Lung cancer is a leading cause of cancer death. Smoking is the primary risk factor. The document describes the different histological subtypes of lung cancers including squamous cell carcinoma, adenocarcinoma, large cell carcinoma, and small cell lung cancer. Clinical presentations are outlined based on tumor location and include symptoms such as cough, hemoptysis, chest pain, and paraneoplastic syndromes. Prognosis depends on cancer type, stage at diagnosis, and patient factors.

1. Lung Neoplasms
Zube B
Schwartzs 11
1

2. Introduction
• Lung cancer is the leading cancer killer in the
United States
• The overall 5-year survival for all patients with
lung cancer is 15%
• Positive survival factors are female sex, younger
age, and white race
• Most patients are diagnosed at an advanced
stage of disease, so therapy is rarely curative
2

3. Epidemiology
• Cigarette smoking is the primary cause of lung
cancer
– 2 lung cancer cell types, squamous cell carcinoma and
small cell carcinoma, are extraordinarily rare in the
absence of cigarette smoking
– Only 15% of lung cancers are not related to smoking, and
the majority of these are adenocarcinomas
• Over 3000 chemicals have been identified in tobacco
smoke, but the main chemical carcinogens are
polycyclic aromatic hydrocarbons
3

4. Cont.
• The risk of developing lung cancer escalates with the
number of cigarettes smoked, the number of years
smoked, and the use of unfiltered cigarettes
– Conversely, the risk of lung cancer declines with smoking
cessation
– However, even after smoking cessation, the risk never drops
to that of people who never smoked
• Secondhand (or passive) smoke exposure has been
shown to confer an excess risk of 25% of developing lung
cancer when a nonsmoker lives with a smoker
4

5. Cont.
• Preexisting lung disease (TB, COPD) confers an
increased risk of lung cancer (up to 13%)
– Related to poor clearance of inhaled carcinogens
and/or to the effects of chronic inflammation
• Exposure to a number of industrial compounds,
including asbestos, arsenic, and chromium
compounds
– Combination of asbestos exposure and cigarette
smoking together have a multiplicative effect on risk,
as opposed to an additive effect
5

6. Normal Lung Histology
• The tracheobronchial tree consists of approximately 23 airway
divisions to the level of the alveoli
– It includes the main bronchi, lobar bronchi, segmental bronchi, and
terminal bronchioles (i.e., the smallest airway vessels that lack
alveoli and are lined by bronchial epithelium)
• The tracheobronchial tree is normally lined by pseudostratified
ciliated columnar cells and mucous (goblet) cells except the
respiratory bronchioles which are lined by cuboidal epithelium
– The normal bronchial epithelium also contains bronchial submucosal glands,
which are mixed salivary-type glands containing mucous cells, serous cells, and
Kulchitsky cells (neuroendocrine cells)
– These can give rise to salivary gland–type tumors (previously referred to as
"bronchial gland tumors"), including mucoepidermoid carcinomas and
adenoid cystic carcinomas
6

7. Cont.
• The alveolar spaces have two primary cell types,
referred to as type I and II pneumocytes
– Type I pneumocytes cover 95% of the surface area of
the alveolar wall, but comprise only 40% of the total
number of alveolar epithelial cells
• These cells are not capable of regeneration because they
have no mitotic potential
– Type II pneumocytes cover only 3% of the alveolar
surface, but comprise 60% of the alveolar epithelial
cells
– In addition, clusters of neuroendocrine cells are seen
in the alveolar spaces
7

8. Preinvasive Lesions
• Squamous Dysplasia and Carcinoma In Situ
– Increased cell size, an increased number of cell layers,
an increased nuclear:cytoplasmic ratio, increased
mitoses, and changes in cellular polarity
• Atypical Adenomatous Hyperplasia
– Rrepresents the beginning stage of a stepwise evolution
to bronchoalveolar carcinoma and then to
adenocarcinoma
• Diffuse Idiopathic Pulmonary Neuroendocrine Cell
Hyperplasia (DIPNCH)
– Preinvasive stages of carcinoid tumors
8

9. Invasive or Malignant Lesions
• Lung cancer is broadly divided into 2 main groups
based primarily on light microscopic
observations:
– Non-small-cell lung carcinoma
• Squamous cell carcinoma
• Adenocarcinoma (including bronchoalveolar carcinoma)
• Large-cell carcinoma
– Neuroendocrine tumors
• Typical carcinoid
• Atypical carcinoid
• Large-cell neuroendocrine carcinoma
• Small-cell carcinoma
Although they differ
in appearance
histologically, their
clinical behavior
and treatment is
similar
9

