Large cell carcinoma

•Accounts for 5-10% of all lung cancers .

•Strongly associated with cigarette smoking.

• The lesion occurs peripherally and grows

rapidly, with early metastases and a poor

outcome •They lack any diagnosic

features to suggest their diagnosis prior to biopsy .

Pancoast tumors •Represent 1-3% of all lung cancers. •Typically involve the lower trunks of the

brachial plexus, intercostal nerves, stellate ganglion, adjacent ribs, and vertebrae.

• More than 95% are NSCC .•Horner's syndrome, mediastinal and

supraclavicular adenopathy and vertebral body invasion portends a poorer prognosis

Pancoast Tumours Imaging

•MRI is more accurate in identification of the extent of tumor involvement; it is superior to CT scanning in

the detection of invasion of adjacent organs (eg, vertebral bodies, brachial plexus, subclavian vessels).

• CT or MRI of the brain is recommended in the initial evaluation, because distant metastases to the brain

are not infrequent •

Differential Diagnosis of an opacity at the Superior Sulcus

•Mesothelioma.•Lymphoma.•Plasmacytoma.•Metastatic malignancies (thyroid, larynx).•Lymphomatoid granulomatosis.•Cervical rib syndrome.•Tuberculosis.•Fungal infections.

Small Cell Lung Cancer•strong association with smoking

.•Rapid growth.•Early spread to distant sites.•Exquisite sensitivity to chemo

and radiotherapy.•Frequent association with

distinct paraneoplastic syndromes .

•Surgery usually plays no role in its management, except in rare

situations (<5% of patients) in which it presents at a very early

stage as a solitary pulmonary nodule

Small cell lung cancer•18% of all lung cancers.•Often present with bulky

hila and mediastinal lymph node masses .

•TNM system does not provide important

prognostic information; only useful in <5%.

Staging of Small Cell Carcinoma Stage Description

Limited stage Disease confined to one hemithorax; includes involvement of mediastinal, contralateral hilar, and/or supraclavicular and scalene lymph nodes.

Extensive stage

Disease has spread beyond the definition of limited stage, or malignant pleural effusion is present

•With central tumors, distinguishing primary tumor from lymph node

metastasis may be impossible

International Staging System for Lung Cancer

•This is the common evaluation framework,because, patient treatment

options and prognosis are directly related to their tumor stage at presentation.

•Derived from a TNM classification scheme with four separate stage groups from I to IV.

Stage I reflects the best prognosis, stage IV the worst .

Tumor (T)

–TX - Positive malignant cytology, no lesion seen –T1 - Diameter smaller than or equal to 3 cm –T2 - Diameter larger than 3 cm –T3 - Extension to pleura, chest wall, diaphragm,

pericardium, within 2 cm of carina, or total atelectasis –T4 - Invasion of mediastinal organs (eg, esophagus,

trachea, great vessels, heart), malignant pleural effusion, or satellite nodules within the primary lobe

T1 Tumor

•Diameter of 3 cm or smaller ,

surrounded by lung or visceral

pleura.

T2: A tumor with any of the following features:

•Larger than 3 cm.•Associated with

atelectasis or post-obstructive

pneumonitis that does not involve the entire

lung. •Invades the visceral

pleura.

T3: A tumor of any size that directly invades any of the following:

•The chest wall (including superior

sulcus tumors), diaphragm,

mediastinal pleura, parietal pericardium.

T3: A tumor of any size that directly invades any of the following

•Tumor in the main bronchus less than 2 cm distal to the carina (but without involvement of

the carina).•Tumor associated with

atelectasis or obstructive pneumonitis

of the entire lung .