Large cell carcinomas constitute 10% to 15% of bronchogenic carcinomas.
Clinical manifestations include chest wall pain, pleural effusion, cough, sputum production, hemoptysis, and airway obstruction resulting in pneumonia if airways are involved.
Cor pulmonale is right ventricular enlargement caused by chronic pulmonary hypertension.
The extent of the primary tumor.
Palliative chemotherapy or radiation.
Periodic chest x-ray films, sputum cytologic analysis, and computed tomography can detect presymptomatic, early stage lung cancers, particularly of the squamous cell type.
New treatments for lung cancer include gene and immunotherapies.
They are diagnosed by a process of exclusion because they show none of the histologic findings of squamous cell carcinoma or adenocarcinoma.
They may cause recurrence of active disease.
Laryngeal cancer represents 2% to 3% of all cancers.
Lung cancer is the most frequent cause of cancer death in the United States.
Lung cancers (bronchogenic carcinomas) arise from the epithelium of the respiratory tract.
Cigarette smoking is the number one risk factor for lung cancer.
Tumors classified as T1, with or without metastasis to the lymph nodes in the ipsilateral hilar region.
Dyspnea when a person lies flat.
Decreased PaCO2.
NSCLC accounts for about 85% of all lung cancers.
Acute bronchitis is an acute infection or inflammation of the airways or bronchi usually caused by a virus.
Cancer cell types include non–small cell lung cancer (squamous cell carcinoma, adenocarcinoma, large cell undifferentiated carcinoma) and neuroendocrine tumors (small cell carcinoma and bronchial carcinoid tumors).
The term lung cancer excludes other pulmonary tumors, including sarcomas, lymphomas, blastomas, hematomas, and mesotheliomas.
NSCLC is less responsive to chemotherapy.
Environmental smoke exposure (exposure to someone else’s cigarette smoke) increases the risk of lung cancer.
Surgical resection of the entire tumor is the only treatment that results in cure.
Dyspnea that occurs at night and requires the person to sit or stand for relief.
Diseases that interfere with oxygenation of the tissues.
Lung cancers arise from mutated epithelial stem cells.
Pneumothorax is the accumulation of air in the pleural space.
Epidermal growth factor receptor (EGFR) mutations are common in adenocarcinoma.
Bronchiolitis is the inflammatory obstruction of small airways.
EGFR tyrosine kinase inhibitors are a targeted approach to therapy for adenocarcinoma.
The toxicities of new chemotherapeutic regimens limit their use.
The inflammatory response isolates colonies of bacilli by enclosing them in tubercles and surrounding the tubercles with scar tissue.
Laryngeal cancer occurs primarily in men.
Swallowing and speech therapy after treatment can significantly improve recovery.
Survival rates dramatically decrease.
Dose-intensified radiation, radiofrequency ablation, microwave ablation, cryotherapy, and brachytherapy.
No conclusive evidence of reduction in lung cancer mortality as a consequence of screening has been found.
A feeling of breathlessness and increased respiratory effort.
Increased alveolar ventilation produced by anxiety, head injury, or severe hypoxemia.
Non-productive cough or hemoptysis is common due to the central location of squamous cell carcinoma tumors.
Adenocarcinoma occurs more frequently in women, non-smokers, and Asians.
The cells are generally larger than leukocytes and contain large, darkly stained nuclei.
Abscesses are usually a result of aspiration pneumonia.
Cigarette tobacco smoking is a common cause of lung cancer.
To determine its cell type and stage the tumor.
It is estimated that one fourth of lung cancer cases among never-smokers could be attributed to exposure to passive tobacco smoke.
Environmental or occupational risk factors associated with lung cancer include benzopyrene, radon gas, metals (chromium, cadmium, arsenic), asbestos fibers, diesel exhaust, nitrogen mustard gases, nickel, silica, vinyl chloride, and chloromethyl methyl ether.
