Bronchogenic carcinoma

Most lung tumors are malignant metastases from primary tumors elsewhere occur more frequently than those that originate in the lung

o It is increasing in incidence, especially in women, in parallel with cigarette smoking. o it is directly proportional in incidence to the number of cigarettes smoked daily number of years of smoking. o Various histologic changes that precede bronchogenic carcinoma in cigarette smokers. squamous metaplasia of the respiratory epithelium atypical changes ranging from dysplasia to carcinoma in situ o Other etiopathogenic factors Air pollution Radiation; incidence increased in radium and uranium workers Asbestos (MCQ) increased incidence with asbestos and greater increase with combination of asbestos and cigarette smoking (MCQ) Industrial exposure to nickel and chromates (MCQ) o Clinical features The 5-year survival rate is less than 10%. The tumor often spreads by local extension into the pleura,

pericardium, or ribs.

Clinical manifestations cough, hemoptysis bronchial obstruction, often with atelectasis and pneumonitis. Superior vena cava syndrome o compression or invasion of the superior vena cava o result in facial swelling and cyanosis o dilation of the veins of the head, neck, and upper extremities Pancoast tumor (superior sulcus tumor); (MCQ) o involvement of the apex of the lung o often with Horner syndrome (ptosis, miosis, and anhidrosis) o involvement of the cervical sympathetic plexus Hoarseness from recurrent laryngeal nerve paralysis Pleural effusion, often bloody o bloody pleural effusion suggests malignancy, tuberculosis, or trauma. Paraneoplastic endocrine syndromes o most frequent is ACTH or ACTH-like activity with small cell carcinoma (MCQ) o SIADH with small cell carcinoma of the lung (MCQ) o parathyroid-like activity with squamous cell carcinoma. (MCQ) Classification All types share a common endodermal origin despite their morphologic differences.

Bronchogenic carcinoma is subclassified into o squamous cell carcinoma o adenocarcinoma (including bronchioloalveolar carcinoma) o small cell carcinoma o large cell carcinoma For therapeutic purposes, the bronchogenic carcinomas are often subclassified into o small cell carcinoma, which is not considered amenable to surgery o non-small cell carcinoma, in which surgical intervention may be considered. Clinical Pearls on Brocnchogenic carcinoma Very High yielding for USMLE, MD Entrance and MBBS Exams Squamous cell carcinoma o Central o Appears as a hilar mass (MCQ) o frequently results in cavitation o clearly linked to smoking o incidence greatly increased in smokers o may be marked by inappropriate parathyroid hormone (PTH)like activity with resultant hypercalcemia(MCQ) Adenocarcinoma carcinoma o Bronchial-derived o Peripheral o Develops on site of prior pulmonary inflammation or injury (scar carcinoma) (MCQ) o less clearly linked to smoking Bronchioloalveolar carcinoma o Peripheral (MCQ) o Less clearly related to smoking o columnar-to-cuboidal tumor cells line alveolar walls o presents with multiple densities on x-ray, mimicking pneumonia(MCQ) Small cell (oat cell) carcinoma o Central o Undifferentiated tumor o most aggressive bronchogenic carcinoma (MCQ) o least likely form to be cured by surgery(MCQ) o usually already metastatic at diagnosis o often associated with ectopic production of corticotrophin (ACTH) or o antidiuretic hormone (ADH) (MCQ) o incidence greatly increased in smokers (MCQ) Large cell carcinoma o Peripheral (MCQ) o Undifferentiated tumor o may show features of squamous cell or adenocarcinoma on electron microscopy Carcinoid tumor o Arise from major bronchi o Low malignancy (MCQ) o spreading by direct extension into adjacent tissues

o may result in carcinoid syndrome (MCQ)