Lung Infection

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Lung Infection Risk Increases with Drinking,Smoking

Drinkers Who Smoke at Greater Risk for Pneumonia

From LSU Health Sciences Center,

About.com Health's Disease and Condition content is reviewed by the Medical Review Board

Researchers have found that drinking alcohol increases the movement of harmful bacteria into thelung while smoking cigarettes exacerbates the alcohol-induced increase in the bacterialpenetration.

Streptococcus pneumoniae is a bacterium that can infect the upper respiratory tract and causepneumonia, as well as infections in other parts of the body such as the bloodstream (bacteremia),lining of the brain and spinal cord (meningitis), bones (osteomyelitis), joints (arthritis), ears (otitismedia) and sinuses (sinusitis).

Alcoholics and cigarette smokers are particularly susceptible to pulmonary infections caused by S.pneumoniae. A rodent study in the May 2005 issue ofAlcoholism: Clinical & Experimental Researchhas found that alcohol consumption increases movement ofS. pneumoniae toward the lungs, andthat smoke exposure exacerbates the alcohol-induced increase in bacterial penetration.

"All of the infections caused by S. pneumoniae start with the bacterium colonizing or binding tocells in the upper part of the nose, which is called the nasopharynx," said Gentry-Nielsen,professor of microbiology and immunology at Creighton University School of Medicine, research

microbiologist at the Omaha Veterans Affairs Medical Center, and corresponding author for thestudy. "The trachea that leads from the nasopharynx to the lungs is lined with cells that have hair-like projections called cilia.

"These cilia beat in an upward direction to sweep mucus and microorganisms like S. pneumoniaeupward and prevent their movement into the lungs. Disease normally occurs when the immunesystem is compromised or the person is colonized with a new or especially virulent strain ofS.

pneumoniae that is able to evade the action of the cilia and travel from the nasopharynx into thelungs."

Gentry-Nielsen said that alcoholics are more susceptible to S. pneumoniae infections for severalreasons. "They have a decreased gag reflex and an increased risk of movement of nasopharyngealand gastric contents into their lungs, especially when they lose consciousness," she said. "Both ofthese defects provide additional opportunities for S. pneumoniae to enter their lungs. Hostdefences within the lungs of alcoholics are also compromised, so they are not well equipped tohandle the infection once the organisms reach the lungs.

80 Percent of Alcoholics Smoke

Cigarette smokers also have an increased susceptibility to pulmonary infections caused by S.pneumoniae. Smokers are much more likely to be colonized with the organism in their mouths andnasopharynx than non-smokers. Smoking also injures cilia and alters the efficiency of their beatingso that bacteria entering the trachea have an increased likelihood of making their way into thelungs."

"Clinical studies of this type are complicated because at least 80 percent of human alcoholicssmoke," added Gregory J. Bagby, Kai and Earl Rozas professor of physiology at Louisiana State

University Health Sciences Center. "Controlled studies in animals are therefore critically importantin identifying interactive and separate effects of these two agents. This group is one of the first tostudy this interaction in a systematic way and the present study on the interactive effects of
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cigarette smoke and alcohol on the mucociliary apparatus is the first study of its kind to myknowledge."

More Bacteria in the Lungs

For 12 weeks, researchers exposed Sprague-Dawley rats (n=64) twice daily to either smokegenerated from 30 cigarettes or room air. For the last five weeks of exposure, rats were fed liquiddiets that contained 0, 16, 26 or 36 percent of their calories as alcohol. The rats were theninfected intranasally with S. pneumoniae, and movement of the organisms into the lowerrespiratory tract was followed.

Results indicate that alcohol ingestion results in a dose-dependent increase in movement ofS.pneumoniae into the rats' lungs, which is further exacerbated by concurrent smoke exposure.

More Susceptible to Infections

"Our study is the first to have reported showing that alcohol consumption in rats impairs the

beating of their tracheal cilia, and that this correlates with increased movement ofS. pneumoniaeinto their lungs," said Gentry-Nielsen. "This alcohol-induced defect was intensified in smoke-exposed animals, although smoke exposure without ethanol ingestion did not increase movementof organisms into the lungs. These results point to alcohol- and smoke-induced defects in ciliarybeating that are likely to make hosts more susceptible to infections caused by microorganisms thatcolonize their upper respiratory tracts."

"This study points to the importance of understanding the potential combined adverse effects ofalcoholism and cigarette smoking on lung defenses against pathogen infection," added Bagby.

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Smoking and Lung Cancer

The Facts About Smoking and Lung Cancer

By Lynne Eldridge MD, About.com Guide

About.com Health's Disease and Condition content is reviewed by the Medical Review Board

Warning Label on Cigarettes

Photo Courtesy of the National Cancer Institute, Bill Branson Photographer

By now, most people are aware of the connection between smoking and lung cancer. Yet I still

hear the comments; "My uncle smoked for 60 years and never got lung cancer. My auntnever smoked, but got lung cancer anyway." What are the facts about cigarette smoking andlung cancer?

Smoking and Lung Cancer The Statistics
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Following the 1964 Surgeon Generals report on Smoking and Health, the public became widelyaware of the risk of smoking. In that report, it was estimated that smokers had a nine- to ten-foldincreased risk of developing lung cancer compared to non-smokers. But we suspected a linkbetween smoking and lung cancer long before that time. Going through my grandparents

belongings, I came across an article in Readers Digest, Cancer by the Carton. It was dated 1952.We now know that smoking is responsible for 87% of lung cancers in the United States.

Men who smoke are 23 times more likely to develop lung cancer than those who dont smoke, andwomen smokers are 13 times more likely to develop the disease than their non-smokingcounterparts. The risk of developing lung cancer is directly related to the number of cigarettessmoked, something we calculate using the term pack-years.

That said, the majority of lung cancers (over 50%) now occur in former smokers that have quit,

and roughly 10% of men and 20% of women with lung cancer have never smoked.

What Other Cancers are related to Smoking?

Smoking and Lung Cancer The Culprits

There are more than 50 chemicals in tobacco smoke that are known to cause cancer. Some of the

better known carcinogens (cancer causing chemicals) include arsenic, benzene, nickel, and vinylchloride. Our About.com Guide to Smoking Cessation, Terry Martin, reviews these chemicals indepth in:

Harmful Chemicals in Cigarettes The List of Additives in Cigarettes Pesticides in Cigarette SmokeSmoking and Lung Cancer Lung Cancer Types

The lung cancer types found in people who smoke often differ from those in non-smokers. Smallcell lung cancers, which account for roughly 20% of lung cancers, occur almost always inindividuals who smoke or have smoked. Non-small cell lung cancers (NSCLC) are the type foundmore commonly in non-smokers, but the majority of cases still occur in people who have smoked.Historically, people who smoke were more likely to have a form of NSCLC called squamous cell

lung cancer, and non-smokers a form called adenocarcinoma. With the switch from unfiltered tofiltered cigarettes, adenocarcinomas have become more common in people who smoke.

