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A 60-year-old woman presents with a solid, nontender, movable mass on her upper chest that's been there for 6 months. It began as a dime-size mass and has been growing more rapidly over the past month (Figure 58-1A). She has lost 10 pounds over the last year without dieting. She has smoked 1 pack of cigarettes per day since age 18 years and gets short of breath easily. Her “smoker's cough” has gotten worse in the last few months and occasionally she coughs up some blood-tinged sputum. Her family physician excised the mass in the office and sent it to pathology (Figure 58-1B). When the result demonstrated squamous cell carcinoma of the lung, a chest x-ray (CXR) was ordered (Figure 58-2A). The radiologist suggested a CT to confirm the diagnosis (Figure 58-2B). The patient chose to have no treatment and passed away in 10 months of her lung cancer.

Figure 58-1

A. Growing chest nodule in a 60-year-old woman who smoked tobacco her whole adult life. The pathology demonstrated metastatic squamous cell carcinoma from the lung. B. The resected nodule was surgically removed by the family physician in the office. (Courtesy of Leonard Chow, MD, and Ross Lawler, MD.)

Figure 58-2

A. Chest x-ray showing squamous cell carcinoma of the lung. B. CT scan demonstrating the architecture of the squamous cell carcinoma of the lung. (Courtesy of David A. Kasper DO, MBA.)

Lung cancer is a malignant neoplasm of the lung arising from respiratory epithelium (bronchi, bronchioles/alveoli), most commonly adenocarcinoma or squamous cell carcinoma.

  • In 2007, lung cancer was diagnosed in 203,546 people in the United States (109,643 men and 93,893 women).1 Both incidence and mortality rates have been decreasing since 1999 for men, but remain level for women.
  • Black men have the highest age-adjusted incidence rates (99.8/100,000) followed by white men (75.3/100,000), and then black women (54.7/100,000) and white women (54.6/100,000); Hispanic men (41.5/100,000) and women (26.1/100,000) have the lowest incidence rates.2
  • Risk increases with age; at age 60 years, 2.29% of men will develop lung cancer in 10 years and 5.64% in 20 years.1 Among women at age 60 years, 1.74% will develop lung cancer in 10 years and 4.27% in 20 years. Median age at diagnosis is 71 years.2
  • In 2007, lung cancer was the leading cause of cancer deaths, accounting for 14% of all cancer diagnoses and 28% of all cancer deaths.3
  • The 2011 estimate for new cases of lung cancer in the United States was 221,130 with 156,940 deaths ...

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