Lungenkarzinom





































Lung cancer (primary lung cancer), or frequently if somewhat incorrectly known as bronchogenic carcinoma, is a broad term referring to the main histological subtypes of primary lung malignancies that are mainly linked with inhaled carcinogens, with cigarette smoke being a key culprit.
This article will broadly discuss all the histological subtypes as a group, focusing on their common aspects and for further details please refer to the specific articles on each subtype described below.
Epidemiology
Lung cancer is a leading type of cancer, equal in prevalence to breast cancer . It is the leading cause of cancer mortality worldwide; accounting for ~20% of all cancer deaths .
Risk factors
The major risk factor is cigarette smoking which is implicated in 90% of cases and increase the risk of lung cancer, which can be divided by histological subtype :
- squamous cell lung cancer: 11x (men), 15x (women)
- small cell lung cancer: 10x (men), 25x (women)
- large cell lung cancer: 7x (men), 8x (women)
- lung adenocarcinoma: 4x (men and women)
Other risk factors:
- asbestos: 5x increased risk
- occupational exposure: uranium, radon, arsenic, chromium
- diffuse lung fibrosis: 10x increased risk
- chronic obstructive pulmonary disease
Associations
Various paraneoplastic syndromes can arise in the setting of lung cancer:
- endocrine/metabolic
- SIADH causing hyponatremia: small-cell subtype
- ACTH secretion (Cushing syndrome): carcinoid and small-cell subtypes
- carcinoid syndrome
- gynecomastia
- adrenal insufficiency (Addison disease): from bilateral metastases
- hyperparathyroidism: NSCLC can produce parathyroid hormone (extremely rare)
- hypocalcemia: occurs in the setting of skeletal metastases; especially associated with NSCLC
- PTH-related peptide (PTHrp) causing hypercalcemia: squamous cell carcinoma
- neurological
- polyneuropathy
- myelopathy
- limbic encephalitis: particularly associated with SCLC
- cerebellar degeneration
- Lambert-Eaton myasthenia syndrome
- other
- finger clubbing
- hypertrophic pulmonary osteoarthropathy (HPOA): squamous cell carcinoma subtype
- nephrotic syndrome
- polymyositis
- dermatomyositis
- eosinophilia
- acanthosis nigricans
- thrombophlebitis: adenocarcinoma subtype
Clinical presentation
Patients with lung cancer may be asymptomatic in up to 50% of cases. Cough and dyspnea are rather non-specific symptoms that are common amongst those with lung cancer.
Central tumors may result in hemoptysis and peripheral lesions with pleuritic chest pain.
Pneumonia, pleural effusion, wheeze, lymphadenopathy are not uncommon. Other symptoms may be secondary to metastases (bone, contralateral lung, brain, adrenal glands, and liver, in frequency order for NSCLC ) or paraneoplastic syndromes.
Pathology
The term bronchogenic carcinoma is somewhat loosely used to refer to primary malignancies of the lung that are associated with inhaled carcinogens and includes four main histological subtypes. These are broadly divided into non-small cell carcinoma and small cell carcinoma as they differ clinically regarding presentation, treatment, and prognosis:
- non-small cell lung cancer (NSCLC) (80%)
- adenocarcinoma (35%)
- most common cell type overall
- most common in women
- most common cell type in non-smokers but still most patients are smokers
- peripheral
- squamous cell carcinoma (30%)
- strongly associated with smoking
- most common carcinoma to cavitate
- poor prognosis
- large-cell carcinoma (15%)
- peripherally located
- very large, usually >4 cm
- adenocarcinoma (35%)
- small cell carcinoma (20%)
- almost always in smokers
- metastasizes early
- most common primary lung malignancy to cause paraneoplastic syndromes and SVC obstruction
- worst prognosis
Other malignant pulmonary neoplasms include lymphoma and sarcoma (rare).
Each subtype has a different radiographic appearance, demographic, and prognosis:
- squamous-cell carcinoma of the lung
- adenocarcinoma of the lung
- large cell carcinoma of the lung
- small cell carcinoma of the lung
Antibodies and markers
Several antibodies or markers from tissue samples may be useful in the diagnosis and prognostication of disease. These include
- programmed death-ligand 1 (PD-L1)-targeted monoclonal antibodies
- thyroid transcription factor 1 (TTF-1): expressed in most lung cancer except squamous cell cancer
Staging
Treatment and prognosis
Treatment and prognosis vary not only with stage but also with cell type. In general, surgery, chemotherapy, and radiotherapy are offered according to the stage, resectability, operability, and functional status.
