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- Solid tumor originating from bronchial epithelial cells
- Malignant transformation of normal epithelial cells
- Arises from normal bronchial epithelial cells that have
acquired multiple genetic lesions and capable of expressing a variety
- Cellular proliferation and malignant transformation due to:
- Activation of proto-oncogenes
- Inhibition or mutation of tumor suppressor genes
- Production of autocrine growth factors Molecular changes affect
disease prognosis and response to therapy.
- Histologic classification
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)
- Leading cause of cancer death in men and women
- Incidence increases with age; peak age of diagnosis
between 55 and 65 years
- No screening test currently recommended.
- Smoking cessation
- Gradual decline in lung
- Cigarette smoking responsible for ~80% of lung
- Spouses of smokers have ~25% higher
risk of lung cancer than spouses of nonsmokers.
- Other risk factors include:
- Exposure to respiratory
carcinogens (e.g., asbestos and benzene)
- Genetic risk factors
- History of other lung diseases (e.g., chronic obstructive
pulmonary disease [COPD] and asthma)
- Location and extent of tumor determine presenting signs
- Thorough history and physical examination necessary to detect:
- Signs and symptoms of primary tumor
- Regional spread of tumor
- Distant metastases
- Paraneoplastic syndromes
- Ability to withstand aggressive surgery or chemotherapy
- Most common initial signs and symptoms:
- Chest pain or discomfort, with or without hemoptysis
- Other systemic symptoms:
- Weight loss
- Disseminated disease:
- Neurologic deficits
from central nervous system (CNS) metastases
- Bone pain or pathologic fractures secondary to bone metastases
- Liver dysfunction from hepatic involvement
- Paraneoplastic syndromes may be first sign of underlying malignancy.
- Syndrome of inappropriate antidiuretic hormone secretion (most
common with SCLC)
- Cushing’s syndrome
Means of Confirmation
- Pathologic confirmation of lung cancer established by
examination of sputum cytology and/or tumor biopsy by bronchoscopy,
mediastinoscopy, percutaneous needle biopsy, or open-lung biopsy.
- Valuable diagnostic tests:
- Chest radiography
- Endobronchial ultrasound
- Computed tomography (CT) scan
- Positron emission tomography (PET) scan
- Integrated CT–PET technology appears to improve diagnostic
accuracy in staging NSCLC over CT or PET alone.
- Sputum cytology
- Tumor biopsy by bronchoscopy, mediastinoscopy, percutaneous
needle biopsy, or open-lung biopsy
- Stage (anatomical extent
of disease) based on:
- Extent and size of primary
- Presence and extent of lymph node involvement (N1–3)
- Presence or absence of distant metastases ...