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Lung cancer

Changed by Martin Bundi Rugendo, 9 Oct 2023
Back to revision history
Disclosures - updated 17 Jan 2023: Nothing to disclose

Updates to Article Attributes

Body was changed:

Primary lung cancer is a broad term referring to the main histological subtypes of primary lung malignancies that are mainly linked with inhaled carcinogens, with tobacco smoke being a key risk factor. 

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

Terminology

Bronchogenic carcinoma is a term that is frequently used as a synonym for lung cancer although is not strictly accurate, in that lung cancers can arise from the lung parenchyma and not just the airways 17.

Epidemiology

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

Risk factors

The major risk factor is tobacco smoking, which is implicated in 90% of cases and increases the risk of lung cancer (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:

Associations

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

Clinical presentation

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

Central tumours may result in haemoptysis 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.

Pathology

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 different radiographic appearances, demographics, and prognoses:

Markers

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

Genetics

  • ROS1 mutation: 1-2% of NSCLC 15; more common in females 14

  • ALK mutation: 2-5% of NSCLC; more common in males, younger, light/never smokers, and more likely to be adenocarcinoma presenting with advanced disease 16 (see: main article)

Staging

Treatment and prognosis

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. Targeted treatments depend on molecular testing, e.g. ALK mutated lung cancers can be treated with ALK-inhibitors (e.g. crizotinib) 16.

Non-small cell carcinoma

  • 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%

Small-cell carcinoma

  • 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)

