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Lung cancer is the leading cause of cancer deaths in both men and women The American Cancer Society estimates 172,570 new diagnoses and 163,510 deaths from lung cancer in the United States in 2005, accounting for approximately 13% of new cancer diagnoses and 28% of all cancer deaths More Americans now die of lung cancer than of colorectal, breast, and prostate cancers combined This dramatic increase in a previously reportable disease is causally related to exposure to carcinogens through inhalation of tobacco smoke The causal connection between cigarettes and lung cancer is now established not only epidemiologically but also through identification of carcinogens in tobacco smoke and analysis of the effect of these carcinogens on specific oncogenes expressed in lung cancer Even cigarette manufacturers no longer dispute the role of tobacco in this epidemic Cigarette smoking causes more than 80% of cases of lung cancer Through the 1990s, mortality from lung cancer fell among men while it increased among women, reflecting changing patterns of tobacco use over the past 30 years (see 1) Other environmental risk factors for the development of lung cancer include exposure to environmental tobacco smoke, radon gas (among uranium miners and in areas where radium in the soil causes significant indoor air contamination), asbestos (60- to 100-fold increased risk in smokers with asbestos exposure), metals (arsenic, chromium, nickel, iron oxide), and industrial carcinogens (bis-chloromethyl ether) A familial predisposition to lung cancer is recognized Certain diseases are associated with an increased risk of lung cancer, including pulmonary fibrosis, chronic obstructive pulmonary disease, and sarcoidosis Second primary lung cancers are more frequent in patients who survive their initial lung cancer The mean age at diagnosis of lung cancer is 60; it is unusual under the age of 40 After the diagnosis of lung cancer is made, approximately 40% of patients survive 1 year The combined 5-year survival rate for all stages of lung cancer is now approximately 15%, improved from 12% in 1974 1976 Four histologic types of bronchogenic carcinoma account for more than 90% of cases of primary lung cancer Squamous cell carcinoma (25 35% of cases) arises from the bronchial epithelium, typically as a centrally located, intraluminal sessile or polypoid mass Squamous cell tumors are more likely to present with hemoptysis and more frequently are diagnosed by sputum cytology They spread locally and may be associated with hilar adenopathy and mediastinal widening on chest radiography Adenocarcinoma (35 40% of cases) arises from mucus glands or, in the case of the bronchioloalveolar cell carcinoma (2% of cases), from any epithelial cell within or distal to the terminal bronchioles Adenocarcinomas usually present as peripheral nodules or masses Bronchioloalveolar cell carcinoma spreads intra-alveolarly and may present as an infiltrate or as single or multiple pulmonary nodules Large cell carcinoma (5 10% of cases) is a heterogeneous group of relatively undifferentiated tumors that share large cells and do not fit into other categories Large cell carcinomas typically have rapid doubling times and an aggressive clinical course They present as central or peripheral masses Small cell carcinoma (15 20% of cases) is a.

New cough, or change in chronic cough Dyspnea, hemoptysis, anorexia, weight loss Enlarging nodule or mass; persistent infiltrate, atelectasis, or pleural effusion on chest radiograph or CT scan Cytologic or histologic findings of lung cancer in sputum, pleural fluid, or biopsy specimen

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tumor of bronchial origin that typically begins centrally, infiltrating submucosally to cause narrowing or obstruction of the bronchus without a discrete luminal mass Hilar and mediastinal abnormalities are common on chest radiography For purposes of staging and treatment, bronchogenic carcinoma is divided into small cell lung cancer (SCLC) and the other three types, conveniently labeled non small cell lung cancer (NSCLC) This practical classification reflects different natural histories and different treatment SCLC is prone to early hematogenous spread It is rarely amenable to surgical resection and has a very aggressive course with a median survival (untreated) of 6 18 weeks The three histologic categories comprising NSCLC spread more slowly They may be cured in the early stages following resection, and they respond similarly to chemotherapy

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