Malignant neoplasms of lungs

Malignant neoplasms of lung 

Updated: 07/11/2022

© Jun Wang, MD, PhD

General features
  • Leading cause of cancer death in the United States
  • Cessation of smoking improves prognosis
  • Metastasis commonly to adrenal glands, brain, contralateral lung, bone, liver, etc
Risk factors
  • Cigarette smoking: Most common risk factor; quantity of cigarette smoking summarized by the number of packs of cigarettes smoked per day multiplied by the number of years smoked
  • Secondhand smoke
  • Radiation at home: Radon
  • Occupational and environmental factors: wood/coal fuels, asbestos, arsenic, radiation, dusts and fumes from nickel, chromium, etc
  • Family and genetic factors
Clinical presentations
  • Coughing
  • Hemoptysis
  • Chest pain
  • Others: Pneumonia, pleural effusion, etc
  • Superior vena cava syndrome
Medical emergency and most often manifests in patients with a malignant disease process within the thorax
Due to obstruction of blood flow through the superior vena cava
May cause obstructive shock
Requires immediate diagnostic evaluation and therapy
Most commonly caused by small cell carcinoma, non Hodgkin lymphoma, and mediastinal tumors
Presentations: Dyspnea (most common), facial swelling, head fullness,  arm swelling, etc
Management: Relieve symptoms and to attempt cure of the primary malignant process, corticosteroids, diuretics, radiation therapy, surgical bypass, etc
  • Horner syndrome
Caused by interruption of the sympathetic nerve supply to the eye
Classic triad of miosis (ie, constricted pupil), partial ptosis, and loss of hemifacial sweating (ie, anhidrosis)
Causes: Neuronal defects, trauma, tumors or infection of the lung apex, dissecting aneurysm, etc
Treatment: Treat underlying diseases
Diagnostic approach
  • Clinical assessment: history, PE, any signs of metastasis
  • Laboratory: CBC, electrolytes, calcium, alkaline phosphatase, etc
  • Image studies
  • Pathological studies: Biopsy, sputum cytology, etc
Current classification
  • Epithelial tumors
Adenocarcinoma, including large cell carcinoma
Squamous cell carcinoma
Neuroendocrine carcinoma
Carcinoid
Adenosquamous cell carcinoma, sarcomatoid carcinoma, salivary gland type tumor, etc
  • Mesenchymal tumors
Inflammatory myofibroblastic tumor
Synovial sarcoma
Myoepithelial tumor, etc
  • Lymphohistiocytic tumors: Lymphomas, etc
  • Tumors of ectopic origin: Teratoma, etc
  • Metastatic tumors: Most common malignant tumor of lungs, usually multiple, express markers of original tumor
Molecular abnormalities
  • KRAS: GTPase, RAS/MAPK pathway
  • EGFR: Protein tyrosine kinase
  • EML4-ALK fusion: Consistent activation of ALK tyrosine kinase domain
  • Others: Including BRAF, Her2, PIK3CA, etc
Current molecular tests and targeted therapies

aAsian populations;         bWestern populations


Treatment
  • Surgery
  • Chemotherapy
  • Radiation therapy
Indicators for poor prognosis
  • High stage at presentation
  • Poor performance scores
  • Weight loss



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