Differential diagnosis

See also

  • -<p>Primary <strong>lung cancer </strong>is a broad term referring to the main histological subtypes of primary lung malignancies that are mainly linked with inhaled carcinogens, with <a href="/articles/tobacco-use-1" title="Tobacco smoker">tobacco smoke</a> being a key risk factor. </p><p>This article will broadly discuss all the histological subtypes as a group, focussing on their common aspects; for further details please refer to the specific articles on each subtype described below. </p><h4>Terminology</h4><p><strong>Bronchogenic carcinoma</strong> is a term that is frequently used as a synonym for lung cancer although is not strictly accurate, in that lung cancers can arise from the lung parenchyma and not just the airways <sup>17</sup>.</p><h4>Epidemiology</h4><p>Lung cancer is a leading type of cancer, equal in prevalence to breast cancer <sup>13</sup>. It is the leading cause of cancer mortality worldwide; accounting for ~20% of all cancer deaths <sup>1</sup>.</p><h5>Risk factors</h5><p>The major risk factor is tobacco smoking, which is implicated in 90% of cases and increases the risk of lung cancer (by histological subtype) <sup>10</sup>:</p><ul>
  • -<li><p>squamous cell lung cancer: 11x (men), 15x (women)</p></li>
  • -<li><p>small cell lung cancer: 10x (men), 25x (women)</p></li>
  • -<li><p>large cell lung cancer: 7x (men), 8x (women)</p></li>
  • -<li><p>lung adenocarcinoma: 4x (men and women)</p></li>
  • -</ul><p>Other risk factors:</p><ul>
  • -<li><p><a href="/articles/asbestos">asbestos</a>: 5x increased risk </p></li>
  • -<li><p>occupational exposure: uranium, radon, arsenic, chromium</p></li>
  • -<li><p>diffuse lung fibrosis: 10x increased risk</p></li>
  • -<li><p><a href="/articles/chronic-obstructive-pulmonary-disease-1">chronic obstructive pulmonary disease</a></p></li>
  • -</ul><h5>Associations</h5><p>Various <a href="/articles/paraneoplastic-syndromes">paraneoplastic syndromes</a> can arise in the setting of lung cancer:</p><ul>
  • -<li>
  • -<p>endocrine/metabolic</p>
  • -<ul>
  • -<li><p><a href="/articles/siadh">SIADH</a> causing hyponatraemia: small-cell subtype</p></li>
  • -<li><p>ACTH secretion (<a href="/articles/cushing-syndrome">Cushing syndrome</a>): carcinoid and small-cell subtypes</p></li>
  • -<li><p><a href="/articles/carcinoid-syndrome">carcinoid syndrome</a></p></li>
  • -<li><p><a href="/articles/gynaecomastia">gynaecomastia</a></p></li>
  • -<li><p><a href="/articles/adrenal-insufficiency-1">adrenal insufficiency</a> (Addison disease): from bilateral metastases <sup>7</sup></p></li>
  • -<li><p><a href="/articles/hyperparathyroidism">hyperparathyroidism</a>: NSCLC can produce <a href="/articles/parathyroid-hormone">parathyroid hormone</a> (extremely rare) <sup>8</sup></p></li>
  • -<li><p>hypocalcaemia: occurs in the setting of skeletal metastases; especially associated with NSCLC <sup>6</sup></p></li>
  • -<li><p>PTH-related peptide (PTHrp) causing hypercalcaemia: squamous cell carcinoma</p></li>
  • -</ul>
  • -</li>
  • -<li>
  • -<p>neurological</p>
  • -<ul>
  • -<li><p>polyneuropathy</p></li>
  • -<li><p>myelopathy</p></li>
  • -<li><p><a href="/articles/autoimmune-encephalitis">limbic encephalitis</a>: particularly associated with SCLC <sup>9</sup></p></li>
  • -<li><p><a href="/articles/paraneoplastic-cerebellar-degeneration">cerebellar degeneration</a></p></li>
  • -<li><p><a href="/articles/lambert-eaton-myasthenic-syndrome">Lambert-Eaton myasthenia syndrome</a></p></li>
  • -</ul>
  • -</li>
  • -<li>
  • -<p>other</p>
  • -<ul>
  • -<li><p><a href="/articles/finger-clubbing">finger clubbing</a></p></li>
  • -<li><p><a href="/articles/hpoa">hypertrophic pulmonary osteoarthropathy (HPOA)</a>: squamous cell carcinoma subtype</p></li>
