A 60-year-old woman presents with a solid, nontender, movable mass on her upper chest that's been present for 6 months. It began as a dime-size mass and has been growing more rapidly over the past month (Figure 60-1A). She has lost 10 pounds over the last year without dieting. She has smoked 1 pack of cigarettes daily 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 60-1B). When the result demonstrated squamous cell carcinoma of the lung, a chest X-ray (CXR) was ordered (Figure 60-2A). The radiologist suggested a CT to confirm the diagnosis (Figure 60-2B). The patient chose to have no treatment and passed away in 10 months of her lung cancer.
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. (Reproduced with permission from Leonard Chow, MD, and Ross Lawler, MD.)
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. (Reproduced with permission from 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 2013, lung cancer was diagnosed in 212,584 people in the United States (111,907 men and 100,677 women) and there were 156,176 deaths from the disease.1
Black men have the highest age-adjusted incidence rates (87.3/100,000) followed by white men (68.1/100,000), and then white women (51.8/100,000) and black women (50.0/100,000); Hispanic men (36.6/100,000) and women (24.8/100,000) have the lowest incidence rates.2
Risk increases with age; at age 60 years, 1.96% of men will develop lung cancer in 10 years and 5.01% in 20 years.1 Among women at age 60 years, 1.5% will develop lung cancer in 10 years and 3.89% in 20 years. Median age at diagnosis is 70 years.1
Estimates for 2016: lung cancer was the leading cause of cancer deaths, accounting for 13.3% of all cancer diagnoses and 26.5% of all cancer deaths.2
ETIOLOGY AND PATHOPHYSIOLOGY