Clinical aspects of lung cancer

L UNG CANCER is the leading cause of cancer-related deaths in American men and women.Over 122,000 Americans died from this disease in 1985; 292,000 deaths are projected for 1989.Although in the past lung cancer was primarily a malignancy of men, it is currently the leading cause of cancer-related deaths in women, accounting for 21% of female cancerrelated mortality.'This article provides a broad overview of the clinical aspects of lung cancer.After a brief outline of the pathologic classification, the preclinical and clinical phases of the disorder are discussed.The clinical phase is divided into manifestations due to local tumor growth and intrathoracic spread, widespread dissemination, and the paraneoplastic syndromes.Next, commonly utilized diagnostic procedures are reviewed.Finally, a general approach to the assessment and management of lung cancer is provided. PATHOLOGIC CLASSIFICATION OF LUNG CANCERAccording to the commonly used World Health Organization classification,' there are four major histologic types of lung cancer: (1) squamous cell carcinoma (formerly referred to as epidermoid cancer), (2) small cell carcinomas (including the oat cell subtype), (3) adenocarcinoma (including bronchioloalveolar cell carcinoma), and (4) large cell carcinoma.Precise delineation of the frequency of each type is difficult, since the statistics are biased by how the pathologic material is obtained.Studies using cytologic examinations of sputa or bronchial washings and brushings indicate a high incidence of squamous cell and small cell cancers.This is not surprising, since these tumors tend to occur in the central airways, lending