  • -<li><p><a href="/articles/nephrotic-syndrome">nephrotic syndrome</a></p></li>
  • -<li><p><a href="/articles/polymyositis">polymyositis </a><sup>3</sup></p></li>
  • -<li><p><a href="/articles/dermatomyositis">dermatomyositis </a><sup>3</sup></p></li>
  • -<li><p><a href="/articles/eosinophilia">eosinophilia</a></p></li>
  • -<li><p><a href="/articles/acanthosis-nigricans-1">acanthosis nigricans</a></p></li>
  • -<li><p><a href="/articles/superficial-thrombophlebitis">thrombophlebitis</a>: adenocarcinoma subtype</p></li>
  • -</ul>
  • -</li>
  • -</ul><h4>Clinical presentation</h4><p>Patients with lung cancer may be asymptomatic in up to 50% of cases. Cough and dyspnoea are rather non-specific symptoms that are common amongst those with lung cancer.</p><p>Central tumours may result in <a href="/articles/haemoptysis-1">haemoptysis</a> and peripheral lesions with pleuritic chest pain.</p><p>Pneumonia, pleural effusion, wheeze, lymphadenopathy are not uncommon. Other symptoms may be secondary to <a href="/articles/pulmonary-metastases">metastases</a> (bone, contralateral lung, brain, adrenal glands, and liver, in frequency order for NSCLC <sup>12</sup>) or <a href="/articles/paraneoplastic-syndromes">paraneoplastic syndromes</a>.</p><h4>Pathology</h4><p>The term bronchogenic carcinoma is somewhat loosely used to refer to primary malignancies of the lung that are associated with inhaled carcinogens <sup>1</sup> 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:</p><ul>
  • -<li>
  • -<p><a href="/articles/non-small-cell-lung-cancer-nsclc">non-small cell lung cancer (NSCLC)</a> (80%)</p>
  • -<ul>
  • -<li>
  • -<p><a href="/articles/adenocarcinoma-of-the-lung">adenocarcinoma</a> (35%)</p>
  • -<ul>
  • -<li><p>most common cell type overall</p></li>
  • -<li><p>most common in women</p></li>
  • -<li><p>most common cell type in non-smokers but still most patients are smokers</p></li>
  • -<li><p>peripheral</p></li>
  • -</ul>
  • -</li>
  • -<li>
  • -<p><a href="/articles/squamous-cell-carcinoma-of-the-lung">squamous cell carcinoma</a> (30%)</p>
  • -<ul>
  • -<li><p>strongly associated with smoking</p></li>
  • -<li><p>most common carcinoma to cavitate</p></li>
  • -<li><p>poor prognosis</p></li>
  • -</ul>
  • -</li>
  • -<li>
  • -<p><a href="/articles/large-cell-lung-cancer-1">large-cell carcinoma</a> (15%)</p>
  • -<ul>
  • -<li><p>peripherally located </p></li>
  • -<li><p>very large, usually &gt;4 cm</p></li>
  • -</ul>
  • -</li>
  • -</ul>
  • -</li>
  • -<li>
  • -<p><a href="/articles/small-cell-lung-cancer-4">small cell lung cancer (SCLC)</a> (20%)</p>
  • -<ul>
  • -<li><p>almost always in smokers</p></li>
  • -<li><p>metastasises early</p></li>
  • -<li><p>most common primary lung malignancy to cause <a href="/articles/paraneoplastic-syndromes">paraneoplastic syndromes</a> and <a href="/articles/superior-vena-cava-obstruction">SVC obstruction</a></p></li>
  • -<li><p>worst prognosis</p></li>
  • -</ul>
  • -</li>
  • -</ul><p>Other malignant pulmonary neoplasms include <a href="/articles/lymphoma">lymphoma</a> and <a href="/articles/sarcoma">sarcoma</a> (rare).</p><p>Each subtype has different radiographic appearances, demographics, and prognoses:</p><ul>
  • -<li><p><a href="/articles/squamous-cell-carcinoma-of-the-lung">squamous-cell carcinoma of the lung</a></p></li>
  • -<li><p><a href="/articles/adenocarcinoma-of-the-lung">adenocarcinoma of the lung</a></p></li>
  • -<li><p><a href="/articles/large-cell-lung-cancer-1">large cell carcinoma of the lung</a></p></li>
  • -<li><p><a href="/articles/small-cell-carcinoma-of-the-lung">small cell carcinoma of the lung</a></p></li>
