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  • • Typically spread by local extension, metastasis to lymph nodes, lung, liver, bone, brain, adrenals

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Non-Small-Cell Lung Carcinoma (NSCLC)

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  • • 80% of cases

    • Classified as:

    • -Early without mediastinal involvement (stage I/II)

      -Locally advanced (stage IIIA/B)

      -Metastatic (stage IV)

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Squamous Cell Carcinoma

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  • • 20% of cases

    • Keratinization, cellular stratification, and intercellular bridges seen pathologically

    • 67% located centrally, 33% located peripherally

    • Growth and metastasis rate slower than other lung tumors

    • Classified into 2 groups:

    • 1. Disease in ipsilateral thorax (including lymph nodes)

      2. Disease beyond thorax (extensive)

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Adenocarcinoma

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  • • 30% of cases

    • 3 subtypes

    • -Acinar (columnar lined glands secreting mucin)

      -Papillary

      -Bronchoalveolar (intraluminal papillary fragments in alveoli)

    • Increasing frequency, may be spread by aerosol transmission

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Large Cell Carcinoma

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  • • Uncommon

    • Large polygonal spindle/oval cells in sheets or nests

    • Tumors seen peripherally

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Small Cell (Oat Cell) Carcinoma

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  • • 15% of cases

    • Small round nuclei with nuclear chromatin and cytoplasm

    • Biologically and clinically distinct from others

    • Occur centrally, early metastasis, highly resistant to treatment

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Adenosquamous Tumors

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  • • Show both cellular features

    • More aggressive than NSCLC

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Epidemiology

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  • • Number 1 cause of cancer-death in men and women

    • 170,000 new cases each year: 157,000 deaths each year

    • Incidence stable among males, increasing among females

    • 85% of cases due to smoking tobacco

    • Asbestos exposure implicated in 23% of lung cancer cases, radon increases risk

    • Occurs more frequently in right lobe than in left

    • Upper lobes affected more than lower or middle lobes

    • Increased risk to develop other cancers:

    • -Upper respiratory tract

      -Esophagus

      -Bladder

      -Kidney

    • No survival benefit from mass screening

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Symptoms and Signs

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  • Central tumors: Cough, hemoptysis, respiratory distress, pain, pneumonia

    Peripheral tumors: Cough, chest wall pain, pleural effusions, pulmonary abscess, Horner syndrome, Pancoast syndrome

    Symptoms from regional spread: Hoarseness (recurrent nerve paralysis), dyspnea (phrenic nerve paralysis), dysphagia (esophageal compression), tamponade (pericardial invasion)

    Systemic symptoms: Anorexia, weight loss, weakness, malaise

    Classic paraneoplastic syndromes:

    • -Small cell: Eaton-Lambert (myasthenia), SIADH, ACTH, carcinoid

      -SCC: Hypercalcemia

      -Adenocarcinoma: acanthosis nigricans

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Laboratory Findings

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  • • Elevated alkaline phosphatase suggests bony metastases

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Imaging Findings

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  • Chest film: Vary from nodule to unresolving infiltrate to total atelectasis

    Chest CT scan: Evaluation of infiltrate, nodule

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  • • Definitive diagnosis obtained in 90% with bronchoscopy or fine-needle aspiration (FNA)

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Rule Out

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  • • Metastatic disease with imaging (see below) and thoracentesis

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  • • Chest film often done for routing physical or for symptoms

    • CT chest/abdomen: to rule out common sites of metastasis, such as liver and adrenals

    • If serum alkaline ...

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