CT scan showing a cancerous tumor in the left lung Primary pulmonary sarcoma in an asymptomatic 72-year-old male Performing a chest radiograph (x-ray) is one of the first investigative steps if a person reports symptoms that may be suggestive of lung cancer. The x-ray may reveal an obvious mass, the widening of the mediastinum (suggestive of spread to lymph nodes there), atelectasis (lung collapse), consolidation (pneumonia), or pleural effusion. Computed tomography (CT) imaging of the chest is often used for diagnosis and may reveal a spiculated mass which is highly suggestive of lung cancer. CT imaging is also used to provide more information about the type and extent of disease. Bronchoscopic or CT-guided biopsy is often used to sample the tumor for histopathology. Lung cancer can often appear as a solitary pulmonary nodule on a chest radiograph. However, the differential diagnosis is wide and many other diseases can also give this appearance, including metastatic cancer, hamartomas, and infectious granulomas caused by tuberculosis, histoplasmosis, or coccidioidomycosis. Lung cancer can also be an incidental finding, as a solitary pulmonary nodule on a chest radiograph or CT scan done for an unrelated reason. The definitive diagnosis of lung cancer is based on the histological examination of the suspicious tissue in the context of the clinical and radiological features. Clinical practice guidelines recommend specific frequencies (suggested intervals of time between tests) for pulmonary nodule surveillance. CT imaging is not suggested to be used for longer or more frequently than indicated in the clinical guidelines, as any additional surveillance exposes people to increased radiation and is costly. Classification image page in Commons for percentages in numbers. Reference: Table 2 in: Age-adjusted incidence of lung cancer by histological type Histological type Incidence per 100,000 per year All types 66.9 Adenocarcinoma 22.1 Squamous-cell carcinoma 14.4 Small-cell carcinoma 9.8 Lung cancers are classified according to histological type. This classification is important for determining both the management and predicting outcomes of the disease. Lung cancers are carcinomas – malignancies that arise from epithelial cells. Lung carcinomas are categorized by the size and appearance of the malignant cells seen by a histopathologist under a microscope. For therapeutic purposes, two broad classes are distinguished: non-small-cell lung carcinoma (NSCLC) and small-cell lung carcinoma (SCLC). Non-small-cell lung carcinoma The three main subtypes of NSCLC are adenocarcinoma, squamous-cell carcinoma, and large-cell carcinoma. Rare subtypes include pulmonary enteric adenocarcinoma. Nearly 40% of lung cancers are adenocarcinomas, which usually come from peripheral lung tissue. Although most cases of adenocarcinoma are associated with smoking, it is also the most common form of lung cancer among people who have smoked fewer than 100 cigarettes in their lifetimes ("never-smokers") and ex-smokers with a modest smoking history. A subtype of adenocarcinoma, the bronchioloalveolar carcinoma, is more common in female never-smokers, and may have a better long-term survival. Squamous-cell carcinoma causes about 30% of lung cancers. They typically occur close to large airways. A hollow cavity and associated cell death are commonly found at the center of the tumor. About 10 to 15% of lung cancers are large-cell carcinoma. These are so named because the cancer cells are large, with excess cytoplasm, large nuclei, and conspicuous nucleoli. Small-cell lung carcinoma In SCLC, the cells contain dense neurosecretory granules (vesicles containing neuroendocrine hormones), which give this tumor an endocrine or paraneoplastic syndrome association. Most cases arise in the larger airways (primary and secondary bronchi). About 60–70% have extensive disease (which cannot be targeted within a single radiation therapy field) at presentation. Others Four main histological subtypes are recognised, although some cancers may contain a combination of different subtypes, such as adenosquamous carcinoma. Rare subtypes include carcinoid tumors, bronchial gland carcinomas, and sarcomatoid carcinomas. Metastasis Typical Napsin-A and TTF-1 immunostaining in primary lung carcinoma Histological type Napsin-A TTF-1 Squamous-cell carcinoma Negative Negative Adenocarcinoma Positive Positive Small-cell carcinoma Negative Positive The lungs are a common place for the spread of tumors from other parts of the body. These tumors are called metastases or secondary tumors. The most common appearance on chest x-ray is the presence of multiple nodules in the lower lobes. Primary lung cancers also most commonly metastasize to the brain, bones, liver, and adrenal glands. Immunostaining of a biopsy usually helps determine the