadium niet-gespecificeerd
German kleinzelliges Lungenkarzinom, kleinzelliges Karzinom der Lunge, Kleinzelliges Lungenkarzinom, Lungenkarzinom, kleinzelliges, kleinzelliges Lungenkarzinom Stadium unbekannt
Portuguese Cancro pulmonar de pequenas células, Carcinoma de pequenas células do pulmão, Carcinoma de Pequenas Células do Pulmão, Carcinoma Avenocelular do Pulmão, Carcinoma Indiferenciado de Pequenas Células do Pulmão, Carcinoma tipo Oat Cell do Pulmão, Carcinoma de Células em Grão de Aveia do Pulmão, Cancro pulmonar de células pequens estádio não especificado
Spanish Carcinoma de células pequeñas de pulmón, Cáncer de pulmón de células pequeñas, Carcinoma de Pulmón de Células en Avena, Carcinoma de Celulas en Grano de Avena del Pulmon, Carcinoma de Pulmon de Celulas en Avena, Carcinoma de Celulas Pequenas del Pulmon, Carcinoma de Células en Grano de Avena del Pulmón, Carcinoma Pulmonar de Celulas Pequenas, Carcinoma de Células Pequeñas del Pulmón, Carcinoma Pulmonar de Células Pequeñas, Carcinoma de Células en Avena del Pulmón, Carcinoma de Celulas en Avena del Pulmon, carcinoma de células en grano de avena de pulmón (trastorno), carcinoma de células en grano de avena de pulmón, carcinoma de células pequeñas de pulmón (trastorno), carcinoma de células pequeñas de pulmón, carcinoma pulmonar de células en grano de avena, carcinoma pulmonar de células pequeñas, Cáncer de pulmón de células pequeñas, estadio no especificado
Czech Malobuněčné maligní nádorové onemocnění plic blíže neurčeného stadia, Malobuněčné maligní nádorové onemocnění plic, Malobuněčný karcinom plic, malobuněčný karcinom plic, karcinom ovískový
French Cancer du poumon à cellules en grains d'avoine, Carcinome du poumon à cellules en grains d'avoine, Cancer du poumon à petites cellules, Carcinome pulmonaire à petites cellules, Carcinome bronchique à petites cellules, Carcinome broncho-pulmonaire à petites cellules, Cancer bronchique à petites cellules, Cancer broncho-pulmonaire à petites cellules, Carcinome du poumon à petites cellules, Cancer bronchopulmonaire à petites cellules, Cancer du poumon à petites cellules stade non précisé
Russian OVSIANOKLETOCHNYI RAK LEGKOGO, KARTSINOMA LEGKOGO MELKOKLETOCHNAIA, ОВСЯНОКЛЕТОЧНЫЙ РАК ЛЕГКОГО, КАРЦИНОМА ЛЕГКОГО МЕЛКОКЛЕТОЧНАЯ
Swedish Småcelligt lungkarcinom
Japanese ｼｮｳｻｲﾎﾞｳﾊｲｶﾞﾝ, 小細胞肺癌、病期不明, ｼｮｳｻｲﾎﾞｳﾊｲｶﾞﾝﾋﾞｮｳｷﾌﾒｲ, 小細胞肺癌, 小細胞性肺癌, 肺癌-小細胞, 肺小細胞癌, 肺癌-燕麦細胞, 燕麦細胞肺癌, 小細胞肺がん
Polish Rak drobnokomórkowy płuc, Rak płuc drobnokomórkowy
Hungarian Kis sejtes nem meghatározott stádiumú tüdőrák, Tüdő kissejtes carcinomája, Kissejtes tüdőrák
Sources
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.
Definition (MEDLINEPLUS)

Lung cancer is one of the most common cancers in the world. It is a leading cause of cancer death in men and women in the United States. Cigarette smoking causes most lung cancers. The more cigarettes you smoke per day and the earlier you started smoking, the greater your risk of lung cancer. High levels of pollution, radiation and asbestos exposure may also increase risk.

Common symptoms of lung cancer include

  • A cough that doesn't go away and gets worse over time
  • Constant chest pain
  • Coughing up blood
  • Shortness of breath, wheezing, or hoarseness
  • Repeated problems with pneumonia or bronchitis
  • Swelling of the neck and face
  • Loss of appetite or weight loss
  • Fatigue

There are many types of lung cancer. Each type of lung cancer grows and spreads in different ways and is treated differently. Treatment also depends on the stage, or how advanced it is. Treatment may include chemotherapy, radiation and surgery.

NIH: National Cancer Institute
Definition (NCI) Cancer that forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.
Concepts Neoplastic Process (T191)
MSH D008175
ICD10 C34.90
SnomedCT 187875007, 154485001, 269561006
English LUNG CARCINOMA, CARCINOMA OF LUNG, CARCINOMA LUNG, PULMONARY CARCINOMA, LUNG CANCER, carcinoma of lung, carcinoma of lung (diagnosis), Carcinoma lung, Carcinoma of lung, Lung carcinoma, Pulmonary carcinoma, carcinoma lungs, Carcinoma;lung, Carcinoma;respiratory, carcinomas lung, carcinoma lung, of lung carcinoma, pulmonary carcinoma, Lung cancer NOS, lung cancer, Lung cancer, Lung Cancer, Cancer of Lung, Cancer of the Lung, Lung Carcinoma, Carcinoma of Lung, Carcinoma of the Lung, Cancer of bronchus; lung, lung carcinoma, carcinoma of the lung
Dutch carcinoom van de long, pulmonaalcarcinoom, longcarcinoom, carcinoom long
French Carcinome du poumon, Carcinome pulmonaire, CARCINOME PULMONAIRE
German Karzinom Lunge, Pulmonalkarzinom, Karzinom der Lunge, Lungenkarzinom, LUNGENKARZINOM
Italian Carcinoma del polmone
Portuguese Carcinoma pulmonar, Carcinoma do pulmão, CARCINOMA PULMONAR
Spanish Carcinoma de pulmón, Carcinoma pulmonar, Lung carcinoma, Lung cancer, CARCINOMA PULMONAR, cáncer de pulmón
Japanese 肺癌, ﾊｲｶﾞﾝ
Czech Karcinom plic, Plicní karcinom
Hungarian Pulmonalis carcinoma, Tüdőcarcinoma, A tüdő carcinomája
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Bronchogenic Carcinoma (C0007121)