10. Squamous Cell Carcinoma
• It accounts for 30 to 40% of lung cancers
• It is the cancer most frequently found in men and is highly
correlated with cigarette smoking
• It is primarily located centrally and arises in the major bronchi,
often causing the typical symptoms of centrally-located
tumors, such as hemoptysis, dyspnea, bronchial obstruction
with atelectasis, and pneumonia
– Occasionally a more peripherally-based SqCC will develop in a
tuberculosis scar or in the wall of a bronchiectatic cavity
• Central necrosis is frequent and may lead to the radiographic
findings of a cavity (possibly with an air-fluid level)
– Such cavities may become infected, with resultant abscess
formation
10

11. Adenocarcinoma
• Accounts for 25 to 40% of all lung cancers
• It occurs with equal frequency in males and females
• Most often a peripherally-based tumor, thus it is
frequently discovered incidentally on routine chest
radiographs
• Symptoms of chest wall invasion or malignant pleural
effusions dominate
• Histologically, adenocarcinoma is composed of glands
with or without mucin production, combined with
destruction of contiguous lung architecture
11

12. Bronchoalveolar Carcinoma
• A relatively unusual (5% of all lung cancers) subtype of
adenocarcinoma that has a unique growth pattern
– Rather than invading and destroying contiguous lung parenchyma,
tumor cells multiply and fill the alveolar spaces
• Because of their growth within alveoli, BAC tumor cells from
one site can aerogenously seed other parts of the same lobe or
lung, or the contralateral lung
– This growth pattern and tendency produces 3 radiographic
presentations: a single nodule, multiple nodules (in single or
multiple lobes), or a diffuse form with an appearance mimicking
that of a lobar pneumonia
• Because tumor cells fill the alveolar spaces and envelop
small airways rather than destroying them, air
bronchograms can be seen, unlike with other carcinomas
12

13. Large-Cell Carcinoma
• Accounts for 10 to 20% of lung cancers and may
be located centrally or peripherally
• As implied by the name, the cells are large, with
diameters of 30 to 50 micrometers
• They are often admixed with other cell types
such as squamous cells or adenocarcinoma
• It can be confused with a large-cell variant of
neuroendocrine carcinoma
– Differentiated with immunohistochemical staining
13

14. Neuroendocrine Neoplasms
• Recently, neuroendocrine lung tumors have
been reclassified into neuroendocrine
hyperplasia and three separate grades of
neuroendocrine carcinoma (NEC)
14

15. Cont.
• Grade I NEC (classic or typical carcinoid)
– It is a low-grade NEC
– An epithelial tumor which arises primarily in the
central airways, although 20% of the time it occurs
peripherally
• It classically presents with hemoptysis, with or without
airway obstruction and pneumonia
– It occurs primarily in younger patients
15

16. Cont.
• Grade II NEC (atypical carcinoid)
– A group of tumors with a degree of aggressive
clinical behavior and much higher malignant
potential
– Unlike Grade I NEC, these tumors are etiologically
linked to cigarette smoking and are more likely to
be peripherally located
16

17. Cont.
• Grade III NEC large-cell type
– Occur primarily in heavy smokers
– These tumors tend to occur in the middle to
peripheral lung fields
17

18. Cont.
• Grade III NEC small-cell type (small-cell lung
carcinoma [SCLC])
– The most malignant NEC
– Accounts for 25% of all lung cancers
– These tumors are centrally located and consist of
smaller cells with a diameter of 10 to 20 m that have
little cytoplasm and very dark nuclei
– They are the leading producer of paraneoplastic
syndromes
18

19. Salivary Gland–Type Neoplasms
• Adenoid cystic carcinoma and mucoepidermoid
carcinoma
– Both tumors occur centrally due to their site of
origin
– Adenoid cystic carcinoma is a slow-growing tumor
that is locally and systemically invasive
• It tends to grow submucosally and infiltrate along
perineural sheaths
– Mucoepidermoid carcinoma consists of squamous
and mucous cells and is graded as low or high grade
19

