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Lung cancer is the leading cause of cancer death worldwide. It often presents with various respiratory symptoms and can metastasize to multiple sites.
Common clinical features of lung cancer include:
Lung cancer commonly metastasizes to the following sites:
“Lung ‘mets’ Love Affective Boneheads and Brainiacs.”
Lung cancer can lead to various complications summarized by the SPHERE acronym:
Key risk factors for lung cancer include:
Type | Location | Characteristics | Histology Features |
---|---|---|---|
Small Cell Carcinoma | Central | Very aggressive, may produce ACTH (Cushing syndrome), ADH (SIADH), or antibodies | Neoplasm of neuroendocrine Kulchitsky cells; small dark blue cells; Chromogranin A ⊕, neuron-specific enolase ⊕, synaptophysin ⊕. Amplification of myc oncogenes is common. Managed with chemotherapy ± radiation. |
Adenocarcinoma | Peripheral | Most common primary lung cancer; more common in women, often arises in non-smokers. Activating mutations include KRAS, EGFR, and ALK; associated with hypertrophic osteoarthropathy (clubbing). | The glandular pattern on histology often stains mucin ⊕. Bronchioloalveolar subtype shows hazy infiltrates on CXR; better prognosis. |
Squamous Cell Carcinoma | Central | Hilar mass arising from bronchus; cavitation; associated with smoking and hypercalcemia (produces PTHrP). | Keratin pearls and intercellular bridges. |
Large Cell Carcinoma | Peripheral | Highly anaplastic undifferentiated tumor; poor prognosis; less responsive to chemotherapy. | Pleomorphic giant cells. |
Bronchial Carcinoid Tumor | Central or Peripheral | Excellent prognosis; metastasis rare; symptoms due to mass effect or carcinoid syndrome (flushing, diarrhea, wheezing). | Nests of neuroendocrine cells; Chromogranin A ⊕. |