Bronchogenic Cancer Research Articles

Cancer of the bronchus and lung: Connecticut 1935–1959

A marked increase has been noted in the incidence of cancer of the bronchus and lung in Connecticut. The incidence of this malignancy in males has risen from 8.7 per 100,000 population in 1935, to 46.7 per 100,000 in 1959; the corresponding figures for females demonstrate a rise from 4.1 to 7.3 per 100,000 population. A detailed 22-year survival analysis by stage, age, histological type, calendar period of diagnosis, and type of treatment of patients with cancer of the bronchus and lung diagnosed in the state of Connecticut between 1935 and 1956 is presented. Observed survival is measured relative to expected survival in the general population. Among patients diagnosed during 1935–1949, only 1 3 of those who were expected to survive the first 6 months after diagnosis, did in fact, survive; less than 20 per cent of these lived 1 year and less than 5 per cent lived 5 years. Patients diagnosed during 1950–1956, experienced only slightly higher 5-year survival rates than those diagnosed in 1935–1949; the relative 10-year survival rate for lung cancer is 4 per cent for females and 2 per cent for males. There does appear to be a slightly higher survival rate for females having bronchogenic cancer. The increase in survival rates from the 1935–1949 period to the 1950–1956 period was possibly related to the increase in the percentage of patients treated by surgical intervention. This study suggests that there is an increase in the survival time of the surgically treated patients. The survival figures for the state of Connecticut are similar to the average figures obtained in other treatment centers of the United States.

Mediastinoscopy in Bronchogenic Cancer

It is stated that mediastinal extension is the cause of nonresectability in a high percentage of cases during exploratory thoracotomy in bronchogenic cancer. Mediastinoscopy is a method of proving this mediastinal extension before thoracotomy. In this article, the results are mentioned of 122 consecutive mediastinoscopies performed on patients with cancer of the lung, with no evidence of non-resectability. In this series, there were 45 patients (36.9 per cent) with tumor bearing tissue in the biopsy specimen. After selection by mediastinoscopy, the resection rate rose to more than 90 per cent. The patients with so-called positive mediastinoscopy were thought to be incurable. The considerations applying to the judgment as to incurability of these patients are mentioned. It is stated that mediastinoscopy should be performed when there is no evidence of incurability and when the patients correspond to one of the following criteria: 1. Central lesions on the x-ray film. 2. Diffuse, poorly demarcated lesions or atelectasis on the x-ray film. 3. Oat cell carcinoma. 4. Dubiously operable patients. Every lymph node metastasis gives a more widespread dissemination of tumor. This is the reason that in 22 per cent of cases, contralateral lymph node metastases were found, right-sided as well as left-sided. In cases of right-sided incurable lung cancer with hypertrophic osteoarthropathy, vagotomy on the right side is possible through the mediastinoscope.

The Etiology of Bronchogenic Carcinoma

1. Bronchogenic carcinoma, an extremely rare disease 25 years ago, has become the most common of all visceral carcinomas, exceeding in frequency cancer of the breast and female genital tract. 2. The unprecedented increase in the incidence of bronchogenic cancer began in the United States approximately 20 years after the first World War, when men began to smoke cigarettes excessively. The increased incidence of bronchogenic cancer definitely parallels the increased sale of cigarettes. 3. Prospective studies involving slightly less than 2,000,000 people show that the more cigarettes smoked the greater the incidence of cancer of the lung. 4. Although influenzal infection was once thought to be the cause of bronchogenic carcinoma, this has been disproved. 5. Studies have shown that air pollution is of no etiologic significance in bronchogenic carcinoma. 6. Next year in the United States more people will die of bronchogenic cancer than will be killed in automobile accidents. 7. Bronchogenic cancer is a preventable disease. The only hope at present is prevention because the curability rate is extremely low–approximately 5 per cent.

Effect of chemical agents on bronchogenic cancer.