Antiangiogenic therapy, targeting of growth factor receptors, tumor sensitizing agents, gene therapy, and immunotherapy.
Tumors classified as T2 but having no nodal or distant metastases.
Overall, only 20% of individuals live 5 or more years after diagnosis.
A bluish discoloration of the skin caused by desaturation of hemoglobin, polycythemia, or peripheral vasoconstriction.
NSCLC has cellular subtypes within squamous cell carcinoma, adenocarcinoma, and large cell undifferentiated carcinoma.
Environmental tobacco smoke, occupational carcinogens, viruses, hormones, and positive family history are associated with adenocarcinoma.
It consists of right ventricular enlargement (hypertrophy, dilation, or both).
Metastasis occurs early and is widespread in large cell carcinoma.
Pulmonary artery hypertension is when the pulmonary artery pressure is 5 to 10 mmHg greater than normal.
Total laryngectomy is required when lesions are extensive and involve the cartilage.
Nodal involvement.
Currently there are no specific tools for predicting risk for or rate of progression of lung cancer.
The death rate in men is declining but continues to rise for women, and lung cancer remains by far the greatest cancer killer of men and women.
Establishing the best methods for screening and early detection.
The stage of cancer progression at the time of diagnosis greatly affects prognosis.
Increased PaCO2.
Neuroendocrine tumors account for about 14% of all lung cancers.
Chest wall compliance is diminished by obesity and kyphoscoliosis, which compress the lungs, and by neuromuscular diseases that impair chest wall muscle function.
Pleural effusion is the accumulation of fluid in the pleural space.
Adenocarcinoma tumors may be asymptomatic and discovered by routine chest roentgenogram in the early stages.
Pulmonary fibrosis diminishes lung compliance.
Clinical trials are in progress to develop immunotherapies/vaccines for NSCLC.
Gene therapy aims to restore normal tumor-suppressor gene function (e.g., p53) in lung cancer treatment.
COPD is the coexistence of chronic bronchitis and emphysema.
Upper respiratory tract infections include rhinitis (the common cold), pharyngitis, and laryngitis.
Common diagnostic modalities include chest x-ray, echocardiography, and computed tomography.
This cell type has lost all evidence of differentiation and is therefore commonly referred to as undifferentiated large cell anaplastic cancer.
Large cell carcinoma is treated surgically.
Cor pulmonale progresses to right ventricular failure if the pulmonary hypertension is not reversed.
Partial laryngectomies are the preferred treatment for small supraglottic and subglottic malignancies.
About 10% to 25% of lung cancers occur in never-smokers.
Surgical resection.
An estimated 159,480 deaths in 2012: 87,260 in men and 72,200 in women.
Chemoprevention in the form of dietary supplements and pharmaceuticals.
Spread to other organs.
Kussmaul, obstructed, restricted, gasping, and/or Cheyne-Stokes respirations, and sighing.
SCC has the strongest association with smoking.
Squamous cell carcinoma tumors tend to remain fairly well localized and do not metastasize until late in the course of the disease.
Aspiration is the passage of fluid and solid particles into the lung, usually from impaired swallowing and coughing.
Metastasis occurs through the pulmonary arterial system and mediastinal lymph nodes in bronchoalveolar cell carcinoma.
Pneumoconiosis is caused by inhalation of dust particles in the workplace, including coal dust, silica, and asbestos.
A common cause of pulmonary edema is left-sided heart failure that increases the hydrostatic pressure in the pulmonary circulation.
Gene therapy aims to alter microRNA function in lung cancer treatment.
Blocking tumor immunosuppression is a strategy in lung cancer treatment.
Symptoms include fatigue, chest discomfort, tachypnea, dyspnea on exertion, palpitations, and cough.
These tumors commonly arise peripherally but are found centrally and can grow to distort the trachea and cause widening of the carina.
Pulmonary vascular diseases are caused by embolism or hypertension in the pulmonary circulation.