Smoking and Lung Cancer Does Quitting Help?

It is never too late to quit smoking. If you quit smoking before the age of 30, you can lower yourrisk to nearly that of someone who has never smoked. Quitting by the age 50, halves your risk ofdeveloping the disease. But quitting at any age can reduce your risk of developing lung cancer.

Smoking and Lung Cancer Smoking After a Diagnosis of Lung Cancer

Even if someone has been diagnosed with lung cancer, quitting smoking can make a difference.Quitting smoking with lung cancer can make surgery more successful, treatment more effective,and lowers the risk of dying from another condition, such as another cancer or heart disease.Quitting smoking may also may also improve quality of life after a diagnosis of lung cancer, andstudies suggest that individuals who continue to smoke have more moderate to severe pain, thanthose who are able to put cigarettes aside.

Why Should I Quit Smoking if I Have Lung Cancer?
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Smoking and Lung Cancer Lung Cancer Screening

In the past, it was thought that performing yearly x-rays might help detect lung cancer at an earlystage in people who had smoked, but this is no longer recommended. Studies are now looking atCT screening as a way to detect lung cancer at the earliest stages. If you have a history ofsmoking, you may wish to discuss the issues about lung cancer screening with your doctor.

Smoking and Lung Cancer The StigmaSince smoking is associated with the majority of lung cancers, there is a stigma associated with

lung cancer. A stigma that somehow individuals have caused their disease and "deserve" to have

cancer. This stigma is damaging and unfair. We dont confront people who are overweight or

sedentary suggesting that they are responsible for illnesses they develop. Regardless of the cause

of a cancer, or any condition for the matter, people who are struggling with a chronic illness need

our unconditional caring and support.

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Chemicals in Cigarettes: What They Are and HowThey Harm Us

Harmful Chemicals in Cigarettes

By Terry Martin, About.com Guide

About.com Health's Disease and Condition content is reviewed by ourMedical Review Board

Image Stockxpert

As smokers, we don't think about the chemicals in cigarettes. We think about how cigarettes helpus cope with the stress of daily life, how they calm us down when we're angry, help us relax at theend of a long day, comfort us when we're sad or lonely. Harmful chemicals in cigarettes? No, wedon't think much about that.

The truth of the matter is that smoking does the opposite of just about everything we give it creditfor. When the chemicals in cigarettes are inhaled, they put our bodies into a state of physical

stress by sending literally thousands of poisons, toxic metals and carcinogens coursing through ourbloodstream with every puff we take. And those chemicals affect everything from blood pressureand pulse rate to the health of our organs and immune system.

While researchers are still working to uncover all of the hazards cigarettes present to human life,

we do know that air tainted with cigarette smoke is dangerous for anyone who breathes it --smoker or not.
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Let's take a closer look at some of the harmful chemicals in cigarettes and how they affect ourhealth.

Chemicals in Cigarettes: Carcinogens

A carcinogen is defined as any substance that can cause or aggravate cancer. Approximately 60 ofthe chemicals in cigarettes are known to cause cancer.

TSNAsTobacco-specific N-nitrosamines (TSNAs) are known to be some of the most potent carcinogenspresent in smokeless tobacco, snuff and tobacco smoke.

BenzeneBenzene can be found in pesticides and gasoline. It is present in high levels in cigarette smoke andaccounts for half of all human exposure to this hazardous chemical.

Pesticides

Pesticides are used on our lawns and gardens, and inhaled into our lungs via cigarette smoke.

FormaldehydeFormaldehyde is a chemical used to preserve dead bodies, and is responsible for some of the nose,throat and eye irritation smokers experience when breathing in cigarette smoke.

Chemicals in Cigarettes: Toxic Metals

Toxic / heavy metals are metals and metal compounds that have the potential to harm our healthwhen absorbed or inhaled. In very small amounts, some of these metals support life, but whentaken in large amounts, can become toxic.

ArsenicCommonly used in rat poison, arsenic finds its way into cigarette smoke through some of thepesticides that are used in tobacco farming.

CadmiumCadmium is a toxic heavy metal that is used in batteries. Smokers typically have twice as muchcadmium in their bodies as nonsmokers.

Chemicals in Cigarettes: Radioactive Toxic Metals

There are a couple of toxic metals in cigarette smoke that carry an extra punch of danger foranyone breathing it in: they are radioactive.

Radioactive Cigarette SmokeLead-210 (Pb-210) and polonium-210 (Po-210) are poisonous, radioactive heavy metals thatresearch has shown to be present in cigarette smoke.

Chemicals in Cigarettes: Poisons

Poison is defined as any substance that, when introduced to a living organism, causes severephysical distress or death. Science has discovered approximately 200 poisonous gases in cigarettesmoke.
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AmmoniaAmmonia compounds are commonly used in cleaning products and fertilizers. Ammonia is alsoused to boost the impact of nicotine in manufactured cigarettes.

Carbon MonoxideCarbon monoxide is present in car exhaust and is lethal in very large amounts. Cigarette smoke

can contain high levels of carbon monoxide.

Hydrogen CyanideHydrogen cyanide was used to kill people in the gas chambers in Nazi Germany during World WarII. It can be found in cigarette smoke.

NicotineNicotine is a poison used in pesticides and is the addictive element in cigarettes.

A Word About Secondhand Smoke

Also known as environmental tobacco smoke, secondhand smoke is a term used to describecigarette smoke that comes from two sources: Smoke that is exhaled by the smoker (mainstreamsmoke) and smoke produced by a smouldering cigarette (sidestream smoke). Secondhand smokeis known to contain at least 250 toxic chemicals, including 50 cancer-causing chemicals. Accordingto the U.S. Surgeon General, there is no risk-free level of exposure to secondhand smoke. Thatmeans if you can smell cigarette smoke in the air, it could be harming your health.http://quitsmoking.about.com/od/chemicalsinsmoke/a/chemicalshub.htm

What's in a cigarette?

The List of Additives A through C



The list of 599 additives approved by the US Government for use in the manufacture ofcigarettes is something every smoker should see. Submitted by the five major American cigarettecompanies to the Dept. of Health and Human Services in April of 1994, this list of ingredients hadlong been kept a secret.

