TUMORS OF LUNG

DR. FAYAZ HUSSAIN BHURGRI

Chief Radiologist
Chandka Medical College Hospital, Larkana
Date 04-09-2014
Tumors of the Lung
Benign.
Malignant.
Carcinoma of Bronchus
It is the commonest most important primary tumor of
lung arises from the bronchial mucosa.
Pathology
There are four types:-
Different cell types of lung cancer tend to show differences in behavoiur.

Squamous cell carcinoma:-

constitute about 30 – 35% of primary lung cancer they tend to arise centrally, grow relatively
slowly and cavitate more usually than other cell types.


Adenocarcinoma
30 – 35%, arise peripherally with less cavitating tendency


Small (Oat) Cell Carcinoma
20 – 25% the tumor is usually central in location, grows very rapidly and usually present
with metastasis.


Large Cell undifferentiated Carcinoma
About 15 – 25% of primary lung cancers.
Clinical Features
It is commoner in man than women but its incidence in
women is rising.
Age 40 to 70 years.

The most important single Aetiologcal factor is Cigarette

smoking.
Other factors include atmospheric pollution and certain
occupations like asbestos.
The tumor usually present with cough, wheeze sputum
production, breathlessness, chest discomfort and
haemoptysis.
About 20% of the patients remain asymptomatic at the
time of presentation.
 Other presentations include finger clubbing, superior vena caval
obstructions, Horner’s syndrome, dysphagia and signs of pericardial
tymponade.
Radiological Features
These depend upon pathology, size and site of tumor.
Radiological Features can be summarized as bellow.
1. Hilar Enlargement
2. Airway Obstruction
3. Peripheral Mass
4. Mediastinal involvement
5. Pleural Involvement
6. Bone Involvement.
1. Hilar Enlargement
This is the common Radiological manifestation of the
disease.
If the primary tumor is central then Hilar Enlargement is
due to tumor itself.
If the tumor is peripheral then it is due to enlargement of
lymph nodes caused by metastasis and the primary tumor
may not be visible.
2. Airway Obstruction.
The tumor arises in the bronchial mucosa and invades
bronchial wall.
About 50% of lung cancers arise centrally that is in or
proximal to segmental bronchi.
The tumor may grow around the bronchus and also in to
bronchial lumen with consequent narrowing of latter.
The bronchial narrowing leads to collapse of lung distal to
the tumor.
Depending on the location of tumor segment, lobe or
rarely entire lung may be collapsed.
2. Airway Obstruction.
Prior to the collapse, of lobe or segment infection may
develop so the segmental or lobar consolidation may be the
manifestation of lung cancer.
Consequently the primary tumor may be obscured by
surrounding consolidation thus the possibility of
underlying endo bronchial lesion may be considered in
case of segmental or lobar pneumonia not resolving with
appropriate treatment.
3. Peripheral Mass
The tumor also commonly presents with peripheral
pulmonary mass.
Malignant masses are usually larger than benign lesions at
the time of presentation.
They have poorly defined lobulated or umblicated margins
or may appear spiculated.
The peripheral mass showing diffuse and central
calcification is usually benign.
The bronchial carcinomas usually have doubling time of
between 01 – 18 months so comparison with the previous x-
rays may be very helpful.
3. Peripheral Mass
Any mass / nodule that has not changed in appearance over
period of 02 years is almost certainly benign.
About 15% of peripheral lung cancers show cavitation and
fluid level may be seen within cavity. The malignant
cavities have thick wall with irregular nodular margin.
Bronchial carcinomas arising at lung apex are called
Pancoast tumors because of the their location they tend to
invade ribs, spine, brachial plexus and inferior cervical
sympathetic ganglia.
4. Mediastinal involvement
Mediastinal lymph node enlargement is typical feature of
small cell carcinoma, but it also occurs with other cell
types.
The mediastinum appears widened and may have
lobulated outline.
The tumor may compress / distort the oesophagus and may
also involve phrenic nerve with consequent elevation of
diaphragm.
Mediastinal spread of tumor may also cause superior vena
caval obstruction.
5. Pleural Involvement
Pleural effusion may result due to direct spread of tumor or
due to lymphatic obstruction.

Sub-pleural tumor may result into Pneumothorax.

6. Bone Involvement.
Hematogenous spread to bone results into usually
osteolytic lesions, they are often painful and easily
identified with isotope bone scan.

Peripheral carcinomas may involve the adjacent bone

directly.

Metastasis from lung cancer may occur any where in body

but hilar, medistinal and supraclavicular lymphnodes
followed by liver, bones, brain, adrenal glands and skin
Metastatic Lung Disease
The secondaries commonly reach the lung through blood
via systemic veins and pulmonary arteries.
 Lymphatic spread is less common and still rare is
endobronchial spread.
 The usual site of origin is breast, bones and urogenital
system.
 About 75% of pulmonary metastasis present as multiple
nodules.
 Lung metastasis are usually bilateral, affecting both lungs
with basal predominance.
 Pulmonary metastasis vary in size from few millimeters to
several centimeters and usually have well defined margins.
Lymphangitis Carcinomatosa
This results from hematogenous metastasis invading
and occluding the peripheral pulmonary capillaries.
The commonest primary sites are carcinoma of lung,
breast, stomach, pancreas, cervix and prostate.
Lymphangitis Carcinomatosa is usually bilateral but
lung and breast cancers may cause unilateral
lymphangitis.
Radiograph shows coarse, linear, reticular and nodular
basal shadowing often with pleural effusion and hilar
lymphadenopathy.