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FILE NAME State of the Art Literature SAL DATE 1942 DOC SAL035 DOCUMENT DESCRIPTION Book Excerpt - Cancers of the Respiratory System noe weet ee ~eer ot re ee : reee emree ee en Se ee oa ok ~ ok . me eee | ! OCCUPATIONAL OCCUPATIONAL OCCUPATIONAL OCCUPATIONAL TTUUMMOORRSS AND ALLIED ALLIED ALLIED ALLIED ALLIED DISEASES DISEASES DISEASES L BY i t W. ; W. C. HUEPER M.D. : ASSISTANT DIRECTOR AND PRINCIPAL PATHOLOGIST { WARNER INSTITUTE FOR THERAPEUTIC RESEARCH | NEW YORK CITY i CHARLES C THOMAS . PUBLISHER SPRINGFIELD ILLINOIS BALTIMORE + MARYLAND TT RE OO, eR PALETTE TY FIP Ty PLETE TUM PE Stal Permery etal bass Neatt taceone avdarkoe aed a catacteey ae ee ree ee ee eae ee me sae eee ote mt eens teen. CANCERS OF THE RESPIRATORY SYSTEM 4013 | *, ar Capacityis pulmonary They occur moreover in the peribronchial lymph nodes within the walls of the sinuses and embedded in fibrous areas In the alveoli they are surround ! ten enlarged the decreased by phagocytic mononuclear cells and foreign body giant cells massed esp cially around the larger bodies The interstitial tissue shows a diffuse diffuse fibri se theart becomes ination of the ir honeycombkause a filmyground glass lanced stages Jeexamination is reveals the runken blue- in the lower surface shows tissue There dhesions and nd brownish the interstitial bedes These thickening and scarring The asbestosis is thus an indurative interstitel diffuse fibrosis of the lung increasing in degree from the apex to the bare Asbestosis and Carcinoma of the Lung It only in very recent years that serious consideration has been given to the possibility of a cancerigenic action of asbestosis upon the lungs In analysis of 18,280 death certificates for cancer of the lung and larynx in males from England and Wales from 1921 to 1932 Kennaway and Kennaway did not find any cases of lung cancer in asbestos workers Since 1935 an appreciable number of cases of asbestosis associated e with carcinoma of the lung have been reported from England Germany and e the United States Lynch and Smith Lynch Gloyne Wood Horning Nordmann and Egbert and Geiger The incidence of lung cancer among tad workers in whom an asbestosis was found at autopsy is relatively high ranging me from 17 per cent Nordmann 2 out of 17 cases to 20 per cent Wood 2 or bee ae possibly 3 out of 12 cases Teleky noted that there exists a minimum of 39 Mew and a maximum of 78 autopsies in fatalities from asbestosis the records not tae teaet being clear in this respect Teleky only knows of 6 cases of pulmonary cancer vam with asbestosis and feels that this ratio is high in comparison to the number mani of necropsies Koelsch mentioned the occurrence of 12 cases Lynch 3 Egbert and Geiger 1 Gloyne 2 Dominici 2 Bander 1 Nordmann to 2 Wood 3 and Horning 1 Lynch and Smith found among 35 ww golden or le body may autopsies with asbestosis 2 cases of pulmonary malignancy six per cent whereas there was an incidence of only 0.3 per cent of this type of neoplasia ne Ames or both ends Le hyA ift is often a Atral Atral filament among approximately 2,300 autopsies of the general population The period of occupational exposure to asbestos dust ranged for five cases from 7 to 21 seat na r years but in an additional case only a year and half In several instances the Atral a hoe or characteristic core lung tumor became manifest several years 10 to 12 after cessation of the work in asbestos Fifteen to twenty years elapsed average 18 years Pe nt The iron between the first exposure to asbestos and the death from asbestosis with : ineedles The } decomposed estos body is . part of the of alteration supposed to ception was { The matter The ' and in the q dutic routes carcinoma of the lung The age at death depended upon the age of the individual at the time of the first exposure The workers dying in the more advanced age groups entered an occupation with an asbestos hazard later in life while those who died at an early age started to work in asbestos plants when still young There was no evidence of a called old age predisposition as two of these cases died at the age of 35 years and a third was 41 years old The majority of neoplasms were cornified squamous carcinomas Only one case was an adenocarcinoma and a second was an anaplastic round carcinoma The latest case reported by Lynch and Smith showed squamous cellular and glandular