Tobacco companies reporting this information were:

American Tobacco CompanyBrown and WilliamsonLiggett Group, Inc.Philip Morris Inc.R.J. Reynolds Tobacco Company

While these ingredients are approved as additives for foods, they were not tested by burningthem, and it is the burning of many of these substances which changes their properties, often forthe worse. Over 4000 chemical compounds are created by burning a cigarette, many of which aretoxic and/or carcinogenic. Carbon monoxide, nitrogen oxides, hydrogen cyanide and ammonia areall present in cigarette smoke. Forty-three known carcinogens are in mainstream smoke,sidestream smoke, or both.

It's chilling to think about not only how smokers poison themselves, but what others are exposedto by breathing in the secondhand smoke. The next time you're missing your old buddy, the
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cigarette, take a good long look at this list and see them for what they are: a delivery system fortoxic chemicals and carcinogens.http://quitsmoking.about.com/cs/nicotineinhaler/a/cigingredients.htm

Pesticides Discovered in Cigarette Smoke



A pesticide is defined as a chemical used to kill pests, usually insects. Pesticides are toxic, and ifwe use them on our lawns or gardens, we're careful to avoid direct contact if possible. Wecertainly wouldn't knowingly breathe pesticides into our lungs, yet that is exactly what smokers doevery time they take a puff of a cigarette.

Researchers at the Colorado School of Mines in Golden, Colorado, have recently identified three

previously undetected pesticides in cigarette smoke.

The pesticides are:

Flumetralin - This chemical is known to be toxic to humans, and is carcinogenic. It's anendocrine disruptor, and its use on tobacco plants has been banned in Europe.

Pendimethalin - This is another endocrine disrupter that targets the thyroid specifically.Pendimethalin is carcinogenic and toxic to humans.

Trifluralin - Like the other two pesticides mentioned, trifluralin is an endocrine disrupter, is toxicto humans and is carcinogenic.

These pesticides find their way into cigarettes because they're used on tobacco plants growing inthe fields.

Endocrine DisruptersEndocrine glands produce hormones which regulate reproduction, growth and development inhumans and animals. Endocrine disrupters are chemicals that interfere with this natural process bymimicking or blocking normal hormone function.

With the use of electron micrometer mass-spectrometry on a variety of smoke samples from bothexperimental and commercial cigarettes, the scientists were able to see the chemical makeup ofthe 3 substances and identify them as dinitroaniline pesticides. They also discovered that these 3pesticides are present in both mainstream smoke and sidestream smoke, and survive thecombustion process in levels as high as 10 percent of the original residue left on tobacco.

"No information exists for long-term, low-level inhalation exposures to these compounds, and nodata exists to establish the possible synergistic effect of these pesticides with each other, or with

the other 4000-plus compounds that have been identified in tobacco smoke." said Kent Voorhees,researcher and co-author of the study The Detection of Nitro Pesticides in Mainstream andSidestream Cigarette Smoke Using Electron Monochromator-Mass Spectrometry.

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Tar in Cigarettes

The Toxic Chemicals in Cigarettes


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The term used to describe the toxic chemicals found in cigarettes. The concentration of tar in acigarette determines its rating:

High-tar cigarettes contain at least 22 milligrams (mg) of tar Medium-tar cigarettes from 15 mg to 21 mg Low-tar cigarettes 7 mg or less of tarCigarette filters were first added to cigarettes in the 1950s when it was reported that the tar in

cigarettes was associated with an increased risk of lung cancer. The idea was that the filter wouldtrap harmful tars and nicotine, but the design never worked as well as hoped. Toxins still make itthrough and into the smoker's lungs, exposing them to the risks of smoking-related disease.

In solid form, tar is the brown, tacky substance that is left behind on the end of the cigarette filter.It stains a smoker's teeth and fingers brown and coats everything it touches with a brownish-yellow film. Imagine that settling into the delicate pink tissue of your lungs.

Tar is present in all cigarettes and tends to increase as the cigarette is burnt down, which canmean that the last puffs on a cigarette may contain as much as twice the amount of tar as the first

puffs.

Tar in cigarette smoke paralyzes the cilia in the lungs, and contributes to lung diseases such asemphysema, chronic bronchitis, and lung cancer

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Lung cancer

From Wikipedia, the free encyclopedia

Jump to: navigation, search

Lung cancer

Classification and external resources

Cross section of a human lung. The white area in the

upper lobe is cancer; the black areas are discoloration due

to smoking.

Lung cancer is a disease that consists of uncontrolled cell growth in tissues of the lung. This

growth may lead to metastasis, which is the invasion of adjacent tissue and infiltration

beyond the lungs. The vast majority of primary lung cancers are carcinomas, derived from

epithelial cells. Lung cancer, the most common cause of cancer-related death in men and

women, is responsible for 1.3 million deaths worldwide annually, as of 2004. The most

common symptoms are shortness of breath, coughing (including coughing up blood), and

weight loss.

The main types of lung cancer are small-cell lung carcinoma and non-small-cell lung

carcinoma. Non-small-cell lung carcinoma (NSCLC) is sometimes treated with surgery,
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while small-cell lung carcinoma (SCLC) usually responds better to chemotherapy and

radiation. The most common cause of lung cancer is long-term exposure to tobacco smoke.

Nonsmokers account for 15% of lung cancer cases, and these cases are often attributed to a

combination ofgenetic factors, radon gas, asbestos, and air pollution including secondhand

smoke.[13][14]

Lung cancer may be seen on chest radiograph and computed tomography (CT scan). The

diagnosis is confirmed with a biopsy. This is usually performed by bronchoscopy or CT-

guided biopsy. Treatment and prognosis depend on the histological type of cancer, the stage

(degree of spread), and the patient's performance status. Possible treatments include surgery,

chemotherapy, and radiotherapy. Survival depends on stage, overall health, and other factors,

but overall only 14% of people diagnosed with lung cancer survive five years after the

diagnosis.

Signs and symptoms

Symptoms that may suggest lung cancer include:[15]

dyspnea (shortness of breath) hemoptysis (coughing up blood) chronic coughing or change in regular coughing pattern wheezing chest pain or pain in the abdomen cachexia (weight loss), fatigue, and loss ofappetite dysphonia (hoarse voice) clubbing of the fingernails (uncommon) dysphagia (difficulty swallowing).

