60 years old male with hemoptysis
Bronchogenic carcinoma, (or frequently known as lung cancer) is the most common cause of cancer in men, and the 6th most frequent cancer in women worldwide. It is the leading cause of cancer mortality worldwide in both men and women and accounts for approximately 20% of all cancer deaths 1.
The major risk factor is cigarette smoking which is implicated in 90% of cases. Other risk factors include radon, asbestos, uranium, arsenic, chromium.
Patients with lung cancer may be asymptomatic in up to 50% of cases. Cough and dypnoea are rather non-specific symptoms that are common amongst those with lung cancer.
Central tumours may result in haemoptysis and peripheral lesions with pleuritic chest pain.
Pneumonia, pleural effusion, wheeze, lymphadenopathy are not uncommon. Other symptoms may be secondary to metastases (brain, liver, bone) or to paraneoplastic syndromes.
o SIADH causing hyponatraemia
o ACTH secretion (Cushing syndrome): small-cell sub type
o PTHrp causing hypercalcaemia: squamous cell carcinoma
o carcinoid syndrome
o cerebellar degeneration
o myasthenia: Eaton-Lambert syndrome
o finger clubbing
o hypertrophic pulmonary osteoarthropathy (HPOA)
o nephrotic syndrome
o polymyositis 3
o dermatomyositis 3
o acanthosis nigricans
The term bronchogenic carcinoma is somewhat loosely used to refer to primary malignancies of the lung that are associated with inhaled carcinogens 1 and includes 4 main histological subtypes. These are broadly divided into non small-cell carcinoma and small cell carcincoma as they are differ clinically in terms of presentation, treatment and prognosis.
• non small-cell lung cancer (NSCLC) (80%)
o squamous cell carcinoma (35%)
strongly associated with smoking
most common carcinoma to cavitate
o adenocarcinoma (30%)
more common in women
more common in non-smokers
o large-cell carcinoma (15%)
• small cell carcinoma (20%)
o strongly associated with smoking
o metastasises early
o most common primary lung malignancy to cause paraneoplastic syndromes and SVC obstruction
o worst prognosis
Other malignant pulmonary neoplasms include lymphoma and sarcoma (rare)
As each sub type has a different radiographic appearance, demographic, and prognosis:
• squamous cell carcinoma of the lung
• adenocarcinoma of the lung
• large cell carcinoma of the lung
• small cell carcinoma of the lung
Treatment and prognosis
Treatment and prognosis varies not only with stage, but also with cell type. In general, surgery, chemotherapy, and radiotherapy are offered according to stage, resectability, operability, and functional status.
Non small-cell carcinoma
o operable disease (stage I to IIIA): surgery
o unresectable disease: neoadjuvant chemotherapy, radiotherapy
o advanced disease: palliative combined chemotherapy
• prognosis : 5 year survival rates)
o local (stage I): 55-67%
o locally advanced (stages II-IIIA): 23-40%
o advanced (stages IIIB and IV): 1-3%
o limited disease: chemoradiotherapy
o extensive disease: palliative combined chemotherapy
• prognosis: poor
o limited: 5 year survival rate 15 - 25%
o extensive: 2 year survival 20% (with palliative combined chemotherapy and supportive care)
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