• Typically spread by local extension, metastasis to lymph nodes, lung, liver, bone, brain, adrenals
Non-Small-Cell Lung Carcinoma (NSCLC)
• 80% of cases
• Classified as:
• 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:
Small Cell (Oat Cell) Carcinoma
• 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
• 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
• No survival benefit from mass screening
• 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
-Adenocarcinoma: acanthosis nigricans
• Chest film: Vary from nodule to unresolving infiltrate to total atelectasis
• Chest CT scan: Evaluation of infiltrate, nodule
• 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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