20. Clinical Presentation
20

21. Cont.
21

22. Based on Tumor Histology
• Squamous cell and small-cell carcinomas frequently
arise in main, lobar, or first segmental bronchi, which
are collectively referred to as the central airways
• Symptoms of airway irritation or obstruction are
common
– Cough
– Hemoptysis
– Dyspnea (due to bronchial obstruction with or without
postobstructive atelectasis)
– Wheezing (due to high-grade airway obstruction)
– Pneumonia (caused by airway obstruction with secretion
retention and atelectasis)
22

23. Cont.
• Adenocarcinomas are often located peripherally
• For this reason, they are often discovered
incidentally as an asymptomatic peripheral
lesion on chest x-ray
• When symptoms occur, they are due to pleural
or chest wall invasion (pleuritic or chest wall
pain) or pleural seeding with malignant pleural
effusion
23

24. Cont.
• Bronchoalveolar carcinoma may present as a
solitary nodule, as multifocal nodules, or as a
diffuse infiltrate mimicking an infectious
pneumonia (pneumonic form)
– In the pneumonic form, severe dyspnea and
hypoxia may occur, sometimes with expectoration
of large volumes (over 1 L/d) of light-tan colored
fluid, with resultant dehydration and electrolyte
imbalance
24

25. Based on invasion of thoracic
structures
• Chest wall invasion
– Pleuritic pain, from noninvasive contact of the
parietal pleura with inflammatory irritation and
from direct parietal pleural invasion
– Localized chest wall pain, with deeper invasion and
involvement of the rib and/or intercostal muscles
– Radicular pain, from involvement of the intercostal
nerve(s)
25

26. Cont.
• Tumors (usually adenocarcinomas) originating in
the posterior apex of the chest, referred to as
superior sulcus tumors, may produce the
Pancoast syndrome
– Depending on the exact tumor location, symptoms
can include:
• Apical chest wall and/or shoulder pain (from involvement of
the first rib and chest wall)
• Horner's syndrome (unilateral enophthalmos, ptosis, miosis,
and facial anhidrosis from invasion of the stellate
sympathetic ganglion)
• Radicular arm pain (from invasion of T1, and occasionally
C8, brachial plexus nerve roots) 26

27. Cont.
• Phrenic nerve invasion
– Shoulder pain (referred)
– Hiccups
– Dyspnea with exertion because of diaphragm
paralysis
– Radiographically, the diagnosis is suggested by
unilateral diaphragm elevation on chest x-ray, and
can be confirmed by fluoroscopic examination of
the diaphragm with breathing and sniffing (the
"sniff" test)
27

28. Cont.
• RLN invasion
– Voice change, often referred to as hoarseness, but
more typically a loss of tone associated with a
breathy quality
– Coughing, particularly when drinking liquids
28

29. Cont.
• Superior vena cava (SVC) syndrome
– Variable degrees of swelling of the head, neck, and
arms
– Headache
– Conjunctival edema
– Most frequently occurs with small-cell carcinoma,
with bulky enlargement of involved mediastinal
lymph nodes and compression of the SVC
29

30. Cont.
• Pericardial invasion may lead to pericardial
effusions (benign or malignant)
– Associated with increasing levels of dyspnea
and/or arrhythmias, and with the potential to
develop pericardial tamponade
30

31. Cont.
• Invasion of a vertebral body
– Back pain, which is often localized and severe
• If the neural foramina are involved, radicular pain may
also be present
31

32. Cont.
• Invasion of esophagus
– Dysphagea
– Usually secondary to external compression by
enlarged lymph nodes involved with metastatic
disease, usually with lower lobe tumors
32

33. Cont.
• Invasion of the diaphragm
– Dyspnea
– Referred shoulder pain
– Pleural effusion
33

34. Paraneoplastic Syndromes
• The majority of such syndromes are caused by small-cell
carcinomas
• Paraneoplastic syndromes may produce symptoms even
before symptoms are produced by the primary tumor,
thereby leading to early diagnosis
• Their presence does not influence resectability or the
potential to successfully treat the tumor
• Symptoms of the syndrome often will abate with
successful treatment, and recurrence may be heralded
by recurrent paraneoplastic symptoms 34

35. Cont.
Endocrine
• Hypercalcemia (ectopic
parathyroid hormone)
• Cushing's syndrome
• SIADH
• Carcinoid syndrome
• Gynecomastia
• Hyperthyroidism
• Hypercalcitoninemia
• Elevated growth hormone
• Elevated prolactin, FSH, LH
• Hypoglycemia
Neurologic
• Encephalopathy
• Subacute cerebellar
degeneration
• Progressive multifocal
leukoencephalopathy
• Peripheral neuropathy
• Autonomic neuropathy
• Eaton–Lambert syndrome
• Optic neuritis
• Polymyositis
35

