Snapshot A 69-year-old male with a 50 pack-year smoking history presents to his physician with complaint of worsening cough. He describes frequently coughing up blood in the past few weeks. He has unintentionally lost about 10 pounds of weight in the past month and has felt more fatigued than usual. On physical examination, he has ptosis and a constricted pupil in his left eye. His right eye is normal. A chest radiograph is obtained and is shown in the image. Introduction Overview lung cancer is a malignancy that affects the lung parenchyma or airways login to view 3 more bullets Epidemiology login to view 10 more bullets Prognosis login to view 1 more bullet Screening login to view 4 more bullets Classification Small Cell Lung Cancer (SCLC) Type Location Associated Findings Histology Small cell (oat cell)lung cancer Central MYC gene amplication May produce adrenocorticotropic hormone (ACTH) leads to Cushing syndrome excessive anti-diuretic hormone (ADH) leads to syndrome of inappropriate ADH (SIADH) presynaptic calcium channel antibodies leads to Lambert Eaton syndrome Small dark blue tumor cells with lack of nucleoli and high nuclear:cytoplasm ratio Positive staining for neuron-specific enolase chromogranin A Non-Small Cell Lung Cancer (NSCLC) Type Location Associated Findings Histology Adenocarcinoma Peripheral Most common cause of lung cancer in non-smokers cause of lung cancer (excluding metastasis) Adenocarcinoma in situ tumor growth along alveolar structures lepidic growth pattern Patients may havehypertrophic osteoarthropathy Common gene mutations include KRAS EGFR ALK Typically mucin positive and has a glandular appearance Large cell carcinoma Peripheral Associated with a poor prognosis Highly associated with smoking Pleomorphic giant cells Squamous cell carcinoma of the lung Central Can arise from the bronchus Keratin pearls Intracellular bridges Bronchial carcinoid tumor Central or peripheral Carcinoid syndrome Better prognosis Neuroendocrine cells Chromogranin A positive Presentation Symptoms login to view 8 more bullets Physical exam login to view 1 more bullet Imaging Radiography login to view 3 more bullets Computerized tomography (CT) scan login to view 4 more bullets Studies Laboratory testing login to view 8 more bullets Pulmonary function tests Evaluation of an incidental solitary pulmonary nodule login to view 22 more bullets Differential Tuberculosis login to view 3 more bullets Treatment Small cell lung cancer login to view 1 more bullet Non-small cell lung cancer login to view 2 more bullets Complications Superior vena cava syndrome Pancoast tumor login to view 1 more bullet Metastasis Pericardial effusion Pleural effusion Paraneoplastic syndromes login to view 5 more bullets