If the cancer grows in the airway, it may obstruct airflow, causing breathing difficulties. The

obstruction can lead to accumulation of secretions behind the blockage, and predispose to

pneumonia. Many lung cancers have a rich blood supply. The surface of the cancer may be

fragile, leading to bleeding from the cancer into the airway. This blood may subsequently be

coughed up.

Depending on the type of tumor, so-called paraneoplastic phenomena may initially attract

attention to the disease.[16]

In lung cancer, these phenomena may include Lambert-Eaton

myasthenic syndrome (muscle weakness due to auto-antibodies), hypercalcemia, or syndrome

of inappropriate antidiuretic hormone (SIADH). Tumors in the top (apex) of the lung, known

as Pancoast tumors,[17]may invade the local part of the sympathetic nervous system, leading

to changed sweating patterns and eye muscle problems (a combination known as Horner's

syndrome) as well as muscle weakness in the hands due to invasion of the brachial plexus.

Many of the symptoms of lung cancer (bone pain, fever, and weight loss) are nonspecific; in

the elderly, these may be attributed to comorbid illness.[3]

In many patients, the cancer has

already spread beyond the original site by the time they have symptoms and seek medical

attention. Common sites ofmetastasis include the brain, bone, adrenal glands, contralateral

(opposite) lung, liver, pericardium, and kidneys.[18]

About 10% of people with lung cancer do

not have symptoms at diagnosis; these cancers are incidentally found on routine chest

radiograph.

[2]
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[edit] Causes

The main causes of any cancer include carcinogens (such as those in tobacco smoke),

ionizing radiation, and viral infection. This exposure causes cumulative changes to the DNA

in the tissue lining the bronchi of the lungs (the bronchial epithelium). As more tissue

becomes damaged, eventually a cancer develops.[3]

[edit] Smoking

NIH graph showing the correlation and time-lag between tobacco smoking and lung cancer rate in

the U.S. male population.

Smoking, particularly ofcigarettes, is by far the main contributor to lung cancer.[19]

Cigarette

smoke contains over 60 known carcinogens,[20]including radioisotopes from the radon decay

sequence, nitrosamine, and benzopyrene. Additionally, nicotine appears to depress the

immune response to malignant growths in exposed tissue.[21]

Across the developed world,

91% of lung cancer deaths in men during the year 2000 were attributed to smoking (71% for

women).[22]

In the United States, smoking is estimated to account for 87% of lung cancer

cases (90% in men and 85% in women).[23]

Among male smokers, the lifetime risk of

developing lung cancer is 17.2%; among female smokers, the risk is 11.6%. This risk is

significantly lower in nonsmokers: 1.3% in men and 1.4% in women.[24]

Women who smoke (former smokers and current smokers) and take hormone therapy are at a

much higher risk of dying of lung cancer. In a study by Chlebowski et al. published in 2009,the women taking hormones were about 60% more likely to die of lung cancer than the

women taking a placebo. Not surprisingly, the risk was highest for current smokers, followed

by past smokers, and lowest for those who have never smoked. Among the women who

smoked (former or current smokers), 3.4% of those taking hormone therapy died of lung

cancer compared to 2.3% for women taking the placebo.[25]

The time a person smokes (as well as rate of smoking) increases the person's chance of

developing lung cancer. If a person stops smoking, this chance steadily decreases as damage

to the lungs is repaired and contaminant particles are gradually removed.[26]

In addition, there

is evidence that lung cancer in never-smokers has a better prognosis than in smokers,[27]

and

that patients who smoke at the time of diagnosis have shorter survival times than those whohave quit.

[28]
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Passive smokingthe inhalation of smoke from another's smokingis a cause of lung

cancer in nonsmokers. A passive smoker can be classified as someone living or working with

a smoker. Studies from the U.S.,[29]

Europe,[30]

the UK,[31]

and Australia[32]

have consistently

shown a significant increase in relative riskamong those exposed to passive smoke. Recent

investigation ofsidestream smoke suggests that it is more dangerous than direct smoke

inhalation.[33]

1015% of lung cancer patients have never smoked.[34]

That means between 20,000 to 30,000

never-smokers are diagnosed with lung cancer in the United States each year. Because of the

five-year survival rate, each year in the U.S. more never-smokers die of lung cancer than do

patients of leukemia, ovarian cancer, or AIDS.[35]

[edit] Radon gas

Radon is a colorless and odorless gas generated by the breakdown of radioactive radium,

which in turn is the decay product ofuranium, found in the Earth's crust. The radiation decayproducts ionize genetic material, causing mutations that sometimes turn cancerous. Radon

exposure is the second major cause of lung cancer in the general population, after smoking[8]

with the risk increasing 816% for every 100 Bq/m increase in the radon concentration.[36]

Radon gas levels vary by locality and the composition of the underlying soil and rocks. For

example, in areas such as Cornwall in the UK (which has granite as substrata), radon gas is a

major problem, and buildings have to be force-ventilated with fans to lower radon gas

concentrations. The United States Environmental Protection Agency (EPA) estimates that

one in 15 homes in the U.S. has radon levels above the recommended guideline of 4

picocuries per liter (pCi/L) (148 Bq/m).[37]

Iowa has the highest average radon concentration

in the United States; studies performed there have demonstrated a 50% increased lung cancer

risk, with prolonged radon exposure above the EPA's action level of 4 pCi/L.[38][39]

[edit] Asbestos

Ferruginous bodies the histopathologic finding associated with asbestosis.

Asbestos can cause a variety of lung diseases, including lung cancer. There is a synergisticeffect between tobacco smoking and asbestos in the formation of lung cancer.[9]