  • -</ul><h5>Markers</h5><p>Several antibodies or markers from tissue samples may be useful in the diagnosis and prognostication of disease. These include</p><ul>
  • -<li><p><a href="/articles/programmed-death-ligand-1-pd-l1-targeted-monoclonal-antibodies">programmed death-ligand 1 (PD-L1)-targeted monoclonal antibodies</a> </p></li>
  • -<li><p><a href="/articles/thyroid-transcription-factor-1">thyroid transcription factor 1 (TTF-1)</a>: expressed in most lung cancer except squamous cell cancer </p></li>
  • -</ul><h5>Genetics</h5><ul>
  • -<li><p><a href="/articles/ros1-mutation">ROS1 mutation</a>: 1-2% of NSCLC <sup>15</sup>; more common in females <sup>14</sup></p></li>
  • -<li><p><a href="/articles/anaplastic-lymphoma-kinase-alk-gene-rearrangements">ALK mutation</a>: 2-5% of NSCLC; more common in males, younger, light/never smokers, and more likely to be adenocarcinoma presenting with advanced disease <sup>16</sup> (see: <a href="/articles/anaplastic-lymphoma-kinase-alk-fusion-oncogene-positive-non-small-cell-lung-cancer-1">main article</a>)</p></li>
  • -</ul><h5>Staging</h5><ul>
  • -<li><p>according to the <a href="/articles/lung-cancer-staging-iaslc-8th-edition">IASLC (International Association for the Study of Lung Cancer) 8<sup>th</sup> edition lung cancer staging system</a></p></li>
  • -<li><p>previously small cell and non-small cell lung cancers were staged differently, but since 2013 all lung cancers are staged the same way</p></li>
  • -</ul><h4>Treatment and prognosis</h4><p>Treatment and prognosis vary not only with stage but also with cell type. In general, surgery, chemotherapy, and radiotherapy are offered according to the <a href="/articles/lung-cancer-iaslc-7th-edition-staging">stage</a>, resectability, operability, and functional status. Targeted treatments depend on molecular testing, e.g. ALK mutated lung cancers can be treated with ALK-inhibitors (e.g. crizotinib) <sup>16</sup>.</p><h5>Non-small cell carcinoma</h5><ul>
  • -<li>
  • -<p><strong>treatment</strong></p>
  • -<ul>
  • -<li><p>operable disease (stage I to IIIA): surgery</p></li>
  • -<li><p>unresectable disease: neoadjuvant chemotherapy, radiotherapy</p></li>
  • -<li><p>advanced disease: palliative combined chemotherapy</p></li>
  • -</ul>
  • -</li>
  • -<li>
  • -<p><strong>prognosis </strong>(5-year survival rates)<strong>:</strong></p>
  • -<ul>
  • -<li><p>local (stage I): 55-67%</p></li>
  • -<li><p>locally advanced (stages II-IIIA): 23-40%</p></li>
  • -<li><p>advanced (stages IIIB and IV): 1-3%</p></li>
  • -</ul>
  • -</li>
  • -</ul><h5>Small-cell carcinoma</h5><ul>
  • -<li>
  • -<p><strong>treatment</strong></p>
  • -<ul>
  • -<li><p>limited disease: chemoradiotherapy</p></li>
  • -<li><p>extensive disease: palliative combined chemotherapy</p></li>
  • -</ul>
  • -</li>
  • -<li>
  • -<p><strong>prognosis</strong>: poor</p>
  • -<ul>
  • -<li><p>limited: 5-year survival rate 15-25%</p></li>
  • -<li><p>extensive: 2-year survival 20% (with palliative combined chemotherapy and supportive care)</p></li>
  • -</ul>
  • -</li>
  • -</ul><h4>Differential diagnosis</h4><ul>
  • -<li><p><a href="/articles/fibrosing-mediastinitis" title="Fibrosing mediastinitis">fibrosing mediastinitis</a></p></li>
  • -<li><p><a href="/articles/tuberculosis-pulmonary-manifestations-1" title="Pulmonary tuberculosis">pulmonary tuberculosis</a></p></li>
  • -<li><p><a href="/cases/pulmonary-vein-occlusion" title="Venous varices" data-annotation-id="2085">venous collateral pathways</a> - venous varices</p></li>
  • -</ul><h4>See also</h4><ul>
  • -<li><p><a href="/articles/ct-guided-thoracic-biopsy">CT guided thoracic biopsy</a></p></li>
  • -<li><p><a href="/articles/lung-cancer-staging-iaslc-8th-edition" title="Lung cancer staging">lung cancer staging</a></p></li>
