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For further information, see CMDT Part 41-03: Bronchogenic Carcinoma
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Essentials of Diagnosis
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New cough or change in chronic cough
Dyspnea, hemoptysis, anorexia, weight loss
Enlarging lung nodule or mass, persistent opacity, 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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General Considerations
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Leading cause of cancer deaths
Cigarettes smoking causes 85–90% of lung cancers
Small cell lung cancer (SCLC) (13%)
Bronchial origin, begins centrally, and infiltrates submucosally
Prone to early hematogenous spread
Has a very aggressive course
Non–small cell lung cancer (NSCLC)
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The American Cancer Society estimates 236,740 new diagnoses and 130,180 deaths from lung cancer in the United States in 2022, accounting for approximately 12% of new cancer diagnoses and 21% of all cancer deaths
Median age at diagnosis in the United States is 71 years
Environmental risk factors include
Tobacco smoke
Radon gas
Asbestos
Metals
Diesel exhaust
Ionizing radiation
Industrial carcinogens
A familial predisposition is recognized
Chronic obstructive pulmonary disease, pulmonary fibrosis, and sarcoidosis are associated with an increased risk of lung cancer
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Majority of patients are symptomatic at diagnosis
Presentation depends on
Type and location of tumor
Extent of spread
Presence of distant metastases
Any paraneoplastic syndromes
Anorexia, weight loss, and asthenia in 55–90%
New or changed cough in up to 60%
Hemoptysis in 6–31%
Pain, often from bony metastases, in 25–40%
Local spread may result in endobronchial obstruction with atelectasis and post-obstructive pneumonia, pleural effusions (12–33%), or a change in voice due to recurrent laryngeal nerve involvement
Superior vena cava (SVC) syndrome
Horner syndrome
Liver metastases are associated with asthenia and weight loss
Possible presentation of brain metastases
Headache
Nausea and vomiting
Seizures
Dizziness
Altered mental status
Paraneoplastic syndromes (10–20 % of lung cancer patients) (eTable 41–1)
Syndrome of inappropriate antidiuretic hormone secretion occurs in 10–15% of SCLC patients
Hypercalcemia occurs in 10% of squamous cell carcinoma patients
Digital clubbing in up to 20% of patients at diagnosis
Other common syndromes
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