Definition

Lung cancer is a malignant tumor that develops from both lung and bronchial cells. There
are two categories of lung cancer clinically important considering the origin and behavior
of cancer cells:

1. Small cell lung cancer (SCLC).

2. Non-small cell lung cancer (NSCLC).

The first represents about 25% of lung cancers and is very aggressive in behavior,
proliferating rapidly. It shows the greatest relation with smoking, since 98% of the
patients presenting it have a history of smoking.

On the other hand, the second constitutes approximately 75% of lung cancer types and
is divided into three major subtypes:

a) Squamous cell (squamous) cell cancer:

It represents 30% of all cases of lung cancer, shows a strong relationship with
tobacco and is associated with the best prognosis.

b) Adenocarcinoma: It occupies the first place in epidemiological frequency (50%)

and is also the most common type in non-smoking patients.

It arises from mucoproductive cells and is classified into four subtypes:

Acinar.
Papillary.
Bronchioloalveolar.
Solid mucin-secreting variety.

c) Undifferentiated carcinomas, which occupy 5% of cases, including large cell

carcinoma, which can arise anywhere in the lung, has a poor prognosis and is
also associated with smoking.

There is a significant risk of a second primary lung tumor synchronous (1-7%) or

metachronous (10%).

Synchronous is defined as the presence of two tumors at the same time or detected
within a very short interval after diagnosis.

Metachronous is the second cancer that appears after a wide interval of time, 12 months
or more.
The dissemination patterns that occur in the CP are by direct extension, affecting the
pleura, vessels, lymph nodes, chest wall, etc., lymphatically to the bronchial, hilar and
mediastinal ganglia and through the hematogenous route that cant respect any organ.
The most affected are bone, adrenal, liver and brain.

Etiopathogeny

Etiology

The main causes of lung cancer, as well as cancer in general, include carcinogens such
as cigarette smoke, ionizing radiation and viral infections. Exposure to these agents
causes cumulative changes in the DNA of cells, progressively accumulating genetic
alterations that transform the epithelium that examine the bronchi of the lung. As the
deeper damage, lung cancer develops.

Anatomy

The lungs are located in the thorax. When you breathe, the air passes through the nose,
down the trachea and reaches the lungs, where it flows through ducts called bronchi.
Most lung cancers begin in the cells lining these ducts.

CPCNP arises from the pulmonary epithelial cells of the central bronchus to the terminal
alveolus. The histological type of CPCNP correlates with the site of origin, reflecting a
variation in the respiratory tract epithelium from the bronchus to the alveolus. Squamous
cell carcinoma usually begins near the central bronchus. Adenocarcinoma and
bronchoalveolar carcinoma usually originate in the peripheral tissue of the lung.

Pathogeny

Carcinogenesis of the lung associated with smoking is a multi-stage process. Squamous

cell carcinoma and adenocarcinoma have defined premalignant precursor lesions.
Before becoming invasive, the lung epithelium may present morphological changes that
include the following:

Hyperplasia.
Metaplasia.
Dysplasia.
Carcinoma in situ.

Dysplasia and carcinoma in situ are considered the main premalignant lesions because
they are more likely to evolve into invasive cancer and less likely to recur spontaneously.
In addition, after resection of lung cancer, there is between 1 and 2% risk of a second
lung cancer per patient per year.

Pathology

Non-small cell lung cancer (NSCLC) is a heterogeneous conglomeration of histologies.

The most common stories are:

Squamous or squamous cell carcinoma.

Adenocarcinoma.
Large cell carcinoma.

These histologies are often classified together because of diagnostic methods, staging,
prognosis and similar treatment.

Diagnosis

Staging tests

After you know that you have lung cancer, you may need staging tests to help with your
treatment decisions. Staging tests can show the stage (the extent) of lung cancer; That
is, if the cancer cells have spread to other parts of the body.

When lung cancer spreads, cancer cells are often found in nearby lymph nodes. Lung
cancer cells can spread from the lung to almost any other part of the body, such as the
brain, bones, other lungs, liver or adrenal glands.

Staging tests may include:

Computed Tomography Scan: An x-ray machine attached to a computer takes

a series of detailed pictures of your chest, abdomen, brain, or other parts of your
body. You will be given a contrast material by means of an injection into a vein in
your arm or hand. For a CT scan of the abdomen, you will also be given contrast
material by the mouth. The contrast material helps to make the abnormal areas
look more easily. Images from a CT scan may show the size of the lung tumor.
The images may also show cancer that has spread to your liver, adrenal glands,
brain, or other organs.
Positron Emission Tomography (PET): Your doctor may use a positron
emission tomography scan to get a better view of the tumor in the lung or to find
cancer that has spread. The doctor will inject a small amount of radioactive sugar.
A machine generates computerized sugar images that the cells of your body use.
 Since cancer cells use sugar faster than normal cells, the areas with cancer cells
look brighter in the images.
Magnetic Resonance (MRI): A powerful magnet connects to a computer to
generate detailed images of your head or spine. Magnetic resonance imaging
can show if the cancer has spread to these areas. Sometimes contrast material
is used to make abnormal areas appear more clearly in the image.
Bone scan: A small amount of radioactive substance will be injected into a blood
vessel. The radioactive substance travels through your bloodstream and
accumulates in your bones. A machine called a scanner detects and measures
radiation. The scanner creates images of your bones. As larger amounts of the
substance accumulate in areas where cancer is present, the pictures may show
cancer that has spread to the bones.

Further testing may be necessary. For example, your doctor may take samples from
lymph nodes or other tissues to see if lung cancer has spread.

Treatment

Surgery, with the removal of the entire lobe where the tumor is located, is the
primary treatment for patients with early stage cancer who have a good overall
health. The goal of surgery is to completely eliminate all tumor cells and thus
cure the disease.
Lobectomy, the removal of a whole lung lobe, is an accepted procedure to
eliminate cancer when the lungs work well.
Radiation therapy or radiation therapy delivers high-energy x-rays that can
destroy cancer cells. It has many uses for lung cancer:
o As primary treatment
o To reduce tumor size before surgery
o After surgery to remove any cancer cells that may have been left
in the treated area.
o To treat lung cancer that has spread to the brain or other parts of
the body.
Annexed