36. Cont.
Skeletal
• Clubbing
• Pulmonary hypertrophic
osteoarthropathy
Cutaneous
• Hyperkeratosis
• Dermatomyositis
• Acanthosis nigricans
• Hyperpigmentation
• Erythema gyratum
repens
• Hypertrichosis
lanuginosa acquista
36

37. Cont.
Hematologic
• Anemia
• Leukemoid reactions
• Thrombocytosis
• Thrombocytopenia
• DIC
• Eosinophilia
• Pure red cell aplasia
• Leukoerythroblastosis
Other
• Nephrotic syndrome
• Hypouricemia
• Secretion of vasoactive
intestinal peptide with
diarrhea
• Hyperamylasemia
• Anorexia or cachexia
37

38. Cont.
• Hypertrophic pulmonary osteoarthropathy (HPO)
– Characterized by tenderness and swelling of the ankles, feet,
forearms, and hands
• Symptoms may be severe and debilitating
• Clubbing of the digits may occur
– It is due to periostitis of the fibula, tibia, radius, metacarpals,
and metatarsals
– Plain films of the affected areas show periosteal
inflammation and elevation
• A bone scan demonstrates intense but symmetric uptake in the
long bones
– Relief is afforded by aspirin or NSAIDs and by successful
surgical or medical eradication of the tumor
38

39. Cont.
• Hypercalcemia
– It occurs in up to 10% of patients with lung cancer and
is most often due to metastatic disease
– However, 15% of cases are due to secretion of ectopic
parathyroid hormone–related peptide, most often with
squamous cell carcinoma
• Diagnosis can be made by measuring elevated serum levels of
parathyroid hormone
– Symptoms include lethargy, depressed level of
consciousness, nausea, vomiting, and dehydration
– Following complete resection the calcium level will
normalize
39

40. Cont.
• Endocrinopathies
– Caused by the release of hormones or hormone
analogues into the systemic circulation
– Most occur with SCLCs
40

41. Cont.
• Cont.
– SIADH
• Occurs in 10 to 45% of patients with SCLC
• Characterized by confusion, lethargy, and possible
seizures
• Diagnosed by the presence of hyponatremia, low
serum osmolality, and high urinary sodium and
osmolality
41

42. Cont.
• Cont.
– Cushing's syndrome
• Due to production of ACTH-like molecule and occurs
principally in patients with SCLC
• ACTH production is autonomous and not suppressible by
dexamethasone
• Because the serum elevation of ACTH is rapid, the physical
signs of Cushing's syndrome (e.g., truncal obesity, buffalo
hump, striae) are unusual
• Dx
– Hpokalemia (<3.0 mmol/L); nonsuppressible elevated plasma cortisol
levels that lack the normal diurnal variation; elevated blood ACTH
levels
42

43. Cont.
• Peripheral and central neuropathies
– Among the most common in lung cancer,
particularly in SCLC and squamous cell carcinoma
– Felt to be immune mediated
– Up to 16% of patients with lung cancer have
evidence of neuromuscular disability
– In patients with neurologic or muscular symptoms,
central nervous system (CNS) metastases must be
ruled out with imaging
43

44. Cont.
• Lambert-Eaton syndrome
– A myasthenia-like syndrome usually seen in patients
with SCLC
– Autoimmune phenomena
– Gait abnormalities are due to proximal muscle
weakness and fatigability
– Therapy is directed at the primary tumor
– For patients with refractory symptoms, treatment is
medical
• Guanidine hydrochloride, Prednisone, Azathioprine, and
occasionally plasma exchange.
• Unlike with myasthenia gravis patients, neostigmine is usually
ineffective
44

45. Metastatic Symptoms
• Metastases occur most commonly in the CNS, vertebral
bodies, bones, liver, adrenal glands, lungs, and skin and
soft tissues
– At diagnosis, 10% of patients with lung cancer have CNS
metastases; another 10 to 15% will develop CNS metastases
– Bone metastases are seen in 25% of all patients with lung
cancer
• They are primarily lytic, producing localized pain
• Lung cancer is the most common cause of spinal cord compression
(Direct extension of a vertebral metastasis or foraminal invasion
from the primary tumor)
– Liver and adrenal metastases are most often an incidental
finding on CT scan
– Skin and soft tissue metastases occur in 8% of patients
dying of lung cancer, and generally present as painless
subcutaneous or intramuscular masses
45

