system
Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.
user
In a chronic smoker a highly malignant aggressive and metastatic lung carcinoma is
assistant
The correct answer is  Cigarette smoking is most strongly associated with squamous cell carcinoma and small cell carcinoma. Small cell carcinoma variant is more malignant and metasizes Ref Harrison 19th edition pg 1702