1. Tobacco smokingMost impcarcinogens e.g, polycyclic aromic hydrocarbons Enviromental exposureradiation, asbestos, air pollution GeneticsK-RAS, EGFR, c-MYC and HER2Loss of p53, RB, p16

2. Primary benign (rare) malignant (very common) Metastatic (Very common) 3. Squamous cell ca Small cell ca Combined small cell ca Adenocarcinoma Acinar, papillary, broncoalveolar,solid, mixed Large cell ca large cell neuroendocrine ca. Adenosquamous ca Ca with pleomorphic sarcomatoid element Carcinoid tumorTypical, atypical Ca of salivary gland type Unclassified ca 4. Frequency: 35% Smoking: X 25 (increased risk) Males > females Survival (5 years): 15 - 20% Arises in bronchial squamous metaplasia Centrally located May cavitate 5. Frequency: 30% Smoking: X 3 (increased risk) Males < females Survival (5 years): 15 - 20% Peripheral 6. Frequency: 2% Smoking: yes Males = females Survival (5 years): 25 a 40 %. Presentation: Single or multiple tumor nodules Miliary tumor Pneumonic form 7. Frequency: 25 % Smoking: 95% of patients Males >> females Survival (5 years): 1 - 5 %. Central or hilar tumor Associated with paraneoplastic syndromes 8. Frequency: 10 % Gross Peripheral lesion Microscopic Wastebasket group of tumors that do not fitthe criteria of a squamous cellcarcinoma,adenocarcinoma, or small cellcarcinoma Prognosis Similar to adenocarcinoma 9. Mesothelioma: Malignant tumor of mesothelial cells Highly malignant neoplasm with short survival Most patients (70%) have an asbestosexposure history Asbestos exposure also increases the risk ofpulmonary cancer Smoking is not related to mesothelioma 10. Neuro-endocrine tumours. Not related to cigarette smoking. Polypoid intrabronchial masses, but may infiltrate bronchial wall and surrounding lung tissue. Slow-growing, low-grade malignant, as opposedto the aggressive behaviour of small cell carcinomas. Similar in appearance and behaviour to carcinoid tumours arising in other organs. Neuropeptides demonstrable in tumour cells, but the majority are endocrinologically silent. 11. Secondary(metastatic) tumours More common than primary lung tumours. Carcinomas or sarcomas. 12. Benign lung tumours Rare. Commonest:Hamartoma (chondroma) 13. Ahamartoma is a benign focal malformation. Resembles a neoplasm in the tissue of itsorigin. This is not a malignant tumor, and it grows atthe same rate as the surrounding tissues. It is composed of tissue elements normallyfound at that site, but which are growing in adisorganized mass. 14. Macroscopic appearances -The papillomas have a cauliflower-likeappearance. Histopathology - The great majority are exophytic, but an invertedvariant has been reported.-A loose fibrovascular core is covered by stratifiedsquamous epithelium with orderly maturation.-- -Wrinkled nuclei and koilocytes may beapparent-There may be the occasional large atypical cell. 15. A paraneoplastic syndrome is a disease or symptom that is the consequence of the presence of cancer in the body, but is not due to the local presence of cancer cells.[1] These phenomena are mediated by humoral factors (by hormones or cytokines) excreted by tumor cells or by an immune response against the tumor 16. Endocrinopathies Neuromyopathies Osteochondral Disorders Vascular Phenomena Fever Nephrotic Syndrome 17. Cushings SyndromeAdrenal carcinoma (cortisol) more commonwith benign adrenal processes. Small cell undifferentiated lung cancer (ACTH)released through cleavage of pro-opiomelano-cortin gene product. Inappropriate ADH syndrome (Hyponatremia)Small cell undifferentiated lung cancer(vassopressin-like hormone.Hypothalamic tumors (vasopressin) 18. Hypercalcemia(Cancer is the most common cause of hypercalcemia by either humoral or metastatic mechanisms) Squamous cell lung cancer (PTH-like peptide) Renal cell carcinoma (prostaglandins) Parathyroid carcinoma (PTH) Multiple myeloma and T-cell lymphoma (IL-1 and perhaps TGF-a) Breast carcinoma, usually by bone metastasis 19. Hypoglycemia- caused by tumor over- production of insulin or insulin like activitiesFibrosarcoma, Cerebellar hemangioma,HepatocarcinomaCarcinoid syndrome - Caused by serotonin,bradykinin or ?histamine produced by thetumorBronchial carcinoids, Pancreatic carcinoma,Carcinoid tumors of the bowel 20. Polycythemia- caused by tumor production oferythropoietins Renal cell carcinoma, Cerebellar hemangioma,Hepatocarcinoma WDHA syndrome (watery diarrhea, hypokalemia, andachlorhydria) - caused by tumor production ofvasoactive intestinal polypeptide (VIP). Islet cell tumors, Intestinal carcinoid tumors 21. Myasthenia - A block in neuromuscular transmission possibly caused by host antibodies against the tumor cells that cross react with neuronal cells or perhaps caused by toxins. Bronchogenic carcinoma, Breast cancer CarcinomatousMyopathy - probably immune- mediated 22. HypertrophicOsteoarthropy - clubbing, periosteal new bone, and arthritis Isolated clubbing occurs in chronic obstructive pulmonary disease and in cyanotic congenital heart disease, but the full-blown syndrome is limited to lung cancer. 23. Altered Coagulability - caused by the release oftumor products Migratory Venous Thromboses (Trousseaus sign) Pancreatic, gastric, colon, and bronchogenic carcinomas; particularly adenocarcinoma of the lung. Marantic endocarditis - Small thromboticvegetations on mitral or aortic valves thatoccur with advanced carcinomas. 24. Associatedwith bacterial infections-Common where blockage of drainage occurs-Decreased immunity may play a role Not associated with infection-Episodic as with Hodgkins lymphoma;poor prognostic sign in sarcomas, indicatesdissemination-Likely caused by response to necrotic tumorcells and/or immune response to necrotictumor proteins. 25. Excessiveloss of protein in the urine probably caused by damage to renal glomeruli by tumor antigen-antibody complexes.