46. Nonspecific Symptoms
• Lung cancer often produces a variety of
nonspecific symptoms such as:
– Anorexia
– Weight loss
– Fatigue
– Malaise
• Should raise concern about possible metastatic
disease
46

47. Diagnosis, Evaluation, and
Staging
47

48. Cont.
• Assessment encompasses three areas:
– The primary tumor
– Presence of metastatic disease
– Functional status (the patient's ability to tolerate a
pulmonary resection)
48

49. Assessment of the Primary Tumor
• History
– Pulmonary, nonpulmonary thoracic, and
paraneoplastic symptoms
• P/E
– Chest
– Voice
• Investigation
– Contrast CT scan
– Routine use of MRI in lung cancer patients is reserved
for those with:
• Contrast material allergies
• Suspected mediastinal, vascular, or vertebral body invasion
49

50. Cont.
• Tissue diagnosis
– Bronchoscopy
• Particularly useful for centrally-located tumors
• Tissue can be obtained by one of four methods:
– Brushings and washings for cytology
– Direct forceps biopsy of a visualized lesion
– FNA with a Wang needle of an externally compressing lesion without
visualized endobronchial tumor
– Transbronchial biopsy with the use of forceps guided to the lesion by
fluoroscopy
– Transthoracic needle aspiration and biopsy
• Ideally suited for peripheral lesions not easily accessible by
bronchoscopy
• Image guided (CT or Fluoroscopy) FNA or core-needle biopsy is
performed
• The primary complication is pneumothorax (in up to 50% of
patients), which is usually minor and requires no treatment
• Three biopsy results are possible: malignant, a specific benign
50

51. Cont.
• Thoracoscopy
– It is potentially a valuable staging tool for assessing the
primary tumor's relationship to contiguous structures
• Thoracotomy
– Required in cases of:
• A deep-seated lesion that yielded an indeterminate needle
biopsy result or that could not be biopsied for technical reasons
– FNA, a Tru-Cut biopsy, or preferably an excisional biopsy is done
• Inability to determine invasion of a mediastinal structure by any
method short of palpation
– When a pneumonectomy is required, a tissue diagnosis of
cancer must be made before excision
51

52. Assessment of Metastatic Disease
• Distant metastases are found in about 40% of patients with
newly diagnosed lung cancer
• History
– Presence or absence of new bone pain, neurologic symptoms, and
new skin lesions
– Constitutional symptoms (e.g., anorexia, malaise, and unintentional
weight loss of greater than 5% of body weight) suggest either a
large tumor burden or the presence of metastases
• P/E
– Examination of all systems
• Laboratory studies
– LFT, Serum calcium level
• Elevation of either hepatic enzymes or serum calcium levels typically
occurs with extensive metastases
52

53. Cont.
• Mediastinal Lymph Nodes
– Chest CT
• Most effective noninvasive method available to assess the mediastinal and
hilar nodes for enlargement
• Any CT finding of metastatic nodal involvement (i.e., nodal diameter more
than 1 cm) must be confirmed histologically
– Up to 30% of the nodes are enlarged from noncancerous reactive causes such as
inflammation due to atelectasis or pneumonia secondary to the tumor
• A negative CT result (lymph nodes less than 1.0 cm) generally is more
accurate
– PET (more accurate than CT)
– Endoesophageal ultrasound
– Bronchoscopic FNA of paratracheal lymph nodes (Stations 4R, 7, and
4L)
– Mediastinoscopy
• It remains the standard method of tissue staging of the mediastinum
53

54. Cont.
• Pleural Effusion
– No pleural effusion should be assumed to be
malignant
• Cytologic proof of the presence of malignant cells is
required
• Effusion is often secondary to the atelectasis or
consolidation seen with central tumors, or it can be
reactive or secondary to cardiac dysfunction
– However, pleural effusion associated with a peripherally-based
tumor, particularly one that abuts the visceral or parietal pleural
surface, does have a higher probability of being malignant
54

55. Cont.
• Evaluation of distant metastasses
– Multiorgan scanning
• Brain CT or MRI
• Abdominal CT
• Bone scan
– Or PET scan
– Routine preoperative multiorgan scanning is not
recommended for patients with a negative clinical
evaluation and clinical stage I disease
• However, it is recommended for patients with regionally
advanced (clinical stage II, IIIA, and IIIB) disease
55