Definition (MSH) Malignant neoplasm arising from the epithelium of the BRONCHI. It represents a large group of epithelial lung malignancies which can be divided into two clinical groups: SMALL CELL LUNG CANCER and NON-SMALL-CELL LUNG CARCINOMA.
Definition (NCI) A lung carcinoma arising from the bronchial epithelium.
Definition (NCI) Cancer that begins in the tissue that lines or covers the airways of the lungs, including small cell and non-small cell lung cancer.
Definition (CSP) group of carcinomas of the lung, arising from the epithelium of the bronchial tree.
Concepts Neoplastic Process (T191)
MSH D002283
SnomedCT 254622008, 363493006, 154485001, 269561006
English Bronchial Carcinomas, Bronchogenic Carcinomas, Carcinoma, Bronchial, Carcinoma, Bronchogenic, Carcinomas, Bronchial, Carcinomas, Bronchogenic, LUNG, CARCINOMA, BRONCHOGENIC, BRONCHIAL CARCINOMA, LUNG CANCER, BRONCHOGENIC CARCINOMA, CARCINOMA BRONCHIOGENIC, Primary bronchial cancer, bronchial carcinoma, Carcinoma bronchiogenic, Ca bronchus, LUNG CANCER BRONCHOGENIC CARCINOMA, Carcinoma, Bronchogenic [Disease/Finding], malignant neoplasm bronchus, Carcinoma;bronchus, bronchus carcinoma, bronchiogenic carcinoma, bronchogenic lung carcinoma, cancer bronchus, carcinoma of bronchus, bronchial cancer, bronchogenic carcinoma, Bronchogenic carcinoma, Bronchial carcinoma, CA - Carcinoma of bronchus, Carcinoma of bronchus, BC - Bronchogenic carcinoma, CA - Cancer of bronchus, Cancer of bronchus, Bronchus carcinoma, Bronchogenic Carcinoma, Bronchial Carcinoma, Bronchiogenic Carcinoma, Bronchogenic Lung Carcinoma, bronchus cancer, carcinoma of the bronchus
Spanish CARCINOMA BRONQUIAL, Cáncer de bronquio, Carcinoma broncogénico, Ca de bronquio, Carcinoma of bronchus, Bronchus carcinoma, carcinoma broncógeno, carcinoma bronquial, Carcinoma bronquial, Carcinoma Broncogénico, Carcinoma Bronquial, Carcinoma Broncogenico
Dutch ca bronchus, carcinoom bronchogeen, kanker van de bronchus, bronchuscarcinoom, Bronchogeen carcinoom, Carcinoom, bronchiaal, Carcinoom, bronchogeen
French Cancer des bronches, Carc des bronches, Carcinome bronchiogène, Cancer bronchique primitif, Carcinome bronchogénique, CARCINOME BRONCHIQUE, Cancer primitif du poumon, Carcinome bronchial, Carcinome bronchique
German Ka der Bronchien, Krebs der Bronchien, Karzinom bronchogen, BRONCHIALKARZINOM, Karzinom der Bronchien, Bronchialkarzinom, Karzinom, Bronchial-, Karzinom, bronchogenes, Bronchogenes Karzinom
Italian Cancro bronchiale, Carcinoma bronchiale, Carcinoma broncogeno
Portuguese Cancro brônquico, Carcinoma broncogénico, Ca brônquico, CARCINOMA DOS BRONQUIOS, Carcinoma Bronquial, Carcinoma bronquial, Carcinoma Broncogênico, Carcinoma Brônquico
Japanese 気管支癌, ｷｶﾝｼｶﾞﾝ, ｷｶﾝｼｹﾞﾝｾｲｶﾞﾝ, 癌-気管支原性, 気管支原性癌, 気管支原性がん, 気管支原性肺がん, 気管支原性肺癌, 肺癌-気管支原性
Swedish Karcinom, bronkogent
Czech karcinom bronchogenní, Maligní nádorové onemocnění bronchu, Bronchogenní karcinom, Karcinom bronchu, Bronchiální karcinom
Finnish Bronkogeeninen karsinooma
Russian KARTSINOMA BRONKHIAL'NAIA, KARTSINOMA BRONKHOGENNAIA, КАРЦИНОМА БРОНХИАЛЬНАЯ, КАРЦИНОМА БРОНХОГЕННАЯ
Croatian KARCINOM, BRONHOGENI
Polish Rak odoskrzelowy, Rak oskrzelopochodny
Hungarian Hőrgőcarcinoma, Hörgő carcinoma, Carcinoma bronchiogen, Hörgőrák
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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