Lung cancer

Learning objectives

Lung cancer is the most common cause of cancer mortality worldwide for men and women
Lung cancer or lung carcinoma is a malignant tumor characterized by uncontrolled cell growth in lung tissue
Lung carcinomas derive from transformed, malignant cells that originate as epithelial cells, or from tissues composed of epithelial cells
Sarcomas are generated by the malignant transformation of connective tissues, which arise from mesenchymal cells
Lung cancer often starts in the bronchi, bronchioles, or alveoli
Two types:
- Non-small-cell lung cancer
  - The most common form, accounting for around 80% of lung cancer cases
  - Common types include: squamous cell carcinoma, adenocarcinoma, or large-cell carcinoma
- Small-cell lung cancer
  - Less common
  - Spreads faster and harder to treat than non-small-cell lung cancer
Other tumors including large cell, neuroendocrine (carcinoid), bronchioloalveolar and rarer forms can all present as lung malignancies
The presentation includes airway obstruction, lung collapse, and distal infection or through spread via the peribronchial tissues with subsequent invasion of the mediastinum
Spreads by both lymphatic and hematological routes and distal metastasis is common in the liver, adrenals, bone, and brain

Smoking
Older age
Genetic mutations
Exposure to harmful substances such as air pollution, radon, asbestos, uranium, silica, coal products
Previous radiation treatment to the thorax
Family history of lung cancer

Anesthetic involvement is mainly for lung resection (e.g. lobectomy, pneumonectomy)
Consider:
- Potentially compromised respiratory function with risk of perioperative respiratory complications
- Mass effects: obstructive pneumonia, lung abscess, SVC syndrome, tracheobronchial distortion, Pancoast’s syndrome, recurrent laryngeal nerve or phrenic nerve paresis, chest wall or mediastinal extension
- Metabolic effects: Lambert–Eaton syndrome, hypercalcemia, hyponatremia, Cushing’s syndrome
- Metastases: particularly to the brain, bone, liver, & adrenal
- Medications: chemotherapy agents, pulmonary toxicity (bleomycin, mitomycin), cardiac toxicity (doxorubicin), renal toxicity (cisplatin)
- Comorbidities including smoking, chronic obstructive lung disease, coronary artery disease, hypertension