  • +<p>Primary <strong>lung cancer </strong>is a broad term referring to the main histological subtypes of primary lung malignancies that are mainly linked with inhaled carcinogens, with <a href="/articles/tobacco-use-1" title="Tobacco smoker">tobacco smoke</a> being a key risk factor. </p><p>This article will broadly discuss all the histological subtypes as a group, focussing on their common aspects; for further details please refer to the specific articles on each subtype described below. </p><h4>Terminology</h4><p><strong>Bronchogenic carcinoma</strong> is a term that is frequently used as a synonym for lung cancer although is not strictly accurate, in that lung cancers can arise from the lung parenchyma and not just the airways <sup>17</sup>.</p><h4>Epidemiology</h4><p>Lung cancer is a leading type of cancer, equal in prevalence to breast cancer <sup>13</sup>. It is the leading cause of cancer mortality worldwide; accounting for ~20% of all cancer deaths <sup>1</sup>.</p><h5>Risk factors</h5><p>The major risk factor is tobacco smoking, which is implicated in 90% of cases and increases the risk of lung cancer (by histological subtype) <sup>10</sup>:</p><ul>
  • +<li><p>squamous cell lung cancer: 11x (men), 15x (women)</p></li>
  • +<li><p>small cell lung cancer: 10x (men), 25x (women)</p></li>
  • +<li><p>large cell lung cancer: 7x (men), 8x (women)</p></li>
  • +<li><p>lung adenocarcinoma: 4x (men and women)</p></li>
  • +</ul><p>Other risk factors:</p><ul>
  • +<li><p><a href="/articles/asbestos">asbestos</a>: 5x increased risk </p></li>
  • +<li><p>occupational exposure: uranium, radon, arsenic, chromium</p></li>
  • +<li><p>diffuse lung fibrosis: 10x increased risk</p></li>
  • +<li><p><a href="/articles/chronic-obstructive-pulmonary-disease-1">chronic obstructive pulmonary disease</a></p></li>
  • +</ul><h5>Associations</h5><p>Various <a href="/articles/paraneoplastic-syndromes">paraneoplastic syndromes</a> can arise in the setting of lung cancer:</p><ul>
  • +<li>
  • +<p>endocrine/metabolic</p>
  • +<ul>
  • +<li><p><a href="/articles/siadh">SIADH</a> causing hyponatraemia: small-cell subtype</p></li>
  • +<li><p>ACTH secretion (<a href="/articles/cushing-syndrome">Cushing syndrome</a>): carcinoid and small-cell subtypes</p></li>
  • +<li><p><a href="/articles/carcinoid-syndrome">carcinoid syndrome</a></p></li>
  • +<li><p><a href="/articles/gynaecomastia">gynaecomastia</a></p></li>
  • +<li><p><a href="/articles/adrenal-insufficiency-1">adrenal insufficiency</a> (Addison disease): from bilateral metastases <sup>7</sup></p></li>
  • +<li><p><a href="/articles/hyperparathyroidism">hyperparathyroidism</a>: NSCLC can produce <a href="/articles/parathyroid-hormone">parathyroid hormone</a> (extremely rare) <sup>8</sup></p></li>
  • +<li><p>hypocalcaemia: occurs in the setting of skeletal metastases; especially associated with NSCLC <sup>6</sup></p></li>
  • +<li><p>PTH-related peptide (PTHrp) causing hypercalcaemia: squamous cell carcinoma</p></li>
  • +</ul>
  • +</li>
  • +<li>
  • +<p>neurological</p>
  • +<ul>
  • +<li><p>polyneuropathy</p></li>
  • +<li><p>myelopathy</p></li>
  • +<li><p><a href="/articles/autoimmune-encephalitis">limbic encephalitis</a>: particularly associated with SCLC <sup>9</sup></p></li>
  • +<li><p><a href="/articles/paraneoplastic-cerebellar-degeneration">cerebellar degeneration</a></p></li>
  • +<li><p><a href="/articles/lambert-eaton-myasthenic-syndrome">Lambert-Eaton myasthenia syndrome</a></p></li>
  • +</ul>
  • +</li>
  • +<li>
  • +<p>other</p>
  • +<ul>
  • +<li><p><a href="/articles/finger-clubbing">finger clubbing</a></p></li>
  • +<li><p><a href="/articles/hpoa">hypertrophic pulmonary osteoarthropathy (HPOA)</a>: squamous cell carcinoma subtype</p></li>
