Lung, Primary Malignancies
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Basics
Description
- Primary lung cancers are the leading cause of cancer-related deaths in the United States (estimated 154,050 deaths in 2018, 25.3% of all cancer-related deaths).
- Divided into two broad categories
- Non–small cell lung cancer (NSCLC) (>85% of all lung cancers); normally originate in periphery
- Adenocarcinoma (~40% of NSCLC): most common type in the United States and also nonsmokers; metastasizes earlier than squamous cell; lepidic growth, a subtype of adenocarcinoma has better prognosis.
- Squamous cell carcinoma (SCC) (also known as epidermoid carcinoma) (~25% of NSCLC): dose-related effect with smoking; slower growing than adenocarcinoma
- Large cell (~10% of NSCLC): prognosis similar to adenocarcinoma
- Small cell lung cancer (SCLC) (16% of all lung cancers): centrally located, early metastases, aggressive
- Non–small cell lung cancer (NSCLC) (>85% of all lung cancers); normally originate in periphery
- Others: mesothelioma and carcinoid tumor
- Staging
- Both NSCLC and SCLC: staged from I to IV based on: primary tumor (T), lymph node status (N), and presence of metastasis (M)
- SCLC further staged by:
- Limited disease: confined to ipsilateral hemithorax
- Extensive disease: beyond ipsilateral hemithorax (stages IIIB and IV), which may include malignant pleural or pericardial effusion or hematogenous metastases (stage IV)
- Tumor locations: upper: 60%; lower: 30%; middle: 5%; overlapping and main stem: 5%
- May spread by local extension to chest wall, diaphragm, pulmonary vessels, vena cava, phrenic nerve, esophagus, or pericardium
- Most commonly metastasize to lymph nodes (pulmonary, mediastinal), then liver, adrenal glands, bones, brain
Epidemiology
Incidence- Estimated 234,030 new cases in the United States in 2018
- Usual age of diagnosis: between 65 and 74 years; peak at 70 years
- Predominant sex: male > female
Prevalence
- Most common cancer worldwide
- Lifetime probability: men: 1 in 15; women: 1 in 17
Etiology and Pathophysiology
Multifactorial; see “Risk Factors.”
GeneticsNSCLC
- Oncogenes: Ras family (H-ras, K-ras, N-ras)
- Tumor suppressor genes: retinoblastoma, p53
Risk Factors
- Smoking
- Secondhand smoke exposure
- Radon
- Environmental and occupational exposures
- Asbestos exposure (synergistic increase in risk for smokers)
- Air pollution
- Ionizing radiation
- Mutagenic gases (halogen ethers, mustard gas, aromatic hydrocarbons)
- Metals (inorganic arsenic, chromium, nickel)
- Lung scarring from tuberculosis
- Radiation therapy to the breast or chest
General Prevention
- Smoking cessation and prevention programs
- Screening recommended by NCCN and shown to reduce mortality in National Lung Screening Trial (NLST) (1)[A]
- Annual screening recommended with low-dose computed tomography (CT) in adults aged 55 to 74 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years
- Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.
- Prevention via aggressive smoking cessation counseling and therapy; a 20–30% risk reduction occurs within 5 years of cessation.
- Avoid hormone replacement therapy in postmenopausal smokers or former smokers (increased risk of death from NSCLC).
Commonly Associated Conditions
- Paraneoplastic syndromes: hypertrophic pulmonary osteoarthropathy, Lambert-Eaton syndrome, Cushing syndrome, hypercalcemia from ectopic parathyroid-releasing hormone, syndrome of inappropriate antidiuretic hormone (SIADH)
- Hypercoagulable state
- Pancoast syndrome
- Superior vena cava syndrome
- Pleural effusion
- Chronic obstructive pulmonary disease (COPD), other sequelae of cigarette smoking
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- Primary lung cancers are the leading cause of cancer-related deaths in the United States (estimated 154,050 deaths in 2018, 25.3% of all cancer-related deaths).
- Divided into two broad categories
- Non–small cell lung cancer (NSCLC) (>85% of all lung cancers); normally originate in periphery
- Adenocarcinoma (~40% of NSCLC): most common type in the United States and also nonsmokers; metastasizes earlier than squamous cell; lepidic growth, a subtype of adenocarcinoma has better prognosis.
- Squamous cell carcinoma (SCC) (also known as epidermoid carcinoma) (~25% of NSCLC): dose-related effect with smoking; slower growing than adenocarcinoma
- Large cell (~10% of NSCLC): prognosis similar to adenocarcinoma
- Small cell lung cancer (SCLC) (16% of all lung cancers): centrally located, early metastases, aggressive
- Non–small cell lung cancer (NSCLC) (>85% of all lung cancers); normally originate in periphery
- Others: mesothelioma and carcinoid tumor
- Staging
- Both NSCLC and SCLC: staged from I to IV based on: primary tumor (T), lymph node status (N), and presence of metastasis (M)
- SCLC further staged by:
- Limited disease: confined to ipsilateral hemithorax
- Extensive disease: beyond ipsilateral hemithorax (stages IIIB and IV), which may include malignant pleural or pericardial effusion or hematogenous metastases (stage IV)
- Tumor locations: upper: 60%; lower: 30%; middle: 5%; overlapping and main stem: 5%
- May spread by local extension to chest wall, diaphragm, pulmonary vessels, vena cava, phrenic nerve, esophagus, or pericardium
- Most commonly metastasize to lymph nodes (pulmonary, mediastinal), then liver, adrenal glands, bones, brain
Epidemiology
Incidence- Estimated 234,030 new cases in the United States in 2018
- Usual age of diagnosis: between 65 and 74 years; peak at 70 years
- Predominant sex: male > female
Prevalence
- Most common cancer worldwide
- Lifetime probability: men: 1 in 15; women: 1 in 17
Etiology and Pathophysiology
Multifactorial; see “Risk Factors.”
GeneticsNSCLC
- Oncogenes: Ras family (H-ras, K-ras, N-ras)
- Tumor suppressor genes: retinoblastoma, p53
Risk Factors
- Smoking
- Secondhand smoke exposure
- Radon
- Environmental and occupational exposures
- Asbestos exposure (synergistic increase in risk for smokers)
- Air pollution
- Ionizing radiation
- Mutagenic gases (halogen ethers, mustard gas, aromatic hydrocarbons)
- Metals (inorganic arsenic, chromium, nickel)
- Lung scarring from tuberculosis
- Radiation therapy to the breast or chest
General Prevention
- Smoking cessation and prevention programs
- Screening recommended by NCCN and shown to reduce mortality in National Lung Screening Trial (NLST) (1)[A]
- Annual screening recommended with low-dose computed tomography (CT) in adults aged 55 to 74 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years
- Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.
- Prevention via aggressive smoking cessation counseling and therapy; a 20–30% risk reduction occurs within 5 years of cessation.
- Avoid hormone replacement therapy in postmenopausal smokers or former smokers (increased risk of death from NSCLC).
Commonly Associated Conditions
- Paraneoplastic syndromes: hypertrophic pulmonary osteoarthropathy, Lambert-Eaton syndrome, Cushing syndrome, hypercalcemia from ectopic parathyroid-releasing hormone, syndrome of inappropriate antidiuretic hormone (SIADH)
- Hypercoagulable state
- Pancoast syndrome
- Superior vena cava syndrome
- Pleural effusion
- Chronic obstructive pulmonary disease (COPD), other sequelae of cigarette smoking
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