Other tumors include small cell (oat cell) carcinoma, bronchial adenoma, adenocystic tumors (cylindromas), mucoepidermoid carcinomas (bronchial tumors), and mesothelioma.
SCLC is staged as either limited or extensive.
The extent of metastasis.
Primary lung cancers arise from cells that line the bronchi within the lungs and are therefore called bronchogenic carcinomas.
Reduction of exposure to carcinogens.
Tumors classified as T2, with metastasis only to the ipsilateral hilar lymph nodes.
It is a protective reflex that expels secretions and irritants from the lower airways.
Inflamed pleurae, trachea, bronchi, or respiratory muscles.
Neuroendocrine tumors of the lung can be divided into small cell carcinoma, large cell neuroendocrine carcinoma, typical carcinoid tumors, and atypical carcinoid tumors.
Pneumonia and atelectasis are often associated with squamous cell carcinoma.
Empyema is the presence of pus in the pleural space (infected pleural effusion).
Bronchoalveolar cell carcinoma tumors tend to arise from the terminal bronchioles and alveoli.
Inhalation of noxious gases or prolonged exposure to high concentrations of oxygen can damage the bronchial mucosa or alveolocapillary membrane.
Overall survival rates for advanced stage lung cancer remain poor.
Gene therapy aims to increase tumor responsiveness to chemoradiation through gene transfer in lung cancer treatment.
Emphysema results from destruction of the alveolar septa and loss of passive elastic recoil, leading to airway collapse and obstruction to gas flow during expiration and air trapping.
Serious lower respiratory tract infections include pneumonia and tuberculosis.
General therapies include administration of oxygen, diuretics, and anticoagulants and avoidance of contributing factors such as air travel, decongestant medications, nonsteroidal anti-inflammatory medications, pregnancy, and tobacco use.
Surgical therapy is limited to palliative procedures designed to relieve obstructive pneumonitis or prevent recurrence of pleural effusion.
PE is the occlusion of a portion of the pulmonary vascular bed by a thrombus, tissue fragment, or air bubble.
Different types of lung cancer cause distinctive clinical manifestations and differ in likelihood of metastasis and prognosis.
The TNM classification system.
The use of biomarkers.
An estimated 22,190 new cases in 2013: 118,080 in men and 110,100 in women.
Smoking cessation.
All tumors more extensive than T2 or any tumor with metastasis to the lymph nodes in the mediastinum or adjacent organs.
Expectoration of bloody mucus that can be caused by bronchitis, TB, abscess, neoplasms, and other conditions that cause hemorrhage from damaged vessels.
Hypoxemia is a reduced PaO2 caused by decreased oxygen content of inspired gas, hypoventilation, diffusion abnormality, ventilation-perfusion mismatch, or shunting.
Pneumothorax can be caused by spontaneous rupture of weakened areas of the pleura or can be secondary to pleural damage caused by disease, trauma, or mechanical ventilation.
Adenocarcinoma tumors more commonly arise in the peripheral regions of the pulmonary parenchyma.
Bronchiolitis is most common in children.
Surgical resection is possible in a high proportion of adenocarcinoma cases.
New understandings of genetic and immunologic features of lung cancer cells have led to new treatments.
Asthma is a chronic inflammatory disorder of the bronchial mucosa that causes bronchial hyperresponsiveness, mucosal edema, airway constriction, and variable obstruction to airflow.
Emphysema in which septal deterioration results from smoking tends to be centriacinar.
Pneumococcal pneumonia is an acute lung infection resulting in an inflammatory response with four phases: consolidation, red hepatization, gray hepatization, and resolution.
An electrocardiogram that shows right ventricular hypertrophy.
The most effective treatment is the treatment of the primary disorder.
The right ventricle usually fails when pulmonary artery pressure equals systemic blood pressure.
Large cell carcinoma has a rapid growth rate.
An embolus can cause hypoxic vasoconstriction, pulmonary edema, atelectasis, pulmonary hypertension, shock, and even death.
