Howard A. Buechner

Bronchogenic carcinoma in young men

Abstract 1.1. In a study of bronchogenic carcinoma occurring in a group of thirty men less than forty years of age, it has been found that twenty-three, or 77 per cent, of the primary lesions were peripheral in location whereas only six, or 20 per cent, were situated in the lung-root zone. (One lesion was too extensive to warrant classification.) Twenty of the peripheral lesions were nodular in nature and only three produced atelectasis. 2.2. In twenty-seven of the patients in whom the histology of the growths was established, there were eleven adenocarcinomas, eleven undifferentiated tumors and only five squamous cell cancers. 3.3. The presenting symptom-patterns, bronchoscopic results and cytologic studies of the sputum were consistent with the high incidence of peripherally situated neoplasms. Twentytwo patients (73 per cent) described chest and/or shoulder pain, usually of a severe degree, eighteen (60 per cent) had cough, and only four had experienced hemoptysis. Seven patients had no pulmonary symptoms on admission. Bronchoscopy was performed in twenty-three individuals but yielded a positive diagnosis on only four occasions. Of fourteen patients whose sputum was studied cytologically, the findings were negative in twelve instances and suggestive of malignancy in two. 4.4. Because of the inaccessibility of biopsy material, the diagnosis was established by exploratory thoracotomy in thirteen cases and by necropsy in four. 5.5. The rapidity of growth and spread of pulmonary cancer in young people is reflected in a number of facts: seven patients had evidences of central nervous system metastases when first seen, eight had foci of tumor in peripheral lymph nodes and, although fourteen cases were subjected to exploration, the tumors in only six were resectable. This procedure was curative in no known case. The average duration of life from the onset of symptoms until death was fourteen months, but of greater significance in this comparatively small series was the median value of 7.5 months and the fact that only 25 per cent of the patients lived longer than a year. 6.6. These observations, as a whole, represent a marked contrast to the manifestations of bronchogenic carcinoma in old people, and it is suggested that these variations represent the effect of different causal mechanisms.