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Chapter 3: Respiratory oncology 137

no involvement of the heart, great vessels, trachea, Clinical features

oesophagus or vertebrae. The tumour can present with obstruction, recurrent
no malignant pleural effusion. haemoptysis or with metastatic disease. There may be

no contralateral node involvement. weight loss.

no distant metastases (chest CT, serum alkaline phos-

phatase).
Macroscopy/microscopy
adequate lung function (FEV 1 > 1.5 L, gas transfer

They arise from lobar or segmental bronchi into which
>50% normal).
they protrude as a rounded mass usually covered by in-
Surgery (only usually possible in 25%) involves the re-
tact epithelium. Cells are cuboidal, arranged in a mosaic
moval of the anatomical unit containing the tumour
or trabecular pattern and have a dense core and neurose-
(segment,lobeorlung)togetherwiththeassociatedlym-
cretory granules.
phatic drainage. 35–40% 5-year survival rate but closer
to 90% with peripheral lesions.
Complications
1 Lung collapse and consolidation distal to the obstruc-
Prognosis tion.
Non-small cell – 20% have successful resection, 10% 2 Local invasion, spread to lymph nodes and distant

survive for 5 years. Inoperable non-small cell carci- metastasis.
noma – chemotherapy is effective in ∼20% and at best 3 Rarely, the carcinoid syndrome – recurrent episodes
givesasurvivalbenefitofafewmonths,andithastoxic of a combination of
side-effects. Median survival ∼8months with combi- flushing of the face and neck sometimes leading to
nation chemotherapy. telangectasia (due to kinins).
Small cell carcinoma limited to thorax: Median sur- abdominal pain, nausea, vomiting and watery di-

vival 18–24 months with combination chemotherapy arrhoea (5HT).
and radiotherapy and up to 20% survive 2 years, only tricuspid regurgitation or pulmonary stenosis.
6–12 weeks without treatment. Small cell carcinoma
with metastases: Median survival ∼8months with
Investigations
combination chemotherapy, rarely survive to 2 years. Chest X-ray may show a rounded lesion.
The rare alveolar carcinoma carries a poor prognosis Bronchoscopy usually shows a pedunculated vascular

due to its multifocal nature.
tumour protruding into the lumen.
24-hour urinary excretion of the metabolite of 5HT.

(5-hydroxyindoleacetic acid (5-HIAA)) on a low sero-
Bronchial carcinoid tumours tonindiet(excludingbananas,tomatoes,walnuts,etc.)
Definition
Arare neuroendocrine tumour of the lung. Management
Local resection is indicated in all cases.

Pathophysiology
These are highly vascular, low-grade malignant tumours Prognosis
80% 10-year survival.
which are locally invasive and can metastasise. They arise
from bronchial enterochromaffin (Kulchitsky) cells, and
can secrete various amines and peptides, including Secondary lung tumours
serotonin (5-hydroxytryptamine (5HT)), histamine and
bradykinin. These rarely cause the carcinoid syndrome, Definition
as to do so they have to metastasise to the liver first (the Metastases to the lung are very common due to
peptides are metabolised in the liver). haematogenous spread.