Squamous cell carcinoma of the true vocal cords is the most common type of laryngeal cancer.
Each type of lung cancer arises in a characteristic site or type of tissue.
The most common cause of lung cancer is tobacco smoking.
Tobacco smoke contains several organ-specific carcinogens, and smoking has been causally related to carcinogenesis at several sites.
Chemotherapy (e.g., platinum) and radiation.
Occupational risk factors include exposure to asbestos dust, arsenic, chromium, nickel, ionizing radiation, chloromethyl methyl ether, coal products, mustard gas, and vinyl chloride.
The disease is often too advanced by the time of diagnosis for surgery to be indicated.
A change in the amount, consistency, color, and odor of sputum.
Increased PaCO2 caused by a decrease in minute volume (respiratory rate × tidal volume).
Lung cancers are divided into non-small cell lung carcinoma (NSCLC) and neuroendocrine tumors.
Small cell carcinoma is the most common neuroendocrine tumor.
Chest pain is a late symptom associated with large squamous cell carcinoma tumors.
The source of the pus in empyema is usually lymphatic drainage from sites of bacterial pneumonia.
Bronchoalveolar cell carcinoma tumors are slow-growing with an unpredictable pattern of metastasis.
Inhalation of noxious gases or prolonged exposure to high concentrations of oxygen can cause inflammation or acute respiratory failure.
Pulmonary edema is excess water in the lung caused by disturbances of capillary hydrostatic pressure, capillary oncotic pressure, or capillary permeability.
Gene therapy aims to restore normal DNA methylation patterns in lung cancer treatment.
Direct tumor delivery of activating cytokines is a method in lung cancer treatment.
They may be candidates for lung transplantation.
Right ventricular filling pressures are normal until failure occurs.
There were an estimated 12,260 new cases and 3630 deaths in 2013.
Large cell carcinoma is diagnosed through sputum analysis, bronchoscopy, and electron microscopy by exclusion of other cell types.
Pulmonary artery hypertension is caused by elevated left ventricular pressure, increased blood flow through the pulmonary circulation, obliteration or obstruction of the vascular bed, or active constriction of the vascular bed produced by hypoxemia or acidosis.
A clinical symptom of squamous cell carcinoma of the true vocal cords is progressive hoarseness.
Approximately 10% to 15% of active smokers will develop lung cancer.
Many genetic mechanisms have been implicated in the risk for lung cancer including gene mutations, gene amplification, increases in protein expression, losses in protein expression, tumor-suppressing alterations, tumor-acquired DNA methylation, and chromosomal aberrations.
It is usually widely metastasized.
Warning signs of lung cancer include a persistent cough, sputum streaked with blood, chest pain, recurring attacks of pneumonia or bronchitis, weight loss, and hard nodes in neck or axilla.
Radiation therapy and chemotherapy can be used as adjunctive or palliative treatment modalities.
Adjustments made by the body to minimize the work of respiratory muscles.
Squamous cell carcinoma tumors are typically located centrally near the hila and project into bronchi.
Adenocarcinoma constitutes 35% to 40% of all bronchogenic carcinomas.
Aspiration frequently results in pneumonitis and pulmonary infection.
Bronchoalveolar cell carcinoma has the weakest association with smoking.
Pneumoconiosis can cause chronic inflammation, pulmonary fibrosis, and susceptibility to lower airway infection and tumor formation.
ARDS results from an acute, diffuse injury to the alveolocapillary membrane and decreased surfactant production.
Immunologic therapies include vaccines that stimulate tumor-specific antibodies in lung cancer treatment.
The effectiveness, timing of delivery, optimal drug combinations, and side effects of new lung cancer treatment strategies are still being evaluated.
TB is a lung infection caused by M. tuberculosis (tubercle bacillus).
It can be made only with right-sided heart catheterization.
Cor pulmonale is secondary to pulmonary artery hypertension.
