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Lung cancer

Lung cancer (or frequently if somewhat incorrectly known as bronchogenic carcinoma) 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.

Epidemiology

The major risk factor is cigarette smoking which is implicated in 90% of cases.  Other risk factors include radon, asbestos, uranium, arsenic, chromium.

Clinical presentation

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.

Paraneoplastic Syndromes

Pathology

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 four main histological subtypes. These are broadly divided into non small-cell carcinoma and small cell carcinoma as they are differ clinically in terms of presentation, treatment and prognosis:

Other malignant pulmonary neoplasms include lymphoma and sarcoma (rare)

As each sub type has a different radiographic appearance, demographic, and prognosis:

Staging

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
  • treatment
    • operable disease (stage I to IIIA): surgery
    • unresectable disease: neoadjuvant chemotherapy, radiotherapy
    • advanced disease: palliative combined chemotherapy
  • prognosis: 5 year survival rates)
    • local (stage I): 55-67%
    • locally advanced (stages II-IIIA): 23-40%
    • advanced (stages IIIB and IV): 1-3%
Small-cell carcinoma
  • treatment
    • limited disease: chemoradiotherapy
    • extensive disease: palliative combined chemotherapy
  • prognosis: poor
    • limited: 5 year survival rate 15-25%
    • extensive: 2 year survival 20% (with palliative combined chemotherapy and supportive care)

See also

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