Introduction In an informative article written during 1957, Budinger2concluded with the following statement: That such a large series of terminal patients is easily accumulated testifies to the subtlety of bronchogenic carcinoma and perhaps to the failure of patient education in this group. At present, the great majority of patients with lung cancer at Boston City Hospital are seen too late to permit an attempt at definitive therapy. Hayward5made the following observation:... if a hint that surgical successes are few creeps in [the literature], it is fashion to counter it by a call for earlier diagnosis, thus creating the impression that this will correct the position. I... do not believe that earlier diagnosis [of lung cancer] will increase surgical cures to a really significant percentage.... surgery of carcinoma of the lung is depressing.... The idea that more extensive operations or more powerful X-ray machines will go an

Current Concepts in the Surgical Diagnosis and Treatment of Bronchogenic Cancer

Current Concepts in the Surgical Diagnosis and Treatment of Bronchogenic Cancer

Endoscopic Appearance of 100 Cases of Bronchogenic Cancer: Diagnostic Considerations

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Experimental Cancer of the Lung

The induction of cancer of the lung by administration of chemical carcinogens into the respiratory passages of experimental animals is of interest because of the increasing incidence of pulmonary cancer in man and the urgent need for its control. An analysis of the literature and of some of our own data showed that experimental lung cancer has been produced only in a few instances. The author believes that the critical moment in lung-cancer induction is the fixation or deposition of the carcinogenic substance in the lung tissue. Bronchogenic cancer was induced in about 30 percent of rats by intratracheal intubation of 6 to 10 mg of 7,12-dimethylbenz[a]anthracene with black-ink powder, in recent experiments performed in our laboratory. These cancers were usually epidermoid carcinomas originating from metaplastic bronchial epithelium, but there were also some adenocarcinomas. Both epidermoid carcinoma and adenocarcinoma gave rise to metastases. Many multicentric focal proliferations of bronchial epithelium, both adenomatous and metaplastic, were, in all probability, morphologically visible precursors of lung cancer. These proliferations usually arose in the areas of application of the carcinogen and were unrelated to inflammation.

Effect of tobacco tars on regenerating tracheal mucosa.

The effect of tobacco tars on bronchial mucosa and the relationship of such products to bronchogenic cancer continue to be subjects of considerable interest and investigation. The increasing incidence of bronchogenic carcinoma and the statistical evidence showing a correlation with tobacco consumption demonstrate the need for continued work in this field. The studies here being reported will demonstrate a different technique for the evaluation of the effects of crude tobacco tar on regenerating tracheal epithelium as well as report the results obtained. Methods and Materials In this study a 2 cm. square area of the anterior lower cervical trachea was excised. Ivalon sponge, compressed to one-fourth its usual thickness, was substituted for the defect thus created. In 36 dogs, sterile, chemically clean Ivalon prostheses were substituted for a portion of the anterior wall of the trachea. These dogs were killed at intervals of 1, 2, 4, and 12 weeks to

Treatment of bronchogenic cancer with conventional x-rays according to a specific time-dose pattern.

This is A report of 43 patients with advanced nonresectable cancer of the lung who received conventional x-ray therapy according to an abbreviated time-dose pattern and showed subjective and objective improvement. Inoperable carcinoma of the lung is essentially an incurable disease either because of its local extension to vital structures (1) or because of distant metastasis. Experience has shown that when a dose of radiation sufficient to eradicate the local disease is delivered, irreparable changes in the surrounding normal lung tissue may be produced. While the morbidity secondary to these changes is incapacitating, it would be a small price to pay were the disease cured. However, with the frequent incidence of local extension and/or distant spread, both of which mitigate against cure, one should be circumspect in delivering high dosage to the lung. There is little doubt that irradiation can induce a significant degree of palliation in a great many patients. This should be accomplished with a dose that...

Intensive cobalt-60 teletherapy of lung cancer.

The fact that bronchogenic carcinoma can seldom, if ever, be cured by irradiation has rarely been disputed. There are many factors which account for the failure of radiation to cure carcinoma of the lung. The most important of these are as follows: 1. Bronchogenic carcinoma is usually invasive by nature, and, because it is growing in an organ which is extremely vascular, it invades the blood and lymphatic channels early, often producing metastases before detection of the primary tumor. 2. Bronchogenic carcinomas are generally radioresistant. Undifferentiated carcinomas often have been classified erroneously as radiosensitive tumors. They are more correctly classified as radio-responsive, since they respond promptly but usually have invaded the blood and lymphatic channels before they are controlled locally, and thus are never cured. 3. Patients with bronchogenic cancer have often so deteriorated before the diagnosis is made that they are unable to tolerate cancerocidal tumor doses. 4. The lung tolerates r...

BRONCHOGENIC CARCINOMA COMPLICATING PULMONARY TUBERCULOSIS: A REPORT OF EIGHT CASES AND A REVIEW OF 140 CASES SINCE 1932

Excerpt Within the last three years we have encountered eight cases of coexistent active pulmonary tuberculosis and bronchogenic carcinoma. This seemed a high coincidence of the two conditions and ...