Cardiac output falls with exercise.
The goal is to decrease the workload of the right ventricle by lowering pulmonary artery pressure.
The human papillomavirus (HPV) has been linked to both benign and malignant disease of the larynx.
Cough occurs less commonly and may follow swallowing.
Bronchial carcinoid tumors represent about 1% of all lung tumors.
Decreased alveolar ventilation caused by airway obstruction, chest wall restriction, or altered neurologic control of breathing.
Acute respiratory failure is caused by inadequate gas exchange or ventilation (PaO2 ≤ 50 mmHg or PaCO2 ≥ 50 mmHg and pH ≥ 7.25).
Tension pneumothorax is a life-threatening condition caused by trapping of air in the pleural space.
Pulmonary adenocarcinoma develops in a stepwise fashion through atypical adenomatous hyperplasia, adenocarcinoma in situ, and minimally invasive adenocarcinoma to invasive carcinoma.
Pulmonary fibrosis is an excessive amount of connective tissue in the lung.
The 5-year survival rate remains below 15% for lung cancers presenting in advanced stages.
Gene therapy is emerging as a way of inducing tumor apoptosis in lung cancer treatment.
Obstruction in asthma is caused by episodic attacks of bronchospasm, bronchial inflammation, mucosal edema, and increased mucus production.
Upper respiratory tract infections are the most common cause of short-term disability in the United States.
Viral pneumonia is an acute, self-limiting lung infection usually caused by the influenza virus.
Examination may reveal peripheral edema, jugular venous distention, a precordial heave, and accentuation of the pulmonary compartment of the second heart sound.
Treatment relies on the use of supplemental oxygen to reverse hypoxic vasoconstriction.
The heart appears normal at rest.
The highest incidence is in men between 50 and 75 years of age.
Laryngeal pain or a sore throat is likely to be present with supraglottic lesions.
They rarely produce endocrine symptoms.
Mesotheliomas are associated with asbestos exposure (80%).
They are associated with malignant transformations.
By the time manifestations are severe enough to motivate the individual to seek medical advice, the disease is usually advanced.
The goal is to establish the presence of a primary lung cancer.
NSCLC can be subdivided into squamous cell carcinoma, adenocarcinoma, and large cell undifferentiated carcinoma.
Flail chest results from rib or sternal fractures that disrupt the mechanics of breathing.
Pleural effusion usually results from disorders that promote transudation or exudation from capillaries underlying the pleura but occasionally results from blockage or injury that causes lymphatic vessels to drain into the pleural space.
An individual may seek treatment for pleuritic chest pain and shortness of breath from pleural involvement by the tumor.
Pulmonary fibrosis may be idiopathic or caused by disease.
New chemotherapeutic agents have slightly improved outcomes in the management of lung cancer.
Gene therapy promotes tumor-suicide gene expression in lung cancer treatment.
Chronic bronchitis is a chronic inflammation of the bronchi that causes airway obstruction resulting from bronchial smooth muscle hypertrophy and production of thick, tenacious mucus.
Laboratory studies include arterial blood gas testing, liver function testing, HIV serology, electrocardiography, chest x-ray and CT scanning, pulmonary function testing, polysomnography, ventilation-perfusion scanning, and echocardiography.
The pulmonary component of the second heart sound may be accentuated.
Laryngeal dysplasia has a high risk of progressing to malignancy.
A biopsy can be obtained during this procedure.
Small cell carcinoma arises from neuroendocrine cells that contain neurosecretory granules.
They cause obstruction.
These changes progress from metaplasia to carcinoma in situ and finally to invasive carcinoma.
Screening for the presence of asymptomatic tumors in high-risk individuals remains controversial.
Atelectasis is the collapse of alveoli resulting from compression of the lung tissue or absorption of gas from obstructed alveoli.
Diagnosis of NSCLC requires cytologic analysis from biopsy.
