Non-Small Cell Cancer of the Lung courtesy of Elekta

Adenocarcinoma is the most common non-small cell cancer of the lung that occurs in the United States. The majority of these cancers develop in the periphery (outer part) of the lung. Since these cancers are in the outer portion of the lung, the patient often does not have any symptoms when the cancer is found on a chest x-ray. Adenocarcinomas tend to metastasize (spread to other parts of the body) to the bone, the central nervous system (the brain and spinal cord), the adrenal glands, the liver and the opposite lung.

Frequently, there is scarring in adenocarcinomas. Sometimes, the cancer arises in an area of old scarring of the lung. In other cases, the scar appears to arise secondary to the growth of the cancer.

Bronchoalveolar carcinoma or alveolar cell carcinoma is a non-small cell carcinoma that can be found throughout the respiratory tract. When it is discovered as a single mass on a patient’s x-ray, this type of lung cancer has an excellent prognosis. Five year survival after surgery is in the 75-90% range. If, however, it is found in its diffuse form (meaning it has spread beyond a single mass), the prognosis is quite poor.

Squamous cell carcinomas comprise 30-40% of non-small cell carcinomas of the lung. This type of cancer tends to be located in the more central portion of the lung. Often, this is in a bronchus (a large airway of the lung). Since these cancers are located near or in these airways, they can cause symptoms earlier in their growth. Coughing and production of phlegm (sputum) that is bloody are common symptoms. The cancer can block airways which can lead to shortness of breath or pneumonia.

Large cell carcinomas represent about 10% of non-small cell cancers of the lung. This form of lung cancer has fewer structural characteristics when viewed under a microscope. It is sometimes difficult to distinguish this form of lung cancer from cancers which have spread to the lung from another place in the body.

Patient history and diagnosis

53-year-old woman presented in February 2005 with repeated chest infection. A CT scan showed a left lung mass and a soft tissue mass in relation to the left hilum. A biopsy showed consistency with non-small cell lung cancer.

The patient had no breathing difficulties and was commenced on down staging chemotherapy to which she had a partial response, with complete disappearance of left hilar mass and reduction of the apical tumor. Surgery was not possible as the tumor lay close to the pericardium and vital structures, primarily spinal cord. The patient was then referred for radiation therapy.

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