Case ReportAnterior Mediastinal Mass in a Young Marijuana Smoker: A Rare Case of Small-Cell Lung Cancer

Jiten P. Kothadia1, Saurabh Chhabra 2, AlanMarcus 3, MichaelMay 3, Biren Saraiya 2, and Salma K. Jabbour 1

1. Department of Radiation Oncology, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08901, USA2. Division of Medical Oncology3. Department of Pathology

Hindawi Publishing CorporationCase Reports in MedicineVolume 2012, Article ID 754231, 4 pagesReceived 14 December 2011; Accepted 30 January 2012

INTRODUCTION• Cannabis is most widely consumed illicit drug worldwide• Perceived to be harmless• Link of cannabis smoking to lung cancer is inconclusive• Tobacco smoke and cannabis have similar toxic irritants• Research on effects of cannabis are mainly on mental

health, very little on pulmonary effects• Current research in not very extensive and contradictory

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CASE PRESENTATION• 22 year old male• Bilateral lymphadenopathy (swollen lymph nodes)• Fatigue • Sore throat• Treated for upper respiratory tract infection• One month prior• Cough• Exertional dyspnea (shortness of breath with exercise)• Chest pain• Hoarseness• Solid food dysphagia (difficulty swallowing)• Facial and neck swelling

• No family history• Smoked 1 joint three times a week for three years but no

cigarettes

CASE PRESENTATION

• Initial chest radiograph showed a large right hilar with right paratracheal soft tissue mass

CASE PRESENTATION

• Chest computed tomography (CT) demonstrated a large anterior mediastinal mass

CASE PRESENTATOIN

• Positron emission tomography (PET) scan showing a hypermetabolic mediastinal mass

CASE PRESENTATION

• Patient was diagnosed with Small Cell Lung Cancer• No sign of the cancer outside his chest• Treated with urgent radiation therapy, cisplatin

(chemotheraphy) and etoposide (anti-cancer medication)• Patient was free of disease for 16 months• Subsequently experience metastatic disease in the liver

and para-aortic lymph notes

DISCUSSION

• Marijuana is the most commonly used illicit drug in the USA• In 2009, there were 16.7 million pastmonth (current) users• 6.6% of the US population

• delta-9-tetradydrocannabinol (THC)• Perceived to be safe• Greater potential to cause lung cancer than cigarette smoke• Similar to tobacco smoke • 50-70% more carcinogentic hydrocarbons

DISCUSSION

• Blunts combine nicotine and other chemicals• Less densely packed, no filters, smaller butt size• Higher concentrations of smoke are inhaled

• Inhale more deeply and hold breath longer• Absorb more CO than cigarettes

• Regular marijuana smokers long term pulmonary consequences• Chronic cough• Airway inflammation and injury• Dysregulated growth of respiratory cells• Molecular abnormalities in respiratory tracts

DISCUSSION

• Very rare to have SCLC this young• 0.03 cases per 1000 reported in patients younger than

39 • No cigarette smoking• No genetic predisposition • Study of one joint per day (New Zealand)• Increase risk of cancer 8%• Equals 20 cigarettes per day

LIMITATIONS

• Only one case• Contradicting studies• Smoking marijuana without tobacco• Need larger studies to evaluate association

SIGNIFICANCE• Physicians and patients need to be aware • Smoking cannabis may be associated with lung cancer

• Dispel myths• Youths who smoke cannabis and cigarettes• More and more users avoiding inhalation• Vaporizers - heats the cannabis before it combusts• Eating it – ‘cannabutter’

Marijuana butter Marijuana vaporizers