56. Assessment of Functional Status
• Two flights of stairs
• Flat surface
• Pulmonary functions
– Routinely performed when any resection greater than
a wedge resection will be performed
• FEV1
– >2L can tolerate pneumonectomy and >1 L can tolerate lobectomy
– Or percent predicted value >50%
• DLCO (carbon monoxide diffusion capacity )
• O2max (Maximal O2 consumption)
• Quantitative perfusion scan
– To estimate the functional contribution of a lobe or
whole lung
Other pertinent elements of the assessment
are current smoking status and sputum
production
Smoking should be stopped for ideally 8 wks
but atleast 2 wks before surgery
Sputum production: cause should be treated
56

57. Lung Cancer Staging
• Occult stage
– Microscopically identified cancer cells in lung
secretions on multiple occasions (or multiple daily
collections); no discernible primary cancer in the
lung
• Stage 0
– Carcinoma in situ
57

58. Cont.
• Stage IA
– Tumor surrounded by lung or visceral pleura ≤3
cm arising more than 2 cm distal to the carina (T1
N0)
• Stage IB
– Tumor surrounded by lung >3 cm, or tumor of any
size with visceral pleura involved arising more
than 2 cm distal to the carina (T2 N0)
58

59. Cont.
• Stage IIA
– Tumor ≤3 cm not extended to adjacent organs, with
ipsilateral peribronchial and hilar lymph node
involvement (T1 N1)
• Stage IIB
– Tumor >3 cm not extended to adjacent organs, with
ipsilateral peribronchial and hilar lymph node
involvement (T2 N1)
– Tumor invading chest wall, pleura, or pericardium but
not involving carina, nodes negative (T3 N0)
59

60. Cont.
• Stage IIIA
– Tumor invading chest wall, pleura, or pericardium and
nodes in hilum or ipsilateral mediastinum (T3, N1–2) or
tumor of any size invading ipsilateral mediastinal or
subcarinal nodes (T1–3, N2)
• Stage IIIB
– Direct extension to adjacent organs (esophagus, aorta,
heart, cava, diaphragm, or spine); satellite nodule in
same lobe, or any tumor associated with contralateral
mediastinal or supraclavicular lymph-node involvement
(T4 or N3)
60

61. Cont.
• Stage IV
– Separate nodule in different lobes or any tumor
with distant metastases (M1)
61

62. Treatment
62

63. Early-Stage Disease
• Stages I and II
• The current standard of treatment is surgical resection
– Lobectomy
– Sleeve lobectomy
– Pneumonectomy (rarely performed)
• Indicated primarily for :
– Larger central tumors involving the distal main stem bronchus when a
bronchial sleeve resection is not possible
– When resection of involved N1 lymph nodes cannot be achieved short of
pneumonectomy
• Other options (for patients unfit for surgery due to
inadequate pulmonary reserve or other medical
conditions)
– Limited surgical resection (Segmentectomy or wedge
resection) OR
– Radiotherapy
63

64. Locoregional Advanced Disease (stage III)
• Surgical resection as sole therapy has a limited
role in stage III disease
– Therefore, definitive treatment of stage III disease
(when surgery is not felt to be feasible at any
time) is usually a combination of chemotherapy
and radiation
• Chemo followed by radiation or given at the same time
(concurrent)
• Neoadjuvant chemo is another option
64

65. Metastatic disease
• The treatment of patients with stage IV
disease is chemotherapy
– Surgery has a very limited value (metastasectomy)
65

66. Small-Cell Lung Carcinoma
• It is not generally treated surgically
– These aggressive neoplasms have early widespread
metastases
– Patients with either early or metastatic stage are
treated primarily with chemotherapy and radiation
• Three groups of SCLC are recognized:
– Pure small-cell carcinoma (sometimes referred to as oat
cell carcinoma)
– Small-cell carcinoma with a large-cell component
– Combined (mixed) tumors
66

67. Metastatic Lesions to the Lung
• Features suggestive of metastatic disease are
multiplicity; smooth, round borders on CT scan
• Surgical resection has a role in properly selected
patients
– The primary tumor must already be controlled
– The patient must be able to tolerate general anesthesia,
potential single-lung ventilation, and the planned
pulmonary resection
– The metastases must be completely resectable
according to CT imaging
– There must be no evidence of extrapulmonary tumor
burden
– Alternative superior therapy must be unavailable
67

68. The End!
68