Non-small cell carcinoma
- treatment
- operable disease (stage I to IIIA): surgery
- unresectable disease: neoadjuvant chemotherapy, radiotherapy
- advanced disease: palliative combined chemotherapy
- prognosis (5-year survival rates):
- local (stage I): 55-67%
- locally advanced (stages II-IIIA): 23-40%
- advanced (stages IIIB and IV): 1-3%
Small-cell carcinoma
- treatment
- limited disease: chemoradiotherapy
- extensive disease: palliative combined chemotherapy
- prognosis: poor
- limited: 5-year survival rate 15-25%
- extensive: 2-year survival 20% (with palliative combined chemotherapy and supportive care)
See also
Siehe auch:
- Lymphom
- Dermatomyositis
- CT gesteuerte Lungenbiopsie
- Pierre-Marie-Bamberger-Krankheit
- Adenokarzinom der Lunge
- sarkomatoides Karzinom der Lunge
- Plattenepithelkarzinom
- Morbus Cushing
- Gynäkomastie
- adenocarcinoma
- Plattenepithelkarzinom der Lunge
- Lungenkarzinom Staging
- Karzinoidsyndrom
- Nephrotisches Syndrom
- Asbest
- nichtkleinzelliges Lungenkarzinom
- Trommelschlägelfinger
- transbronchiale Nadelaspiration (EBUS-TBNA)
- large cell carcinoma of the lung
- Metastasen
- Kleinzelliges Lungenkarzinom
- kleinzelliges Karzinom
- large-cell carcinoma
und weiter:
- Tumoren der Schädelkalotte
- Mediastinalshift
- solitäre lytische Läsion des Schädels
- Bronchogene Zyste
- Kerley-Linien
- Pneumatozele
- cancer
- Pancoast tumour
- bronchocoele
- Milzmetastasen
- Lungenabszess
- pulmonary opacification
- solitärer fibröser Tumor der Pleura
- distal appendicular skeletal metastases
- solitärer pulmonaler Rundherd
- Pleuramesotheliom
- Luftsichelzeichen
- Mesotheliom
- Tumoren der Trachea
- Metastasen in der Orbita
- Obere Einflussstauung
- Anthrakose
- ultrasound appearances of liver metastases
- bilaterale axilläre Lymphadenopathie
- Phrenikusparese
- pulmonary cavity (mnemonic)
- Rundpneumonie
- Krukenberg-Tumor
- causes of perfusion defects on a VQ scan
- fibrinous pericarditis
- bronchial arterial aneurysm
- lung mass with calcification
- radiation-induced lung cancer
- large-cell lymphoma of the mediastium
- Lungentumor
- metastases to the pituitary gland
- hiläre Lymphadenopathie
- Tumoren des Tracheobronchialsystems
- skeletal mass with fluid-fluid levels
- endobronchial metastases
- lobar collapse
- metastatic axillary lymphadenopathy of unknown primary
- differential of an air crescent sign
- reverse S sign of Golden
- pleomorphic carcinoma of lung
- neuroendocrine tumours of the lung
- haemorrhagic metastases (mnemonic)
- Raucherlunge
- AIDS defining malignancies
- pulmonary neuroendocrine tumours
- smoking related respiratory tract disease
- intramuskuläre Metastasen
- differential of a large unilateral pleural effusion
- monophasic sarcomatoid carcinoma of lung
- dense hilum sign
- inorganic dust
- Syndrom der inadäquaten ADH-Sekretion (SIADH)
- bronchiale Tumoren
- Hämoptyse
- In Situ Adenokarzinom der Lunge
- more black sign
- Lipidpneumonie
- focal pulmonary opacity (mnemonic)
- Kavernöse Lungenläsionen
- pulmonary paragonimiasis
- Flüssigkeit-Flüssigkeitsspiegel
- Thorax Onlinekurs
- idiopathisches Lungenemphysem mit riesigen Bullae
- Bronchusobstruktion durch Neoplasien
- small round cell lung carcinoma with neuroendocrine features
- Asbest assoziierte Erkrankungen
- Kaverne der Lunge
- gemischt osteolytisch osteoblastische Knochenmetastasen
- cavitating lung cancer
- multifocal lung adenocarcinoma
- kongenitale pulmonale Atemwegsmalformation (CPAM)
- adenosquamöses Karzinom der Lunge
- IASLC
- Pankreasmetastasen (Lungenkarzinom)
- liver metastases from lung cancer
- metastatic pulmonary nodule from lung carcinoma
- hilar lung cancer
- lung carcinoma - on ultrasound
- radionuclide noninvasive determination of lung cancer