Silicosis is a type of pneumoconiosis caused by inhalation of silica.
ARDS increases membrane permeability and causes edema and atelectasis.
Antibodies to epidermal growth factor receptors (erlotinib, gefitinib, and cetuximab) are used in immunologic therapies for lung cancer.
New knowledge is leading to new opportunities for lung cancer treatment.
The diagnosis of IPAH is made when all other causes of pulmonary hypertension have been ruled out.
Chest pain is common.
Its success depends on reversal of the underlying lung disease.
Squamous cell carcinoma is the most common cell type.
Indirect laryngoscopy provides a stereoscopic view of the structure and movement of the larynx.
Cell sizes range from 6 to 8 μm.
No, bronchial carcinoid tumors are not related to smoking.
No, cells are not recovered from bronchial washings because the tumor is covered with normal mucosa.
Most mesotheliomas are aggressive malignant tumors.
Tobacco smoke contains as many as 30 lung carcinogens.
Bronchiectasis is abnormal dilation of the bronchi secondary to another pulmonary disorder, usually infection or inflammation.
Therapy for NSCLC is based on histologic and molecular markers.
Hypersensitivity pneumonitis (extrinsic allergic alveolitis) is an allergic or hypersensitivity reaction to many allergens.
Obstructive pulmonary disease is characterized by airway obstruction that causes difficult expiration.
Anti-angiogenesis drugs are used in immunologic therapies for lung cancer.
Serious lower respiratory tract infections occur most often in older adults and individuals with impaired immunity or underlying disease.
Disease severity is quantified using the New York Heart Association or WHO classification of functional status of patients with pulmonary artery hypertension.
It develops as pulmonary artery hypertension creates chronic pressure overload in the right ventricle.
A pulmonic valve murmur and a tricuspid valve murmur may be present.
Metastasis develops by spreading to the draining lymph nodes, and distant metastasis, usually to the lung, is rare.
Direct laryngoscopy provides specific visualization of the tumor.
Because resulting signs and symptoms (called paraneoplastic syndromes) may be the first manifestation of the underlying cancer.
Thoracoscopy may also be used for biopsy.
Symptoms include coughing, chest pain, excessive sputum production, hemoptysis, pneumonia, airway obstruction, pleural effusions, and weight loss.
Screening using low-dose spiral CT scans decreases the risk of dying from lung cancer in heavy smokers.
Obstructive pulmonary disease can be acute or chronic and includes asthma, chronic bronchitis, and emphysema.
Emphysema in which septal deterioration is caused by α1-antitrypsin deficiency or old age tends to be panacinar.
Pneumonia can be categorized as community-acquired (CAP), healthcare-associated (HCAP), hospital-acquired (HAP), or ventilator-associated (VAP).
Medications include prostacyclin analogs (epoprostenol, beraprost, iloprost), endothelin receptor antagonists (bosentan, ambrisentan), and phosphodiesterase-5 inhibitors.
Acute hypoxemia can exaggerate pulmonary hypertension and dilate the ventricle.
Laryngeal cancer represents approximately 2% to 3% of all cancers in the United States.
Magnetic resonance imaging (MRI) and positron-emission tomography (PET) can be used for staging.
No, neither radiation therapy nor chemotherapy has been successful in increasing survival for effusion.
Most tumors arise from the central part of the lung.
Examples include hyponatremia (antidiuretic hormone), Cushing syndrome (adrenocorticotropic hormone), hypocalcemia (calcitonin), gynecomastia (gonadotropins), and carcinoid syndrome (serotonin).
Osteopontin and mesothelin are being explored as potential tumor markers for early diagnosis.
They are likely to be attributed by the individual to the effects of smoking.
The diagnosis of lung cancer relies on the history of risk factors and symptoms, a careful physical examination, and a constellation of diagnostic tests.
It is no longer reversible.
They may appear only during exercise testing.
Gastroesophageal reflux disease is also a risk factor.