In the UK,
http://en.wikipedia.org/wiki/Passive_smokinghttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-AUTOREF7-28http://en.wikipedia.org/wiki/Lung_cancer#cite_note-AUTOREF7-28http://en.wikipedia.org/wiki/Lung_cancer#cite_note-AUTOREF7-28http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Boffetta-29http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Boffetta-29http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Boffetta-29http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Committee-30http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Committee-30http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Committee-30http://en.wikipedia.org/wiki/Lung_cancer#cite_note-NHMRC-31http://en.wikipedia.org/wiki/Lung_cancer#cite_note-NHMRC-31http://en.wikipedia.org/wiki/Relative_riskhttp://en.wikipedia.org/wiki/Sidestream_smokehttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Schick-32http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Schick-32http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Schick-32http://en.wikipedia.org/wiki/Lung_cancer#cite_note-AUTOREF8-33http://en.wikipedia.org/wiki/Lung_cancer#cite_note-AUTOREF8-33http://en.wikipedia.org/wiki/Lung_cancer#cite_note-AUTOREF8-33http://en.wikipedia.org/wiki/Lung_cancer#cite_note-AUTOREF9-34http://en.wikipedia.org/wiki/Lung_cancer#cite_note-AUTOREF9-34http://en.wikipedia.org/wiki/Lung_cancer#cite_note-AUTOREF9-34http://en.wikipedia.org/w/index.php?title=Lung_cancer&action=edit&section=4http://en.wikipedia.org/wiki/Radonhttp://en.wikipedia.org/wiki/Gashttp://en.wikipedia.org/wiki/Radiumhttp://en.wikipedia.org/wiki/Uraniumhttp://en.wikipedia.org/wiki/Crust_(geology)http://en.wikipedia.org/wiki/Ionhttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Catelinois-7http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Catelinois-7http://en.wikipedia.org/wiki/Becquerelhttp://en.wikipedia.org/wiki/Cubic_metrehttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-35http://en.wikipedia.org/wiki/Lung_cancer#cite_note-35http://en.wikipedia.org/wiki/Lung_cancer#cite_note-35http://en.wikipedia.org/wiki/Cornwallhttp://en.wikipedia.org/wiki/Granitehttp://en.wikipedia.org/wiki/United_States_Environmental_Protection_Agencyhttp://en.wikipedia.org/wiki/Picocuriehttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-EPA_radon-36http://en.wikipedia.org/wiki/Lung_cancer#cite_note-EPA_radon-36http://en.wikipedia.org/wiki/Iowahttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Field-37http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Field-37http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Field-37http://en.wikipedia.org/w/index.php?title=Lung_cancer&action=edit&section=5http://en.wikipedia.org/wiki/Ferruginous_bodieshttp://en.wikipedia.org/wiki/Histopathologichttp://en.wikipedia.org/wiki/Asbestoshttp://en.wikipedia.org/wiki/Synergyhttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-O.27Reilly-8http://en.wikipedia.org/wiki/Lung_cancer#cite_note-O.27Reilly-8http://en.wikipedia.org/wiki/Lung_cancer#cite_note-O.27Reilly-8http://en.wikipedia.org/wiki/File:Ferruginous_body.jpghttp://en.wikipedia.org/wiki/File:Ferruginous_body.jpghttp://en.wikipedia.org/wiki/File:Ferruginous_body.jpghttp://en.wikipedia.org/wiki/File:Ferruginous_body.jpghttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-O.27Reilly-8http://en.wikipedia.org/wiki/Synergyhttp://en.wikipedia.org/wiki/Asbestoshttp://en.wikipedia.org/wiki/Histopathologichttp://en.wikipedia.org/wiki/Ferruginous_bodieshttp://en.wikipedia.org/w/index.php?title=Lung_cancer&action=edit&section=5http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Field-37http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Field-37http://en.wikipedia.org/wiki/Iowahttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-EPA_radon-36http://en.wikipedia.org/wiki/Picocuriehttp://en.wikipedia.org/wiki/United_States_Environmental_Protection_Agencyhttp://en.wikipedia.org/wiki/Granitehttp://en.wikipedia.org/wiki/Cornwallhttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-35http://en.wikipedia.org/wiki/Cubic_metrehttp://en.wikipedia.org/wiki/Becquerelhttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Catelinois-7http://en.wikipedia.org/wiki/Ionhttp://en.wikipedia.org/wiki/Crust_(geology)http://en.wikipedia.org/wiki/Uraniumhttp://en.wikipedia.org/wiki/Radiumhttp://en.wikipedia.org/wiki/Gashttp://en.wikipedia.org/wiki/Radonhttp://en.wikipedia.org/w/index.php?title=Lung_cancer&action=edit&section=4http://en.wikipedia.org/wiki/Lung_cancer#cite_note-AUTOREF9-34http://en.wikipedia.org/wiki/Lung_cancer#cite_note-AUTOREF8-33http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Schick-32http://en.wikipedia.org/wiki/Sidestream_smokehttp://en.wikipedia.org/wiki/Relative_riskhttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-NHMRC-31http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Committee-30http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Boffetta-29http://en.wikipedia.org/wiki/Lung_cancer#cite_note-AUTOREF7-28http://en.wikipedia.org/wiki/Passive_smoking


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asbestos accounts for 23% of male lung cancer deaths.[40]

Asbestos can also cause cancer of

the pleura, called mesothelioma (which is different from lung cancer).

[edit] Viruses

Viruses are known to cause lung cancer in animals,[41][42]and recent evidence suggests similar

potential in humans. Implicated viruses include human papillomavirus,[43]

JC virus,[44]

simian

virus 40 (SV40), BK virus, and cytomegalovirus.[45]

These viruses may affect the cell cycle

and inhibit apoptosis, allowing uncontrolled cell division.

[edit] Particulate matter

Studies of the American Cancer Society cohort directly link the exposure to particulate matter

with lung cancer. For example, if the concentration of particles in the air increases by only

1%, the risk of developing a lung cancer increases by 14%.[46][47]

Further, it has been

established that particle size matters, as ultrafine particles penetrate further into the lungs.[48]

[edit] Pathogenesis

Main article: Carcinogenesis

Similar to many other cancers, lung cancer is initiated by activation ofoncogenes or

inactivation oftumor suppressor genes.[49]

Oncogenes are genes that are believed to make

people more susceptible to cancer. Proto-oncogenes are believed to turn into oncogenes when

exposed to particular carcinogens.[50]

Mutations in theK-rasproto-oncogene are responsible

for 10

30% of lung adenocarcinomas.

[51][52]

The epidermal growth factor receptor (EGFR)regulates cell proliferation, apoptosis, angiogenesis, and tumor invasion.[51]

Mutations and

amplification of EGFR are common in non-small-cell lung cancer and provide the basis for

treatment with EGFR-inhibitors. Her2/neu is affected less frequently.[51]

Chromosomal

damage can lead to loss of heterozygosity. This can cause inactivation of tumor suppressor

genes. Damage to chromosomes 3p, 5q, 13q, and 17p are particularly common in small-cell

lung carcinoma. Thep53tumor suppressor gene, located on chromosome 17p, is affected in

60-75% of cases.[53]

Other genes that are often mutated or amplified arec-MET,NKX2-1,

LKB1,PIK3CA, andBRAF.[51]

Several genetic polymorphisms are associated with lung cancer. These include

polymorphisms in genes coding for interleukin-1,[54]

cytochrome P450,[55]

apoptosispromoters such as caspase-8,

[56]and DNA repair molecules such as XRCC1.

