Squamous Cell Carcinoma of the Lung

Over the past 6 months, a 72-year-old man was troubled by a persistent cough; he also had lost 9 kg (20 lb). He had no fever or chills, but he noticed mild streaking of blood in his sputum during the past month. He had been a cigarette smoker for 50 years.

A chest film showed a shadow in the patient's right upper lobe. Bronchoscopy visualized a tumor that partially occluded the lumen at the origin of the right main-stem bronchus. Histopathologic examination revealed this lesion to be a squamous cell carcinoma, the cause of the chronic cough and hemoptysis.

CT of the patient's thorax confirmed the presence of massive mediastinal lymphadenopathy caused by metastatic spread of the tumor. The patient was referred for radiation therapy.

Squamous cell carcinoma of the lung, associated with long-standing history of smoking, is usually noted as a central lesion; at times, an exophytic growth can be seen on bronchoscopy. As in this case, the typical presentation is cough, hemoptysis, and weight loss. Endoscopic diagnosis is simple, but Drs Arunabh and John C. Rodrigues of Mineola, NY, stress the need for histologic examination to differentiate the tumor from other types of primary lung carcinoma.

Management of squamous cell cancer of the lung depends on the stage of the tumor. Early lesions (stages I and II) are amenable to surgical resection. In more advanced cases (stages III and IV), radiation therapy is the treatment of choice, but the prognosis remains guarded.