Lung cancer

Dr Tee Yu Jin and A.Prof Frank Gaillard et al.

Lung cancer (primary lung cancer), or frequently if somewhat incorrectly known as bronchogenic carcinoma is a broad term referring to the main histological subtypes of primary lung malignancies that are mainly linked with inhaled carcinogens, with cigarette smoke being a key culprit. 

This article will broadly discuss all the histological subtypes as a group, focusing on their common aspects and for further details please refer to the specific articles on each subtype described below.  

Lung cancer is a leading type of cancer, equal in prevalence with breast cancer 13. It is the leading cause of cancer mortality worldwide; accounting for ~20% of all cancer deaths 1.

Patients with lung cancer may be asymptomatic in up to 50% of cases. Cough and dyspnea are rather non-specific symptoms that are common amongst those with lung cancer.

Central tumors may result in hemoptysis and peripheral lesions with pleuritic chest pain.

Pneumonia, pleural effusion, wheeze, lymphadenopathy are not uncommon. Other symptoms may be secondary to metastases (bone, contralateral lung, brain, adrenal glands, and liver, in frequency order for NSCLC 12) or paraneoplastic syndromes.

The term bronchogenic carcinoma is somewhat loosely used to refer to primary malignancies of the lung that are associated with inhaled carcinogens 1 and includes four main histological subtypes. These are broadly divided into non-small cell carcinoma and small cell carcinoma as they differ clinically regarding presentation, treatment and prognosis:

Other malignant pulmonary neoplasms include lymphoma and sarcoma (rare).

Each subtype has a different radiographic appearance, demographic, and prognosis:

The major risk factor is cigarette smoking which is implicated in 90% of cases and increase the risk of lung cancer, which can be divided by histological subtype 10:

  • squamous cell lung cancer: 11x (men), 15x (women)
  • small cell lung cancer: 10x (men), 25x (women)
  • large cell lung cancer: 7x (men), 8x (women)
  • lung adenocarcinoma: 4x (men and women)

Other risk factors:

Several antibodies or markers from tissue samples may be useful in the diagnosis and prognostication of disease. These include

Various paraneoplastic syndromes can arise in the setting of lung cancer:

Treatment and prognosis vary not only with stage but also with cell type. In general, surgery, chemotherapy, and radiotherapy are offered according to the stage, resectability, operability, and functional status.

  • treatment
    • operable disease (stage I to IIIA): surgery
    • unresectable disease: neoadjuvant chemotherapy, radiotherapy
    • advanced disease: palliative combined chemotherapy
  • prognosis (5-year survival rates):
    • local (stage I): 55-67%
    • locally advanced (stages II-IIIA): 23-40%
    • advanced (stages IIIB and IV): 1-3%
  • treatment
    • limited disease: chemoradiotherapy
    • extensive disease: palliative combined chemotherapy
  • prognosis: poor
    • limited: 5-year survival rate 15-25%
    • extensive: 2-year survival 20% (with palliative combined chemotherapy and supportive care)
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Article information

rID: 1022
System: Chest, Oncology
Synonyms or Alternate Spellings:
  • Primary lung cancer
  • Primary lung carcinoma
  • Bronchogenic cancer
  • Lung cancer: general
  • Primary lung cancer
  • Bronchogenic malignancy
  • Primary lung malignancy
  • Bronchogenic carcinoma
  • Lung cancer: overview
  • Primary lung cancers

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Cases and figures

  • Figure 1: gross pathology - squamous cell carcinoma
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  • Case 1
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  • Figure 2: gross specimen
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  • Case 2: squamous cell carcinoma
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  • Bronchoalveolar c...
    Case 3
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  • Case 4: cavitating
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  • Case 5
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  • Case 6: with SVC obstruction
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  • Case 7: hilar cancer
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  • Case 8: with RUL collapase
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  • Case 9
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  • Case 10
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  • Case 11: CT
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  • Case 12: undifferentiated large cell carcinoma
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  • Bronchogenic aden...
    Case 13: with associated pulmonary embolism
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  • Case 14
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  • Case 15: squamous cell carcinoma
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  • Case 16: CT
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  •  Case 17
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  •  Case 18
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  •  Case 19
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  • Case 25
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