[57]People with

these polymorphisms are more likely to develop lung cancer after exposure to carcinogens.

A recent study suggested that the MDM2 309G allele is a low-penetrant risk factor for

developing lung cancer in Asians.[58]

[edit] Diagnosis
http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Darnton-39http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Darnton-39http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Darnton-39http://en.wikipedia.org/wiki/Pleurahttp://en.wikipedia.org/wiki/Mesotheliomahttp://en.wikipedia.org/w/index.php?title=Lung_cancer&action=edit&section=6http://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Leroux-40http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Leroux-40http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Leroux-40http://en.wikipedia.org/wiki/Human_papillomavirushttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Cheng-42http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Cheng-42http://en.wikipedia.org/wiki/JC_virushttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Zheng-43http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Zheng-43http://en.wikipedia.org/wiki/SV40http://en.wikipedia.org/wiki/SV40http://en.wikipedia.org/wiki/BK_virushttp://en.wikipedia.org/wiki/Cytomegalovirushttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Giuliani-44http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Giuliani-44http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Giuliani-44http://en.wikipedia.org/wiki/Cell_cyclehttp://en.wikipedia.org/wiki/Apoptosishttp://en.wikipedia.org/w/index.php?title=Lung_cancer&action=edit&section=7http://en.wikipedia.org/wiki/Particulate_matterhttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-AUTOREF37-45http://en.wikipedia.org/wiki/Lung_cancer#cite_note-AUTOREF37-45http://en.wikipedia.org/wiki/Lung_cancer#cite_note-AUTOREF37-45http://en.wikipedia.org/wiki/Lung_cancer#cite_note-47http://en.wikipedia.org/wiki/Lung_cancer#cite_note-47http://en.wikipedia.org/wiki/Lung_cancer#cite_note-47http://en.wikipedia.org/w/index.php?title=Lung_cancer&action=edit&section=8http://en.wikipedia.org/wiki/Carcinogenesishttp://en.wikipedia.org/wiki/Oncogenehttp://en.wikipedia.org/wiki/Tumor_suppressor_genehttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Fong-48http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Fong-48http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Fong-48http://en.wikipedia.org/wiki/Genehttp://en.wikipedia.org/wiki/Proto-oncogenehttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Salgia-49http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Salgia-49http://en.wikipedia.org/wiki/Mutationhttp://en.wikipedia.org/wiki/Ras_(protein)http://en.wikipedia.org/wiki/Ras_(protein)http://en.wikipedia.org/wiki/Ras_(protein)http://en.wikipedia.org/wiki/Lung_cancer#cite_note-NEJM-molecular-50http://en.wikipedia.org/wiki/Lung_cancer#cite_note-NEJM-molecular-50http://en.wikipedia.org/wiki/Lung_cancer#cite_note-NEJM-molecular-50http://en.wikipedia.org/wiki/Epidermal_growth_factor_receptorhttp://en.wikipedia.org/wiki/Apoptosishttp://en.wikipedia.org/wiki/Angiogenesishttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-NEJM-molecular-50http://en.wikipedia.org/wiki/Lung_cancer#cite_note-NEJM-molecular-50http://en.wikipedia.org/wiki/Lung_cancer#cite_note-NEJM-molecular-50http://en.wikipedia.org/wiki/Her2/neuhttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-NEJM-molecular-50http://en.wikipedia.org/wiki/Lung_cancer#cite_note-NEJM-molecular-50http://en.wikipedia.org/wiki/Chromosomehttp://en.wikipedia.org/wiki/Loss_of_heterozygosityhttp://en.wikipedia.org/wiki/P53http://en.wikipedia.org/wiki/P53http://en.wikipedia.org/wiki/P53http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Devereux-52http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Devereux-52http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Devereux-52http://en.wikipedia.org/wiki/C-METhttp://en.wikipedia.org/wiki/C-METhttp://en.wikipedia.org/wiki/C-METhttp://en.wikipedia.org/wiki/NKX2-1http://en.wikipedia.org/wiki/NKX2-1http://en.wikipedia.org/wiki/NKX2-1http://en.wikipedia.org/wiki/LKB1http://en.wikipedia.org/wiki/LKB1http://en.wikipedia.org/wiki/PIK3CAhttp://en.wikipedia.org/wiki/PIK3CAhttp://en.wikipedia.org/wiki/PIK3CAhttp://en.wikipedia.org/wiki/BRAF_(gene)http://en.wikipedia.org/wiki/BRAF_(gene)http://en.wikipedia.org/wiki/Lung_cancer#cite_note-NEJM-molecular-50http://en.wikipedia.org/wiki/Lung_cancer#cite_note-NEJM-molecular-50http://en.wikipedia.org/wiki/Lung_cancer#cite_note-NEJM-molecular-50http://en.wikipedia.org/wiki/Genetic_polymorphismhttp://en.wikipedia.org/wiki/Genehttp://en.wikipedia.org/wiki/Interleukinhttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Engels-53http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Engels-53http://en.wikipedia.org/wiki/Cytochrome_P450http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Wenzlaff-54http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Wenzlaff-54http://en.wikipedia.org/wiki/Apoptosishttp://en.wikipedia.org/wiki/Caspasehttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Son-55http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Son-55http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Son-55http://en.wikipedia.org/wiki/XRCC1http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Yin-56http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Yin-56http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Yin-56http://en.wikipedia.org/wiki/Carcinogenhttp://en.wikipedia.org/wiki/MDM2http://en.wikipedia.org/wiki/Allelehttp://en.wikipedia.org/wiki/Asianshttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-pmid19264458-57http://en.wikipedia.org/wiki/Lung_cancer#cite_note-pmid19264458-57http://en.wikipedia.org/wiki/Lung_cancer#cite_note-pmid19264458-57http://en.wikipedia.org/w/index.php?title=Lung_cancer&action=edit&section=9http://en.wikipedia.org/w/index.php?title=Lung_cancer&action=edit&section=9http://en.wikipedia.org/wiki/Lung_cancer#cite_note-pmid19264458-57http://en.wikipedia.org/wiki/Asianshttp://en.wikipedia.org/wiki/Allelehttp://en.wikipedia.org/wiki/MDM2http://en.wikipedia.org/wiki/Carcinogenhttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Yin-56http://en.wikipedia.org/wiki/XRCC1http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Son-55http://en.wikipedia.org/wiki/Caspasehttp://en.wikipedia.org/wiki/Apoptosishttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Wenzlaff-54http://en.wikipedia.org/wiki/Cytochrome_P450http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Engels-53http://en.wikipedia.org/wiki/Interleukinhttp://en.wikipedia.org/wiki/Genehttp://en.wikipedia.org/wiki/Genetic_polymorphismhttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-NEJM-molecular-50http://en.wikipedia.org/wiki/BRAF_(gene)http://en.wikipedia.org/wiki/PIK3CAhttp://en.wikipedia.org/wiki/LKB1http://en.wikipedia.org/wiki/NKX2-1http://en.wikipedia.org/wiki/C-METhttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Devereux-52http://en.wikipedia.org/wiki/P53http://en.wikipedia.org/wiki/Loss_of_heterozygosityhttp://en.wikipedia.org/wiki/Chromosomehttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-NEJM-molecular-50http://en.wikipedia.org/wiki/Her2/neuhttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-NEJM-molecular-50http://en.wikipedia.org/wiki/Angiogenesishttp://en.wikipedia.org/wiki/Apoptosishttp://en.wikipedia.org/wiki/Epidermal_growth_factor_receptorhttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-NEJM-molecular-50http://en.wikipedia.org/wiki/Lung_cancer#cite_note-NEJM-molecular-50http://en.wikipedia.org/wiki/Ras_(protein)http://en.wikipedia.org/wiki/Mutationhttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Salgia-49http://en.wikipedia.org/wiki/Proto-oncogenehttp://en.wikipedia.org/wiki/Genehttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Fong-48http://en.wikipedia.org/wiki/Tumor_suppressor_genehttp://en.wikipedia.org/wiki/Oncogenehttp://en.wikipedia.org/wiki/Carcinogenesishttp://en.wikipedia.org/w/index.php?title=Lung_cancer&action=edit&section=8http://en.wikipedia.org/wiki/Lung_cancer#cite_note-47http://en.wikipedia.org/wiki/Lung_cancer#cite_note-AUTOREF37-45http://en.wikipedia.org/wiki/Lung_cancer#cite_note-AUTOREF37-45http://en.wikipedia.org/wiki/Particulate_matterhttp://en.wikipedia.org/w/index.php?title=Lung_cancer&action=edit&section=7http://en.wikipedia.org/wiki/Apoptosishttp://en.wikipedia.org/wiki/Cell_cyclehttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Giuliani-44http://en.wikipedia.org/wiki/Cytomegalovirushttp://en.wikipedia.org/wiki/BK_virushttp://en.wikipedia.org/wiki/SV40http://en.wikipedia.org/wiki/SV40http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Zheng-43http://en.wikipedia.org/wiki/JC_virushttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Cheng-42http://en.wikipedia.org/wiki/Human_papillomavirushttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Leroux-40http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Leroux-40http://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/w/index.php?title=Lung_cancer&action=edit&section=6http://en.wikipedia.org/wiki/Mesotheliomahttp://en.wikipedia.org/wiki/Pleurahttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Darnton-39