Pneumonia and Bronchogenic Cancer

Pneumonia and Bronchogenic Cancer

A roentgen study of bone metastases from melanoma.

Some cancers have known proclivities to metastasize to specific organs as determined by the route of dissemination and by the unexplained phenomenon of selective localization. Malignant melanomas are known to disseminate widely, but the extent and incidence of visceral involvement have not been fully appreciated. In the course of treating more than 1,300 patients with malignant melanoma, the Mixed Tumor Service of Memorial Cancer Center (New York) has had a unique opportunity of analyzing the distribution of metastases as determined by postmortem examination. The incidence of metastatic involvement of various organs and tissues is illu strated in th e accomp anying diagram (Fig. 1). From a study of this scattergram it may be seen that there is no cancer so commonly inclined to widespread dissemination. For example, in proportion to frequency of occurrence, melanoma involves the brain (38 per cent) more often than any other cancer, exceeding even bronchogenic and mammary cancer. Forty-four per cent of patients dying of malignant melanoma have metastatic deposits in the heart, which is a greater incidence of involvement than obtains for any other neoplasm, even rhabdomyosarcoma and liposarcoma, which are known to disseminate to the heart with some frequency. Forty-nine per cent, or practically one out of two patients dying of melanoma, have bone metastases. The great majority of these metastases are silent or obscured by other symptoms and signs predominating in the terminal stages of the disease. The purpose of the present communication is primarily to discuss the radiographic manifestations of metastatic melanoma of bone. Although such metastases are not frequently encountered by the roentgenologist, it is still necessary for him to be generally acquainted with the appearance that these deposits may present on the radiograph. A survey of the scanty literature dealing with the roentgen findings in this condition revealed several reports, all of which, however, were based on relatively few patients. The most recent, by Wilner and Breckenridge (1), included.) cases in which they characterized these metastases as predominantly osteolytic. They also summarized the pertinent literature and cited 12 cases having depend able roentgen evaluation of the bone lesions, all of which were described as being largely osteolytic (2–5). From the considerable volume of melanomas of the Mixed Tumor Service of the Memorial Cancer Center, 3:3 cases with bone metastases having adequate x-ray film coverage were studied. This provides a sufficient basis, it is believed, to establish the roentgen characteristics of such metastases. Pathological proof was obtained for each tumor but, of course, not every individual bone lesion was proved histologically. In no instance, however, was a second neoplasm known or suspected.

The superior vena cava obstruction syndrome in bronchogenic carcinoma; pathologic physiology and therapeutic management.

The onset of the superior vena cava obstruction syndrome in a patient with a bronchogenic carcinoma is an ominous event, heralding inoperability and producing severe discomfort and curtailment of useful activity. Unless decompression therapy is promptly and effectively instituted, the course is rapidly progressive, characterized throughout by distressing signs and symptoms. In our experience with a series of 38 such patients, roentgen therapy and/or nitrogen mustard5 have provided a striking degree of palliation and prolongation of useful activity in a majority of cases. The pathologic physiology and therapeutic management of this important complication deserve far more generous consideration than they have heretofore been afforded in the literature. Particularly is this so because of the rapidly rising incidence of bronchial cancer in recent years, the relative frequency of obstruction of the superior vena cava in the natural history of that disease, and the striking benefits of prompt treatment with x-rays and/or nitrogen mustard. In earlier communications (19, 20, 21), the authors reported on the use of nitrogen mustard as an adjunct to radiation in bronchogenic cancer, with therapeutic results in 40 patients, among them 9 with the superior vena cava obstruction syndrome. It is proposed, in the present paper, to discuss the pathologic physiology, clinical picture, radiographic features, and therapeutic management of this syndrome in the light of our broader experience. Pathologic Physiology The superior vena cava is the major trunk line for the return of venous blood to the right heart from the head, neck, upper extremities, and upper thorax (see Fig. 1A). This important channel is particularly vulnerable to obstruction by primary bronchial cancer or metastatic mediastinal nodes because (a) it is a thin-walled vessel with very low venous pressure, (b) it is locked in a tight compartment in the right anterior-superior mediastinum behind an unyielding sternum, (c) it is in intimate proximity to the right main bronchus, and (d) it is completely encircled by chains of highly important lymph nodes which drain all of the structures of the right thoracic cavity and the lower part of the left (5, 14, 22). In front of the superior vena cava lie the right anterior mediastinal or prevascular nodes. Behind it lurk the right lateral or paratracheal nodes, the lowermost and largest of which threatens the arch of the vena azygos, the great vein's most vital auxiliary (see Fig. 1B, C, D). Rouvière (22), Drinker (5), and McCort and Robbins (14) have recently added greatly to our knowledge of this important lymphatic drainage system in pulmonary cancer.