Dyspnea can be severe in subglottic tumors.
Small cell lung carcinomas (SCLCs) are the most common type of neuroendocrine lung tumors.
Small cell lung carcinoma has the strongest correlation with tobacco smoking.
Bronchial carcinoid tumors are slow growing and have a low potential to metastasize.
Fifty percent of individuals with bronchial carcinoid tumors are asymptomatic.
Mesotheliomas arise from mesothelial cells that line the pleural cavities.
Tobacco smoke is responsible for the vast majority of lung cancers.
It causes hypertrophy of the normally thin-walled heart muscle and compromises right ventricular myocardial perfusion.
Peripheral edema, hepatic congestion, and jugular venous distention can often be detected.
The presenting symptoms include hoarseness, dyspnea, and cough.
Plain films of the larynx and CT facilitate the identification of tumor boundaries and the degree of extension to surrounding tissue.
Small cell carcinoma is often associated with tumor-derived hormone production.
Yes, they can be malignant and metastasize early.
Diagnosis is made by chest x-ray, CT scan, and thoracentesis with cytologic examination of the pleural fluid.
Tumor progression includes invasion of surrounding tissues and metastasis to distant sites, including the brain, bone marrow, and liver.
The latest guidelines state that the evidence remains insufficient to recommend screening of asymptomatic individuals with sputum cytologic examination, chest x-ray, or spiral CT.
The electrocardiogram shows right ventricular hypertrophy.
Carcinoma of the true vocal cords (glottis) is more common than that of the supraglottic structures.
Evaluation includes external inspection and palpation of the larynx and the lymph nodes in the neck.
SCLCs constitute about 14% of bronchogenic carcinomas.
Because these tumors show a rapid rate of growth and tend to metastasize early and widely.
Carcinoid tumors can occur from childhood through older age.
Local surgical resection is curative if metastasis has not occurred.
The latent interval can be 20 to 40 years.
Carcinogens along with inherited genetic predisposition to cancers result in tumor development.
Diagnosis is made on the basis of physical examination, radiologic examination, and electrocardiogram or echocardiogram, or both.
The risk is increased by the amount of tobacco smoked and is further heightened with the combination of smoking and alcohol consumption.
Dyspnea is rare in the case of supraglottic tumors.
Sequelae such as swallowing and speech difficulties may result.
Staging for small cell carcinoma is divided into limited disease (TNM stages I to III: 20% to 30%) and extensive disease (TNM stage IV: 70% to 80%).
They are rare bronchial gland tumors.
Clinical manifestations include dyspnea and chest pain resulting from tumor-derived pleural fluid and invasion of the chest wall.
Further tumor development is promoted by growth factors that alter cell growth and differentiation, such as epidermal growth factor, and by production of inflammatory mediators, such as toxic oxygen free radicals.
Progressive hoarseness is the most significant symptom and can result in voice loss.
Combined chemotherapy and radiation can result in cure in selected cases.
SCLCs cause 25% of lung cancer deaths.
Survival time for untreated small cell carcinoma is less than 5% at 5 years.
They arise more commonly in the main or segmental bronchi.
They arise predominantly in the trachea or large airways.
Early detection is difficult because radiologic studies do not reveal the tumor at an early stage.
The bronchial mucosa suffers multiple carcinogenic “hits” and eventually epithelial cell changes begin to be visible on biopsy.
Symptoms and signs of metastatic disease may include neurologic deficits and bone pain.
They are easily visualized bronchoscopically and are found on routine chest radiographs.
It is not unusual for an individual to survive 10 to 15 years after diagnosis.
Current management includes a combination of pleuropneumonectomy, chemotherapy, radiation, and hyperthermia.
Diagnostic tests include sputum cytology, chest x-ray, low-dose CT scanning in high-risk individuals, PET scanning, bronchoscopy, biopsy, testing for epidermal growth factor mutations and other molecular markers, and search for potential metastatic disease.
