Practical methods for establishing the diagnosis and determining the clinical stage of a neoplasm are important in selecting appropriate treatment and evaluating the end result of therapy.
So a clinical study including clinical staging by T.N.M. classification was done on 148 cases of histologically proven bronchogenic carcinoma at Seoul National University Hospital from January, 1971 to December, 1975.
The results obtained are summarized as follows;
1. Almost half of the cases belongs to stage 3, and there are two cases of Occult Carcinoma, but there is significant differences in histological types by T.N.M. classification.
Ratio of Stage 1 to Stage 3 in squamous cell carcinoma is 1 : 1. 3, and 1 : 3.8 in small cell carcinoma.
2. During stage 1, hilar lymph nodes involvement was correlated with tumor size. Large size tumor mass(larger than 3 cm in diameter) involved regional lymph nodes more frequently than small size tumor mass (lesser than 3 cm in diameter).
During stage 3, mediastinal lymph nodes involvement was important, so mediastinoscopy must be done when operability was decided.
3. The male to female ratio was 6 : 1, and high risk age group was between 45 years and 65 years, 68% of the cases were belonged to these age group.
4. Incidence of lung cancer was increased parallel to smoking consumption. About 80% were smokers, and 70% were moderate to heavy smokers. Smoking history and histological cell type were correlated, especially in squamous cell carcinoma and small cell carcinoma. In squamous cell carcinoma, p value was less than 0.01 and in small cell carcinoma, p value was between 0.01 and 0.05. So these results were statistically significant.
5. There are two cases of scar cancer which are supposed to be related with tuberculosis. In 5.4% of the cases, lung cancer and active tuberculosis are found in the same subjects, but this association -does not mean that tuberculosis does not predispose to the development of lung cancer.
6. After symptoms developed, early detection did mot mean the good prognosis, because lung cancer in stage 3 grew more rapidly than that in stage 1.
7. Cardinal symptoms at diagnosis in the order of frequence were cough, weight loss, lymphadenaopathy, chest pain, dyspnea, hemoptysis, hepatomegaly, and others.
8. Accuracy of diagnostic methods was as follows sputum cytology (31.4%), bronchoscopy (64.6%) scalene lymph nodes biopsy, when palpable (92.3%) open thoracotomy (100%)
*But sputum cytology at 48 hours or 72 hours later bronchoscopy, positive rate to was increased from 31.4% to 52.4%.
9. There are significant differ;nces in resectability between clinical stage and c.ll type: Inn squamous cell carcinoma, resectability was 42.2%, but 2.8% in small cell carcinoma. So squamous cell carcinoma in stage 1 was best prognostic value.
10. Lung cancer occurs more frequently in the upper lobes than in the lower, is uncommon in the middle lobe, and is found slightly more often in the right lung, probably because it is somewhat larger, so right upper lobe was mist frequent location.
Hilar lesions account for 65. 1%, segmental lesions 24.7%, peripheral lesions 10.2%.
11. Lung cancer is highly malignant and metastasized early, especially in small cell carcinoma. At diagnosis 40% were metastasis to L.N., 12% to liver, 4.7% to brain and 18.9% to bone.
12. Radiation therapy can modify the natural course of the disease, so combined by radical surgery or palliative irradiation was done. Chemotherapy was often effective in small ell carcinoma, and immunotherapy had not been tried in our hospital.
|