23- LUNG CANCER

• Bronchial carcinoma

  Accounts for 95% of primary lung tumors
• Benign tumors and rarer types of lung cancers

  • Alveolar cell carcinoma
• Metastases in the lung

  • Common, primary sites are the kidney, prostate, breast, bone, gastrointestinal tract, cervix or ovary
• Risk factors for lung cancer

  • Tobacco smoking
  • Radon exposure
  • Asbestos exposure
• Symptoms of lung cancer

  • Cough
  • Hemoptysis
  • Dyspnea
  • Wheezing
  • Pneumonia
  • Chest pain
  • Weight loss
  • Hoarseness
• SVC syndrome


  Obstruction of SVC with prominent JVD and facial swelling
• Lung cancer may present with paraneoplastic syndromes
• Diagnostic methods for lung cancer

  • CXR
  • Chest CT with FNA (CT-guided) for peripheral lesions
  • Bronchoscopy (biopsy/ brushing) for central lesions
• SCLC

  Unresectable, often responds to radiation & chemotherapy, usually recurs
• NSCLC

  Surgical resection
• Small cell (oat cell) carcinoma

  Highly associated with cigarette smoking, associated with paraneoplastic syndromes, amplification of myc gene, neoplasm of neuroendocrine Kulchitsky cells, chromogranin A+
• Adenocarcinoma


  • Most common in non-smokers, includes bronchoalveolar carcinoma, mutations: KRAS, EDFR, ALK, clubbing, hazy infiltrates on CXR, glandular pattern, stain mucin+, thickening of alveolar walls
• Squamous cell carcinoma

  • Central hilar mass, cavitation, associated with cigarette smoking, can cause hypercalcemia, keratin pearl, intracellular bridges
• Large cell carcinoma

  • Anaplastic, undifferentiated tumor, poor prognosis, pleomorphic giant cells, can secrete B-hCG
• Bronchial carcinoid tumor

  • Symptoms due to mass effect and carcinoid syndrome (5-HT secretion) - flushing, diarrhea, wheezing, nests of neuroendocrine cells, chromogranin A+