Pathology - Bronchogenic Carcinoma
Smoking cigarettes (particularly associated with small and squamous cell carcinomas); air pollution; ionizing radiation; asbestos; nickel; exposure to chromium Squamous cell: Squamous cells are centralized, have a hilar mass that is cavitated, and become keratinized. Adenocarcinoma: Found in the periphery, comes in two varieties: First, bronchial derived: forms on glandular elements with mucin cells at the scar site; second, bronchioalveolar: many mucinous nodules (that show up on CXR) and tall columnar epithelial cells lining the alveolar walls tiny cell: located in the center; these are spherical, basophilic, and low in cytoplasm cells (oat cell is a neoplasm of neuroendocrine Kulchitsky cells). Large cell: Large polygonal undifferentiated cells (pleomorphic gigantic cells with pieces of leukocytes) located in the periphery within the cytoplasm. Often, all forms of metastases affect the adrenal glands, brain, liver, and bones. Compared to primary lung cancer, metastases of other malignancies to the lung are more frequent and can occur hematogenously through lymphatics or contiguous growth. Lung cancerous tumors can also arise. Clinical Signs and Symptoms symptoms include hemoptysis, dyspnea, coughing, weight loss, pleural effusion (typically bloody), and hoarseness due to paralysis of the recurrent laryngeal nerve. Pancoast tumor: Apical lung tumor that involves the cervical sympathetic plexus and causes Horner syndrome (ptosis, miosis, and anhidrosis). Superior vena cava syndrome: Tumor compression of the SVC causes facial edema and dilated veins in the head and upper extremities. Small cell carcinoma is associated with Cushing syndrome (induced by the synthesis of ACTH-like proteins), SIADH (caused by the production of ADH-like proteins), and Lambert-Eaton Syndrome (mvastenia gravis-like sickness resulting from a deficiency in acetyicholine release). Visualization: Pneumonic coin lesion seen in CXR Results from the lab: PTH-like protein synthesis results in hypercalcemia, which is observed in squamous cell cancer. Treatment For non-small cell lung cancer, surgery, radiation, and chemotherapy are used; for small cell carcinoma, radiation and chemotherapy are used. The 5-year survival rate is 10%–15% overall.
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