Lung Cancer I

Lung Cancer I

OVERVIEW:

Leading cause of cancer death in both men and women in the USA. The common bronchogenic carcinoma may be divided into two broad categories:
• Non-small cell cancer (NSCLC)
• Squamous cell cancer (epidermoid carcinoma)
• Adenocarcinoma
• Large cell carcinoma
• Small cell cancer (oat cell carcinoma; SCLC)
• Other less common primary malignancies of the lung include:
• Mesothelioma
• Carcinoid
• Blastoma
• Sarcoma
• Melanoma
• Lung tumors are staged for treatment and prognostic purposes from Stage 0 to Stage IV. The definitions of each stage are dependent on the primary tumor, lymph node status, and presence of metastasis.

System(s) affected: Pulmonary
Genetics: Increased susceptibility in certain individuals, leading to disease at an early age
Incidence/Prevalence in USA:
• 175,000 new cases per year
• 70/100,000 population
• 80% of new cases are NSCLC and 50% are metastatic at diagnosis
• Most common cancer world-wide (17.6% of cancers in men)
Predominant age: 50-70 years
Predominant sex: Male > Female

SIGNS AND SYMPTOMS:

• May be asymptomatic for majority of course
• Pulmonary
• Cough (new or change in chronic cough)
• Wheezing
• Dyspnea
• Hemoptysis
• Pneumonia
• Constitutional
• Bone pain
• Excess fatigue
• Weight loss
• Fever
• Anemia
• Clubbing of digits
• Other presentations
• Chest pain
• Shoulder/arm pain
• Dysphagia
• Swelling of face or neck

CAUSES:

Multifactorial; closely related to risk factors

RISK FACTORS:

• Smoking (attributable in 90% of cases)
• Passive - second hand smoke exposure
• Chronic obstructive pulmonary disease (COPD)
• Environmental; occupational exposure
• Asbestos exposure
• Ionizing radiation
• Atmospheric pollution
• Gases: halogen ethers, radon, mustard gas
• Metals: inorganic arsenic, chromium, nickel

DIAGNOSIS

DIFFERENTIAL DIAGNOSIS:

• Consider both pulmonary and extrapulmonary causes for symptoms
• Pulmonary
• Chronic bronchitis
• Granulomatous diseases (tuberculosis, sarcoidosis)
• Cardiac
• Congestive heart failure
• Cardiomyopathy

LABORATORY:

• CBC with platelets (look for low H/H, high WBC)
• Basic metabolic panel (look for low Na, high K, high Ca)
• Liver enzymes
• Pro-time (PT), prothrombin (PTT)

Drugs that may alter lab results: None likely
Disorders that may alter lab results: None likely

PATHOLOGICAL FINDINGS:

• Cancer cell type obtained from:
• Cytology (sputum, pleural fluid, node aspirate, bronchial washing) particularly valuable in SCLC
• Histology (tissue biopsies of nodes, nodules or masses)

SPECIAL TESTS:

• Electrocardiogram
• Echocardiogram
• Stress testing (exercise or Persantine thallium scan if applicable)
• Pulmonary function studies
• Quality of life assessments
• Karnofsky Performance Scale (KPS)
• Eastern Cooperative Oncology Group (ECOG)

IMAGING:

• Chest x-ray (important to compare with old films)
• Nodule or mass, especially if calcified
• Persistent infiltrate
• Atelectasis
• Mediastinal widening
• Hilar enlargement
• Pleural effusion
• CT scan of chest (with IV contrast)
• Nodule or mass (central or peripheral)
• Lymphadenopathy
• Other CT scans to look for metastatic disease
• Brain - lesions may be necrotic, bleeding
• Abdomen - hepatic or adrenal masses
• MRI or bone scan
• Vertebral or bony metastases

DIAGNOSTIC PROCEDURES:

• Needle biopsy under CT or fluoroscopic guidance
• Flexible fiberoptic bronchoscopy
• Cervical mediastinoscopy
• Video-assisted thoracoscopy
• Thoracotomy, when appropriate

TREATMENT

APPROPRIATE HEALTH CARE:

• Depends greatly on tumor cell type and stage of disease at diagnosis
• Treatment options for NSCLC include:
• Surgical resection
• Chemotherapy
• Radiation therapy
• Treatment options of SCLC include:
• Chemotherapy
• Radiation therapy

GENERAL MEASURES:

• Relief of symptoms
• Pain relief when applicable

SURGICAL MEASURES:

Resection for non-small cell cancer, when possible, stage I and II and some stage III. Resection of isolated, distant metastases has been acheived and may improve survival.

ACTIVITY:

No limitations; per patient tolerance

DIET:

No restrictions; good nutrition important

PATIENT EDUCATION:

• American Lung Association
• American Cancer Society
• Web resources: www.lungcanceronline.org and www.cancer.about.com
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Medical Diagnosis » L » Lung Cancer I