Newgrowths of the Lung, Primary and Secondary

Abstract

PRIMARY tumors of the lung are being recognized with increasing frequency, both clinically and roentgenographically. One clinician2 states that he can recognize by means of physical examination, a tumor of the lung at a very early stage, even before it is recognizable on roentgen examination. This statement, however, requires further evidence from a series of proven cases. The use of artificial pneumothorax in the differential diagnosis of newgrowth of the lung is advocated by the same author, and should be more frequently utilized. “The writer2, 3 has recently aspirated fluid in the chest and replaced it with air in the usual way in which a pneumothorax for therapeutic purposes is induced. A tumor is then made much clearer on the roentgenographic plate than can be expected otherwise. Similarly a diagnostic pneumothorax is induced in cases without fluid with a view of bringing out the outlines of an intrathoracic neoplasm.” Another authority makes the following interesting statement4: “A decade ago, the diagnosis of tumor of the lung was regarded as a brilliant accomplishment and a clinical tour de force; to-day it may truthfully be said that by a proper combination of clinical and roentgen evidence, few pulmonary neoplasms need escape discovery.” The importance of recognition of very early metastatic lesions in the lung or mediastinum cannot be too strongly emphasized. I have known of error, due to the positive diagnosis of metastatic growth of the lung when no metastatic lesion was present, lead to the withholding of an operative procedure and institution of palliative measures. The error is usually due to attaching undue importance to the peribronchial and root shadows. On the other hand, true early metastatic lesions should always be looked for before any operation for malignant growth is undertaken. Ewing5 makes the following observations: “Bayle, in 1810, vaguely described pulmonary cancer, and Stokes, 1842, recognized several varieties of the disease. Rokitansky recognized several gross varieties of the pulmonary lesions, but the earliest microscopical studies were those of Langhans, Marchiafava, and Malassez, 1871–1876. “Primary malignant tumors of the lung form about 1 per cent of all cancers. Among 16,578 cancer autopsies from various Continental sources, 168 pulmonary cancers were recorded (compiled from Karrenstein and Adler). Kaufman places the proportion much higher—at 1.83 per cent. It is evident that increased attention has greatly augmented the list of observed cases. “Males are much more frequently affected than females, 71.9 per cent. Adler gives the following analysis of age incidence: “The right lung is more frequently affected than the left. According to histogenesis three groups of pulmonary carcinoma must be recognized, as arising from (a) bronchial epithelium (Fig. 1), (b) bronchial mucous glands, (c) alveolar epithelium.