Primary malignancies of the lung and pleura
Description
Histology - the first branch point
| Share | Key features | |
|---|---|---|
| Adenocarcinoma | ~40% | Peripheral, spiculated margins; commonest in never-smokers and in women; metastasises early; may cavitate. Driver mutations concentrate here |
| Squamous cell | ~25-30% | Central, endobronchial; strongly smoking-related; cavitates; PTHrP -> hypercalcaemia |
| Small cell (SCLC) | ~15% | Central, bulky mediastinal nodes; neuroendocrine; almost exclusively smokers; SIADH, ectopic ACTH, LEMS |
| Large cell | ~5-10% | Poorly differentiated, peripheral, aggressive |
| Carcinoid | ~2% | Central, well-vascularised endobronchial; bleeds at bronchoscopy; indolent (typical) |
- NSCLC = adeno + squamous + large cell. Treated by stage and molecular profile
- SCLC = a systemic disease at presentation. Treated by limited vs extensive stage
- Spiculated peripheral margins favour a primary; smooth round lesions favour a metastasis**
Pleural malignancy
- Malignant pleural mesothelioma - the primary pleural cancer; asbestos
- Epithelioid (~60%, best prognosis) / sarcomatoid (worst) / biphasic
- Metastatic pleural disease is far commoner than mesothelioma - lung, breast, lymphoma, ovary
- Rare: solitary fibrous tumour of pleura (may cause hypoglycaemia via IGF-2), pleural lymphoma
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