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SOURCE

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Source: Adams VR, Scarpace Peters S. Lung cancer. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146074875. Accessed May 21, 2017.

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DEFINITION

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  • Solid tumor originating from bronchial epithelial cells.

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ETIOLOGY

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  • Malignant transformation of normal epithelial cells.

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PATHOPHYSIOLOGY

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  • Arises from normal bronchial epithelial cells that have acquired multiple genetic lesions and capable of expressing a variety of phenotypes.

  • Cellular proliferation and malignant transformation due to:

    • Activation of proto-oncogenes.

    • Inhibition or mutation of tumor suppressor genes.

    • Production of autocrine growth factors.

  • Histologic classification.

    • Non-small cell lung cancer (NSCLC)

      • Includes adenocarcinoma (~50%), squamous cell carcinoma (<30%), and large cell carcinoma.

    • Small cell lung cancer (SCLC) (~15% of all lung cancers)

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EPIDEMIOLOGY

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  • Leading cause of cancer death in men and women.

    • The most frequently fatal malignancy in the world.

  • Incidence increases with age; peak age of diagnosis between 55 and 65 years.

  • Overall 5-year survival rate for all types of lung cancer remains a dismal 18%.

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PREVENTION AND SCREENING

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  • Annual screening with low-dose computed tomography imaging (LDCT) is currently recommended to identify lung cancer in high-risk individuals.

    • Individuals aged 55–74 years with a 30-pack-year history who are still smoking or have quit for less than 15 years should be screened.

  • Smoking cessation.

  • Maintain a healthy diet with high amounts of fruits and vegetables.

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RISK FACTORS

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  • Cigarette smoking responsible for <20% lung cancer cases and ~80% of lung cancer deaths.

    • Spouses of smokers have ~25% higher risk of lung cancer than spouses of nonsmokers.

  • Other risk factors include:

    • Exposure to respiratory carcinogens (eg, asbestos, arsenic, and benzene)

    • Genetic risk factors.

    • History of other lung diseases (eg, chronic obstructive pulmonary disease [COPD] and asthma)

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CLINICAL PRESENTATION

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  • Location and extent of tumor determine presenting signs and symptoms.

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SIGNS AND SYMPTOMS
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  • Most common initial signs and symptoms:

    • Cough.

    • Dyspnea.

    • Chest pain or discomfort, with or without hemoptysis.

  • Other systemic symptoms:

    • Anorexia.

    • Weight loss.

    • Fatigue.

    • Rust-streaked or purulent sputum.

    • Chest, shoulder, or arm pain.

    • Wheeze and stridor.

    • Superior vena cava obstruction.

    • Pleural effusion or pneumonitis.

    • Dysphagia (secondary to esophageal compression)

    • Hoarseness (secondary to laryngeal nerve paralysis)

    • Horner’s syndrome.

    • Phrenic nerve paralysis.

    • Pericardial effusion/tamponade.

    • Tracheal obstruction.

  • Disseminated disease:

    • Neurologic deficits.

    • Spinal cord compression.

    • Bone pain or pathologic fractures.

    • Liver dysfunction.

  • Paraneoplastic syndromes may be first sign of underlying malignancy.

    • Weight loss.

    • Cushing’s syndrome.

    • Hypercalcemia (most commonly in squamous cell lung cancer)

    • Syndrome of inappropriate secretion of antidiuretic hormone (most commonly in SCLC)

    • Pulmonary hypertrophic osteoarthropathy.

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DIAGNOSIS

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MEANS OF CONFIRMATION AND DIAGNOSIS
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  • Pathologic confirmation of lung cancer established by examination of sputum cytology and/or tumor biopsy by bronchoscopy, mediastinoscopy, percutaneous needle ...

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