Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • 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:-Early without mediastinal involvement (stage I/II)-Locally advanced (stage IIIA/B)-Metastatic (stage IV) +++ Squamous Cell Carcinoma + • 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) +++ Adenocarcinoma + • 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 +++ Large Cell Carcinoma + • Uncommon• Large polygonal spindle/oval cells in sheets or nests• Tumors seen peripherally +++ 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 +++ Adenosquamous Tumors + • Show both cellular features• More aggressive than NSCLC +++ Epidemiology + • 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 +++ Symptoms and Signs + • 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 +++ Laboratory Findings + • Elevated alkaline phosphatase suggests bony metastases +++ Imaging Findings + • Chest film: Vary from nodule to unresolving infiltrate to total atelectasis• Chest CT scan: Evaluation of infiltrate, nodule + • Definitive diagnosis obtained in 90% with bronchoscopy or fine-needle aspiration (FNA) +++ Rule Out + • Metastatic disease with imaging (see below) and thoracentesis + • Chest film often done for routing physical or for symptoms• CT chest/abdomen: to rule out common sites ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.