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Chest radiograph showing a cancerous tumor in the left lung.

Performing a chest radiograph is the first step if a patient reports symptoms that may suggestlung cancer. This may reveal an obvious mass, widening of the mediastinum (suggestive of

spread to lymph nodes there), atelectasis (collapse), consolidation (pneumonia), or pleural

effusion. If there are no radiographic findings but the suspicion is high (such as a heavy

smoker with blood-stained sputum), bronchoscopy and/or a CT scan may provide the

necessary information. Bronchoscopy or CT-guided biopsy is often used to identify the tumor

type.[2]

Abnormal findings in cells ("atypia") in sputum are associated with an increased risk of lung

cancer. Sputum cytologic examination combined with other screening examinations may

have a role in the early detection of lung cancer.[59]

CT scan showing a cancerous tumor in the left lung.

The differential diagnosis for patients who present with abnormalities on chest radiograph

includes lung cancer as well as nonmalignant diseases. These include infectious causes such

as tuberculosis or pneumonia, or inflammatory conditions such as sarcoidosis. These diseases

can result in mediastinal lymphadenopathy or lung nodules, and sometimes mimic lung

cancers.[3]

Lung cancer can also be an incidental finding: a solitary pulmonary nodule (also

called a coin lesion) on a chest radiograph or CT scan taken for an unrelated reason. The

definitive diagnosis of lung cancer and its classification (described above) is based on

examination of the suspicious tissue under the microscope.
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[edit] Classification

Lung cancers are classified according to histological type. This classification has important

implications for clinical management and prognosis of the disease. The vast majority of lung

cancers are carcinomasmalignancies that arise from epithelial cells. The two most

prevalent histological types of lung carcinoma, categorized by the size and appearance of the

malignant cells seen by a histopathologist under a microscope:non-small-cell and small-cell

lung carcinoma.[60]

The non-small-cell type is the most prevalent by far (see accompanying

table).

Frequency of histological types of lung

cancer[60]

Histological type Frequency (%)

Non-small-cell lung carcinoma 80.4

Small-cell lung carcinoma 16.8

Carcinoid[61]

0.8

Sarcoma[62]

0.1

Unspecified lung cancer 1.9

Cancer found outside of the lung may be determined to have arisen within the lung, as lung

cancers that metastasize, i.e. spread, often retain a cell marker profile that allow a pathologist

to say, with a good deal of certainty, that the tumor arose from the lung, i.e. is aprimary lungcancer. Primary lung cancers of adenocarcinoma histology typically have nuclear

immunostaining with TTF-1.[63][64]

[edit] Non-small-cell lung carcinoma

Micrograph ofsquamous carcinoma, a type of non-small-cell carcinoma. FNA specimen. Pap stain.