Early recognition of bronchogenic carcinoma.

Bronchogenic carcinoma is increasing more than any other cancer in the body. The unprecedented increase is probably due to the carcinogenic effect of cigarette smoking. Unfortunately, a long delay usually occurs between the onset of the disease and the diagnosis. All men past 40 years of age who have been heavy smokers should have x-rays of their chest every three to six months in order that bronchogenic cancer can be detected early.

Newer Palliative Measures in the Management of Inoperable Bronchogenic Carcinoma

1) The significant and growing number of new patients with inoperable bronchogenic cancer makes it mandatory that every new palliative measure be employed to contribute toward the maintenance of their comfort and useful activity during the relentless downhill progress of their disease. 2) Recent advances in widely varied fields of therapy have made possible newer palliative measures which provide amelioration of intractable symptoms, prolongation of useful life, and even a rare chance for cure. 3) The authors have assembled them here and have presented, as well, their combined experience with several hundred patients in the use of radiation therapy, the nitrogen mustards, thoracosurgical and neurosurgical procedures, and a variety of newer palliative medical measures. Radiation therapy, in particular, has provided the most effective and the most prolonged palliation. This agent gives real promise of becoming even more useful in the near future.

The early diagnosis of primary lung cancer by cytologic methods.

Six thousand two hundred and eighty-one specimens of sputum or bronchial secretions from 2,066 patients were studied by cytologic techniques. Two hundred and forty-one patients had bronchogenic cancer diagnosed by pathologic studies. A positive cytologic diagnosis was made in 55 per cent of these 241 patients. When five or more sputum specimens were examined, the accuracy rose to 90 per cent. The clinical applications of cytologic diagnostic techniques are discussed: Cytology is of value to the thoracic surgeon in establishing a reliable preoperative morphologic diagnosis of lung cancer. A positive cytologic diagnosis may be made in many cases where the lesions are located in the periphery of the lung or upper lobe bronchi where bronchoscopic examinations are of limited value. Difficult diagnostic problems may be solved when a definite morphologic diagnosis of cancer is made by positive cytologic studies. In patients with coexistent pulmonary tuberculosis and bronchogenic carcinoma, cytologic studies may clarify a confusing clinical picture. Cytologic studies of sputum may be utilized as routine screening procedures on patients with minimal or no pulmonary symptoms. In our series of pathologically proved bronchogenic cancer, a positive cytologic diagnosis was made oftener and sooner than other morphologic diagnoses. In 47 per cent of these cases cytology was the first diagnostic procedure to establish a morphologic diagnosis. Earlier diagnoses will be made when cytologic techniques are applied immediately after cancer is suspected. Earlier diagnoses will be made when this diagnostic method is utilized on patients with equivocal lung lesions detected by routine roentgen surveys. Earlier diagnoses will be made when patients with cough and sputum—whether cancer is suspected or not—are routinely studied by cytologic techniques.

Nitrogen mustard as an adjunct to radiation in the management of bronchogenic cancer.