  • +<li><p><a href="/articles/nephrotic-syndrome">nephrotic syndrome</a></p></li>
  • +<li><p><a href="/articles/polymyositis">polymyositis </a><sup>3</sup></p></li>
  • +<li><p><a href="/articles/dermatomyositis">dermatomyositis </a><sup>3</sup></p></li>
  • +<li><p><a href="/articles/eosinophilia">eosinophilia</a></p></li>
  • +<li><p><a href="/articles/acanthosis-nigricans-1">acanthosis nigricans</a></p></li>
  • +<li><p><a href="/articles/superficial-thrombophlebitis">thrombophlebitis</a>: adenocarcinoma subtype</p></li>
  • +</ul>
  • +</li>
  • +</ul><h4>Clinical presentation</h4><p>Patients with lung cancer may be asymptomatic in up to 50% of cases. Cough and dyspnoea are rather non-specific symptoms that are common amongst those with lung cancer.</p><p>Central tumours may result in <a href="/articles/haemoptysis-1">haemoptysis</a> and peripheral lesions with pleuritic chest pain.</p><p>Pneumonia, pleural effusion, wheeze, lymphadenopathy are not uncommon. Other symptoms may be secondary to <a href="/articles/pulmonary-metastases">metastases</a> (bone, contralateral lung, brain, adrenal glands, and liver, in frequency order for NSCLC <sup>12</sup>) or <a href="/articles/paraneoplastic-syndromes">paraneoplastic syndromes</a>.</p><h4>Pathology</h4><p>The term bronchogenic carcinoma is somewhat loosely used to refer to primary malignancies of the lung that are associated with inhaled carcinogens <sup>1</sup> 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:</p><ul>
  • +<li>
  • +<p><a href="/articles/non-small-cell-lung-cancer-nsclc">non-small cell lung cancer (NSCLC)</a> (80%)</p>
  • +<ul>
  • +<li>
  • +<p><a href="/articles/adenocarcinoma-of-the-lung">adenocarcinoma</a> (35%)</p>
  • +<ul>
  • +<li><p>most common cell type overall</p></li>
  • +<li><p>most common in women</p></li>
  • +<li><p>most common cell type in non-smokers but still most patients are smokers</p></li>
  • +<li><p>peripheral</p></li>
  • +</ul>
  • +</li>
  • +<li>
  • +<p><a href="/articles/squamous-cell-carcinoma-of-the-lung">squamous cell carcinoma</a> (30%)</p>
  • +<ul>
  • +<li><p>strongly associated with smoking</p></li>
  • +<li><p>most common carcinoma to cavitate</p></li>
  • +<li><p>poor prognosis</p></li>
  • +</ul>
  • +</li>
  • +<li>
  • +<p><a href="/articles/large-cell-lung-cancer-1">large-cell carcinoma</a> (15%)</p>
  • +<ul>
  • +<li><p>peripherally located </p></li>
  • +<li><p>very large, usually &gt;4 cm</p></li>
  • +</ul>
  • +</li>
  • +</ul>
  • +</li>
  • +<li>
  • +<p><a href="/articles/small-cell-lung-cancer-4">small cell lung cancer (SCLC)</a> (20%)</p>
  • +<ul>
  • +<li><p>almost always in smokers</p></li>
  • +<li><p>metastasises early</p></li>
  • +<li><p>most common primary lung malignancy to cause <a href="/articles/paraneoplastic-syndromes">paraneoplastic syndromes</a> and <a href="/articles/superior-vena-cava-obstruction">SVC obstruction</a></p></li>
  • +<li><p>worst prognosis</p></li>
  • +</ul>
  • +</li>
  • +</ul><p>Other malignant pulmonary neoplasms include <a href="/articles/lymphoma">lymphoma</a> and <a href="/articles/sarcoma">sarcoma</a> (rare).</p><p>Each subtype has different radiographic appearances, demographics, and prognoses:</p><ul>
  • +<li><p><a href="/articles/squamous-cell-carcinoma-of-the-lung">squamous-cell carcinoma of the lung</a></p></li>
  • +<li><p><a href="/articles/adenocarcinoma-of-the-lung">adenocarcinoma of the lung</a></p></li>
  • +<li><p><a href="/articles/large-cell-lung-cancer-1">large cell carcinoma of the lung</a></p></li>
  • +<li><p><a href="/articles/small-cell-carcinoma-of-the-lung">small cell carcinoma of the lung</a></p></li>
  • +</ul><h5>Markers</h5><p>Several antibodies or markers from tissue samples may be useful in the diagnosis and prognostication of disease. These include</p><ul>
