• Most closely associated with cigarette smoking of all lung cancers

• Radiation, air pollution and genetic predisposition may also play a role

• BPDE (catabolite of benzo[a]pyrene in cigarette smoke) binds p53 mutational hot spots in lung carcinoma

• p53 mutation affects cell replication and centromere replication

• Sequence of changes from squamous metaplasia to dysplasia to carcinoma in situ and then invasive carcinoma seen.

• Accounts for up to half of all lung cancers.

• Up to 10% of long term cigarette smokers develop

• Central location associated with cough and hemoptysis

• Weight loss and dyspnea

• Staging dependent on extent of disease ranging from I (confined to the lung with >2 cm distance from hilum and pleura) to IV (metastatic disease)

• Metastatic disease to lymph nodes, brain, liver and adrenal glands

• Surgical treatment is preferred; many patients have insufficient pulmonary reserve for surgery; radiation an alternative

• Overall five year survival 10-15%

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• Usually arises from a major bronchus resulting in a central rather than a peripheral location

• Gray white hard granular neoplasm

• Central cavitation common in large cancers

• Uninvolved lung may often show emphysema or other smoking related pathology

• Composed of cells with large irregular nuclei

• Coarse nuclear chromatin with large nucleoli

• Cells arranged in sheets

• May make keratin pearls

• Intercellular bridges considered diagnostic

• Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th edition. Philadelphia, W.B. Saunders, 1994, pp. 720-25.

• Current literature from PubMed at National Library of Medicine