It is generally agreed that pulmonary resection offers the patient with bronchogenic carcinoma his best chance for cure. Unfortunately, most cases are inoperable when first seen. Of the 400 patients with bronchogenic carcinoma seen at the Veterans Administration Hospital in the Bronx (N. Y.) in the past four years, 90 per cent came too late for surgery. At the Hines Veterans Hospital, 95.4 per cent of 1,057 such patients admitted from 1937 to 1947 were already beyond any attempt at salvage by surgical resection (1). This distressing picture is reflected in other hospitals and clinics. It may be estimated that in 1949 there were in this countrya bout 28,000 new patients with bronchial cancer, compared to 10,000 in 1939 (34). Unless treated by irradiation, inoperable bronchogenic carcinoma runs its lethal course rapidly and inexorably, complicated by distressing signs and symptoms, both local and systemic. Of 584 non-irradiated inoperable patients, not one survived more than one year after the onset of the disease, according to the combined reports of Leddy and Moersch (18) at the Mayo Clinic, Widmann (31) at the Pennsylvania General Hospital, and Ariel et al. (1) at the Hines Veterans Hospital. On the other hand, our own experience with the roentgen treatment of 605 inoperable cases in the last fifteen years has demonstrated that, when radiation therapy was feasible, effective relief from intractable local symptoms was often possible. Indeed, prolongation of useful life for many months, and even years, was sometimes accomplished, particularly when the patient's physical condition was such that cancerocidal doses (5,000 to 6,000 r) could be approached. An occasional rare cure may be achieved. These observations are supported by the experience of others in a group of 508 roentgen-treated cases reported in the literature (6, 18, 28, 31). It is not possible, however, to give to every inoperable patient the benefits which irradiation can offer. At intervals in the course of the disease irradiation may seem to be ineffective or, for various reasons, even unfeasible. An effective adjunct to radiotherapy would therefore, appear, to be most desirable during these periods. The object of this paper is to present the results of our investigation of nitrogen mustard or HN2,—methyl-bis (beta chloroethyl) amine hydrochloride—employedin this role.4 Rationale of Nitrogen Mustard Treatment The early investigations of Gilman (11), Goodman (12), Jacobson (13), and Karnofsky (14 and 15), and their co-workers, with nitrogen mustard in human lymphomas, excited our interest in investigating its role as an adjunct to radiotherapy in a variety of malignant disorders. The study was begun in the Radiation Clinic in January 1947, in collaboration with the Committee on Growth of the National Research Council. Bronchogenic carcinomas were included because of scattered reports of clinical benefit by other investigators (33).

The value of roentgen examination in the diagnosis of bronchogenic cancer

The value of roentgen examination in the diagnosis of bronchogenic cancer

Progress in Radiology During 1931: The Thorax

Tumors THAT carcinoma of the lungs, bronchi, and mediastinum has been on the increase in the past few years seems to be the opinion of most of the writers on the subject. The year 1931 produced several excellent articles in which there appear compilations of personal data and reviews of the literature. There have been correlations concerning the age of incidence and the type of growth, the primary focus and type of spread (direct extension or metastasis), and the primary focus and potential metastases. Also there have been descriptions of symptoms, physical signs, roentgen findings and pathologic appearance, as well as considerations of the etiology and therapy. The general opinion seems to be that although primary carcinoma of the thoracic structures is rare, secondary growths are fairly common; and that the similarity of cancer and other chronic pulmonary diseases is so great that all diagnostic means must be employed to establish a positive diagnosis. As to therapy, combinations of radium, X-ray, and surgery seem most successful, although the prognosis for malignancies of the thorax is highly doubtful. Primary Carcinoma of the Lungs and Bronchi.—Valuable data on primary carcinoma of the bronchus are compiled by Atkin,1 who reports necropsies on 93 individuals, from which he draws conclusions as to age, incidence, frequency, metastases, and tendency. In Vinson's2 report of 71 cases of primary carcinoma of the bronchus diagnosed by bronchoscopic examination, he expresses the belief that the condition is not a rare one. He obtained beneficial results from radiotherapy. Beutel and Woldrich3 report an interesting case of primary bronchial carcinoma with a secondary anemia. The subject was a worker in the uranium mines of Joachimstal, and the condition was not diagnosed until the third interval examination, and then there was total stenosis of the bronchus. McCrae's4 article deals with symptomatology, probable etiology, and treatment of bronchial neoplasms. He concludes that if the mortality from this disease is to be reduced, it must be by education of the profession, exact diagnosis, intelligent and proper therapy (preferably radium and X-ray), and team work. Soulas5 advocates bronchoscopic diagnosis of bronchopulmonary cancer to follow and complete clinical and roentgen examinations. Pancoast and Pendergrass6 report a new technic for radiation therapy of primary bronchogenic carcinoma of the lungs. They employ weak radon tubes (not over 1.5 mc.), and implant them in the growth under bronchoscopic guidance. The treatment seems advisable in growths of bronchogenic origin, preferably pedunculated, and those that have not invaded the bronchial wall to a great extent. Menne, Bisaillon, and Robertson7 conclude from their pathologic and clinical study of 16 cases of primary bronchogenic cancer that there are two groups, hilar nodular and diffuse necrotic, and that “further pathologic classification is superfluous and unnecessary.”