original source. The presence of Napsin-A, TTF-1, CK7, and CK20 help confirm the subtype of lung carcinoma. SCLC that originates from neuroendocrine cells may express CD56, neural cell adhesion molecule, synaptophysin, or chromogranin. Staging Lung cancer staging is an assessment of the degree of spread of the cancer from its original source. It is one of the factors affecting both the prognosis and the potential treatment of lung cancer. The evaluation of NSCLC staging uses the TNM classification (tumor, node, metastasis). This is based on the size of the primary tumor, lymph node involvement, and distant metastasis. + TNM classification in lung cancer T: Primary tumor TX Any of: Primary tumor cannot be assessed Tumor cells present in sputum or bronchial washing, but tumor not seen with imaging or bronchoscopy T0 No evidence of primary tumor Tis Carcinoma in situ T1 Tumor size less than or equal to 3 cm across, surrounded by lung or visceral pleura, without invasion proximal to the lobar bronchus T1mi Minimally invasive adenocarcinoma T1a Tumor size less than or equal to 1 cm across T1b Tumor size more than 1 cm but less than or equal to 2 cm across T1c Tumor size more than 2 cm but less than or equal to 3 cm across T2 Any of: Tumor size more than 3 cm but less than or equal to 5 cm across Involvement of the main bronchus but not the carina Invasion of visceral pleura Atelectasis/obstructive pneumonitis extending to the hilum T2a Tumor size more than 3 cm but less than or equal to 4 cm across T2b Tumor size more than 4 cm but less than or equal to 5 cm across T3 Any of: Tumor size more than 5 cm but less than or equal to 7 cm across Invasion into the chest wall, phrenic nerve, or parietal pericardium Separate tumor nodule in the same lobe T4 Any of: Tumor size more than 7 cm Invasion of the diaphragm, mediastinum, heart, great vessels, trachea, carina, recurrent laryngeal nerve, esophagus, or vertebral body Separate tumor nodule in a different lobe of the same lung N: Lymph nodes NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Metastasis to ipsilateral peribronchial and/or hilar lymph nodes N1a Metastasis to a single N1 nodal station N1b Metastasis to two or more N1 nodal stations N2 Metastasis to ipsilateral mediastinal and/or subcarinal lymph nodes N2a1 Metastasis to one N2 nodal station with no involvement of N1 nodes N2a2 Metastasis to one N2 nodal station and at least one N1 nodal station N2b Metastasis to two or more N2 nodal stations N3 Any of: Metastasis to scalene or supraclavicular lymph nodes Metastasis to contralateral hilar or mediastinal lymph nodes M: Metastasis MX Distant metastasis cannot be assessed M0 No distant metastasis M1a Any of: Separate tumor nodule in the other lung Tumor with pleural or pericardial nodules Malignant pleural or pericardial effusion M1b A single metastasis outside the chest M1c Two or more metastases outside the chest Using the TNM descriptors, a group is assigned, ranging from occult cancer, through stages 0, IA (one-A), IB, IIA, IIB, IIIA, IIIB, and IV (four). This stage group assists with the choice of treatment and estimation of prognosis. + Stage group according to TNM classification in lung cancer TNM Stage group T1a–T1b N0 M0 IA T2a N0 M0 IB T1a–T2a N1 M0 IIA T2b N0 M0 T2b N1 M0 IIB T3 N0 M0 T1a–T3 N2 M0 IIIA T3 N1 M0 T4 N0–N1 M0 N3 M0 IIIB T4 N2 M0 M1 IV SCLC has traditionally been classified as "limited stage" (confined to one-half of the chest and within the scope of a single tolerable radiotherapy field) or "extensive stage" (more widespread disease). However, the TNM classification and grouping are useful in estimating prognosis. For both NSCLC and SCLC, the two general types of staging evaluations are clinical staging and surgical staging. Clinical staging is performed before definitive surgery. It is based on the results of imaging studies (such as CT scans and PET scans) and biopsy results. Surgical staging is evaluated either during or after the operation. It is based on the combined results of surgical and clinical findings, including surgical sampling of thoracic lymph nodes. File:Diagram showing stage 1A and 1B lung cancer CRUK 197.Stage IA and IB lung cancer File:Diagram showing stage 2A lung cancer CRUK 213.Stage IIA lung cancer File:Diagram showing one option for stage 2Ba lung cancer CRUK 176.Stage IIB lung cancer File:Diagram showing one option for stage 2Bb lung cancer CRUK 177.One option for stage IIB lung cancer, with T2b; but if tumor is within 2 cm of the carina, this is stage 3 File:Diagram 1 of 3 showing stage 3A lung cancer CRUK 008.Stage IIIA lung cancer File:Diagram 2
medical cause of Hemoptysis
symptom of Lung cancer
types of Lung cancer
medical cause of Hemothorax
medical cause of Bronchiectasis
medical cause of Chylothorax
medical cause of Bronchiolitis
symptom of Bronchiectasis