The non-small-cell lung carcinomas (NSCLC) are grouped together because their prognosis

and management are similar. There are three main sub-types: squamous cell lung carcinoma,

adenocarcinoma, and large-cell lung carcinoma.
http://en.wikipedia.org/w/index.php?title=Lung_cancer&action=edit&section=10http://en.wikipedia.org/wiki/Histopathologyhttp://en.wikipedia.org/wiki/Carcinomahttp://en.wikipedia.org/wiki/Epithelial_cellhttp://en.wikipedia.org/wiki/Microscopehttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Travis-59http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Travis-59http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Travis-59http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Travis-59http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Travis-59http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Travis-59http://en.wikipedia.org/wiki/Carcinoidhttp://en.wikipedia.org/wiki/Carcinoidhttp://en.wikipedia.org/wiki/Carcinoidhttp://en.wikipedia.org/wiki/Sarcomahttp://en.wikipedia.org/wiki/Sarcomahttp://en.wikipedia.org/wiki/Sarcomahttp://en.wikipedia.org/wiki/Pathologisthttp://en.wikipedia.org/wiki/Cell_nucleushttp://en.wikipedia.org/wiki/Immunostainhttp://en.wikipedia.org/wiki/TTF-1http://en.wikipedia.org/wiki/Lung_cancer#cite_note-pmid18784820-62http://en.wikipedia.org/wiki/Lung_cancer#cite_note-pmid18784820-62http://en.wikipedia.org/wiki/Lung_cancer#cite_note-pmid18784820-62http://en.wikipedia.org/w/index.php?title=Lung_cancer&action=edit&section=11http://en.wikipedia.org/wiki/Micrographhttp://en.wikipedia.org/wiki/Squamous_carcinomahttp://en.wikipedia.org/wiki/FNA_specimenhttp://en.wikipedia.org/wiki/Pap_stainhttp://en.wikipedia.org/wiki/Non-small-cell_lung_carcinomahttp://en.wikipedia.org/wiki/Squamous_cell_lung_carcinomahttp://en.wikipedia.org/wiki/Adenocarcinomahttp://en.wikipedia.org/wiki/Large-cell_lung_carcinomahttp://en.wikipedia.org/wiki/File:Squamous_carcinoma_lung_2_cytology.jpghttp://en.wikipedia.org/wiki/File:Squamous_carcinoma_lung_2_cytology.jpghttp://en.wikipedia.org/wiki/File:Squamous_carcinoma_lung_2_cytology.jpghttp://en.wikipedia.org/wiki/File:Squamous_carcinoma_lung_2_cytology.jpghttp://en.wikipedia.org/wiki/Large-cell_lung_carcinomahttp://en.wikipedia.org/wiki/Adenocarcinomahttp://en.wikipedia.org/wiki/Squamous_cell_lung_carcinomahttp://en.wikipedia.org/wiki/Non-small-cell_lung_carcinomahttp://en.wikipedia.org/wiki/Pap_stainhttp://en.wikipedia.org/wiki/FNA_specimenhttp://en.wikipedia.org/wiki/Squamous_carcinomahttp://en.wikipedia.org/wiki/Micrographhttp://en.wikipedia.org/w/index.php?title=Lung_cancer&action=edit&section=11http://en.wikipedia.org/wiki/Lung_cancer#cite_note-pmid18784820-62http://en.wikipedia.org/wiki/Lung_cancer#cite_note-pmid18784820-62http://en.wikipedia.org/wiki/TTF-1http://en.wikipedia.org/wiki/Immunostainhttp://en.wikipedia.org/wiki/Cell_nucleushttp://en.wikipedia.org/wiki/Pathologisthttp://en.wikipedia.org/wiki/Sarcomahttp://en.wikipedia.org/wiki/Sarcomahttp://en.wikipedia.org/wiki/Carcinoidhttp://en.wikipedia.org/wiki/Carcinoidhttp://en.wikipedia.org/wiki/Lung_cancer#cite_note-Travis-59http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Travis-59http://en.wikipedia.org/wiki/Microscopehttp://en.wikipedia.org/wiki/Epithelial_cellhttp://en.wikipedia.org/wiki/Carcinomahttp://en.wikipedia.org/wiki/Histopathologyhttp://en.wikipedia.org/w/index.php?title=Lung_cancer&action=edit&section=10


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Sub-types of non-small-cell lung cancer in

smokers and never-smokers[65]

Histological sub-type

Frequency of

non-small-celllung cancers (%)

SmokersNever-

smokers

Squamous cell lung carcinoma 42 33

Adenocarcinoma

Adenocarcinoma

(not otherwise

specified)

39 35

Bronchioloalveolar

carcinoma4 10

Carcinoid 7 16

Other 8 6

Pie chart of the incidence of lung cancer types in the Nurses' Health Study, sorted by histological

subtypes, in turn sorted into how many are non-smokers versus smokers[66]

Accounting for 25% of lung cancers,[67]

squamous cell lung carcinoma usually starts near a

central bronchus. A hollow cavity and associated necrosis are commonly found at the center

of the tumor. Well-differentiated squamous cell lung cancers often grow more slowly than

other cancer types.[3]

Adenocarcinoma accounts for 40% of non-small-cell lung cancers.[67]

It usually originates in

peripheral lung tissue. Most cases of adenocarcinoma are associated with smoking; however,

among people who have never smoked ("never-smokers"), adenocarcinoma is the most

common form of lung cancer.[68]A subtype of adenocarcinoma, the bronchioloalveolar
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carcinoma, is more common in female never-smokers, and may have different responses to

treatment.[69]

[edit] Small-cell lung carcinoma

Small-cell lung carcinoma (microscopic view of a core needle biopsy).

Small-cell lung carcinoma (SCLC) is less common. It was formerly referred to as "oat-cell"

carcinoma.[70]

Most cases arise in the larger airways (primary and secondary bronchi) and

grow rapidly, becoming quite large.[71]

The small cells contain dense neurosecretory granules

(vesicles containing neuroendocrine hormones), which give this tumor an

endocrine/paraneoplastic syndrome association.[72]

While initially more sensitive to

chemotherapy and radiation, it is often metastatic at presentation, and ultimately carries a

worse prognosis. Small-cell lung cancers have long been dichotomously staged into limited

and extensive stage disease. This type of lung cancer is strongly associated with smoking.[73]

[edit] Others

Lung cancers are highly heterogeneous malignancies, with tumors containing more than one

subtype being very common.[74]

Currently, the most widely recognized and utilized lung cancer classification system is the

4th revision of the Histological Typing of Lung and Pleural Tumours, published in 2004 as a

cooperative effort by the World Health Organization and the International Association for the

Study of Lung Cancer. It recognizes numerous other distinct histopathological entities of

non-small-cell lung carcinoma, organized into several additional subtypes, including

sarcomatoid carcinoma, salivary gland tumors, carcinoid tumor, and adenosquamouscarcinoma. The latter subtype includes tumors containing at least 10% each of

adenocarcinoma and squamous cell carcinoma. When a tumor is found to contain a mixture

of both small-cell carcinoma and non-small-cell carcinoma, it is classified as a variant of

small-cell carcinoma and called a combined small-cell carcinoma. Combined small-cell

carcinoma is the only currently recognized variant ofsmall-cell carcinoma.

In infants and children, the most common primary lung cancers are pleuropulmonary

blastoma and carcinoid tumor.[75]

[edit] Metastasis
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