  • +<li><p><a href="/articles/programmed-death-ligand-1-pd-l1-targeted-monoclonal-antibodies">programmed death-ligand 1 (PD-L1)-targeted monoclonal antibodies</a> </p></li>
  • +<li><p><a href="/articles/thyroid-transcription-factor-1">thyroid transcription factor 1 (TTF-1)</a>: expressed in most lung cancer except squamous cell cancer </p></li>
  • +</ul><h5>Genetics</h5><ul>
  • +<li><p><a href="/articles/ros1-mutation">ROS1 mutation</a>: 1-2% of NSCLC <sup>15</sup>; more common in females <sup>14</sup></p></li>
  • +<li><p><a href="/articles/anaplastic-lymphoma-kinase-alk-gene-rearrangements">ALK mutation</a>: 2-5% of NSCLC; more common in males, younger, light/never smokers, and more likely to be adenocarcinoma presenting with advanced disease <sup>16</sup> (see: <a href="/articles/anaplastic-lymphoma-kinase-alk-fusion-oncogene-positive-non-small-cell-lung-cancer-1">main article</a>)</p></li>
  • +</ul><h5>Staging</h5><ul>
  • +<li><p>according to the <a href="/articles/lung-cancer-staging-iaslc-8th-edition">IASLC (International Association for the Study of Lung Cancer) 8<sup>th</sup> edition lung cancer staging system</a></p></li>
  • +<li><p>previously small cell and non-small cell lung cancers were staged differently, but since 2013 all lung cancers are staged the same way</p></li>
  • +</ul><h4>Treatment and prognosis</h4><p>Treatment and prognosis vary not only with stage but also with cell type. In general, surgery, chemotherapy, and radiotherapy are offered according to the <a href="/articles/lung-cancer-iaslc-7th-edition-staging">stage</a>, resectability, operability, and functional status. Targeted treatments depend on molecular testing, e.g. ALK mutated lung cancers can be treated with ALK-inhibitors (e.g. crizotinib) <sup>16</sup>.</p><h5>Non-small cell carcinoma</h5><ul>
  • +<li>
  • +<p><strong>treatment</strong></p>
  • +<ul>
  • +<li><p>operable disease (stage I to IIIA): surgery</p></li>
  • +<li><p>unresectable disease: neoadjuvant chemotherapy, radiotherapy</p></li>
  • +<li><p>advanced disease: palliative combined chemotherapy</p></li>
  • +</ul>
  • +</li>
  • +<li>
  • +<p><strong>prognosis </strong>(5-year survival rates)<strong>:</strong></p>
  • +<ul>
  • +<li><p>local (stage I): 55-67%</p></li>
  • +<li><p>locally advanced (stages II-IIIA): 23-40%</p></li>
  • +<li><p>advanced (stages IIIB and IV): 1-3%</p></li>
  • +</ul>
  • +</li>
  • +</ul><h5>Small-cell carcinoma</h5><ul>
  • +<li>
  • +<p><strong>treatment</strong></p>
  • +<ul>
  • +<li><p>limited disease: chemoradiotherapy</p></li>
  • +<li><p>extensive disease: palliative combined chemotherapy</p></li>
  • +</ul>
  • +</li>
  • +<li>
  • +<p><strong>prognosis</strong>: poor</p>
  • +<ul>
  • +<li><p>limited: 5-year survival rate 15-25%</p></li>
  • +<li><p>extensive: 2-year survival 20% (with palliative combined chemotherapy and supportive care)</p></li>
  • +</ul>
  • +</li>
  • +</ul><h4>Differential diagnosis</h4><ul>
  • +<li><p><a href="/articles/fibrosing-mediastinitis" title="Fibrosing mediastinitis">fibrosing mediastinitis</a></p></li>
  • +<li><p><a href="/articles/tuberculosis-pulmonary-manifestations-1" title="Pulmonary tuberculosis">pulmonary tuberculosis</a></p></li>
  • +<li><p><a href="/cases/pulmonary-vein-occlusion" title="Venous varices" data-annotation-id="2085">venous collateral pathways</a> - venous varices</p></li>
  • +</ul><h4>See also</h4><ul>
  • +<li><p><a href="/articles/ct-guided-thoracic-biopsy">CT guided thoracic biopsy</a></p></li>
  • +<li><p><a href="/articles/lung-cancer-staging-iaslc-8th-edition" title="Lung cancer staging">lung cancer staging</a></p></li>
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