carcinomatous structures This numerical distribution between the different histologic types of carcinomas varies distinctly from Fo om. ee we eee er MT Sein ae ees qe oe meet eet ee go re ee ne ne eee ee Le vam ei. ey ww wwe >: ew cr ar AN ete ee Fh * marate ee n a eam me: re agate mm Aa Remmine ag We ~ . - me, 2 - oe By] Z i ; 3 4 ; 3 j i : . : i , : : Oo \ : 1 f 1 . t _ i i . ' ; j ! ; ; 404 OCCUPATIONAL TUMORS AND ALLIED DISEASES that usually observed Nordmann but agrees with the shift toward a more frequent occurrence of the cancroids noted in recent years by Probst in pul monary malignancies of unknown genesis A multicentric development of malignant growths in asbestos lungs was found by Nordmann and Gloyne and it is considered by Nordmann as a characteristic feature of this type of lung cancer A multifocal sprouting of squamous cells lining the bronchial walls was seen by Nordmann who regards these changes as precancerous in nature A diffuse proliferative thickening of the bronchial epithelium was recorded by Gloyne who believed that this constituted a continuous pro longation of epithelial growth from some unknown starting point rather than a series of isolated proliferative units These epithelial prolongations were hollow in places showing a degenerating layer of cells surrounding a central empty space and in turn being enveloped by rings of keratinized squamous cells The carcinomas of three cases were very small Gloyne 2 and Nordmann 1 and had not produced any metastases For this reason two of these cases Gloyne represented coincidental observations made during the mortem examination The other cases were large tumors with ex- tensive metastatic deposits in remote organs . An evaluation of the evidence presented reveals certain features connected . with these cases which are suggestive of an occupational causation There is an incidence of lung cancer in asbestosis of the lung which is definitely excessive The relatively small number of necropsies on which this conclusion is based represents an urgent indication for more extensive mortem examinations in cases of asbestosis especially considering that pulmonary malignancies seen in previously reported cases were in several instances ; very small and were coincidental A observations second point favoring an in- dustrial origin is the young age of an appreciable portion of the cases thus far recorded and the relationship existing between the time of exposure to asbestos dust and the manifestation of the neoplasms throughout the entire series The third factor consists in the shift of the histological types observed in the direction of a predominance of cancroids and in the multicentric de- velopment of two Nordmann and Gloyne and possibly even three Lynch and Smith of these pulmonary neoplasms The existence of the cutaneous warty lesions suggests that asbestos needles embedded in epithelial tissue are apparently capable of eliciting inflammatory epithelial proliferations Nothing is known about the actual causative mechanism through which as bestosis may produce such epithelial lesions and may transform them subse- quently into malignant growths The assumption of a chronic irritation of nonspecific nature or of specific silicotic character such as proposed by Lynch is scarcely acceptable and satisfactory in view of the negative evidence available in this respect One of the cases reported by Nordmann in association with Horning showed symptoms of a marked and generalized allergic disposi tion bronchial asthma and h^'maticcosinophilia which may have played st NO rt i yi oe Sa NT EF NON BAR Ree pe eH oS RRR ne He rem me vers ere - we cee ep i ent cows ee +, 4 pate peters Sider sre rotamer SR ae amen esos ee ee ae ae _. P i CANCERS OF THE RESPIRATORY SYSTEM 405 7ofv\e that possible pulmonary Floyne Floyne contributory role in the development of the neoplastic response Asbestos bodies contain a considerable amount of iron and there exists some evidence ' siderosis and . of points to a causative interrelation of carcinomas of the lung carcinoma The relatively small number of asbestosis pe of : i reported does not disprove an occupational origin of this condition Previous with other industrial neoplasms lung cancer of the Joachimsthal { onchial ; emxipneerriesncaend lung cancer of the chromate workers has shown that such iso- ous in of m was ! lated cases may represent the first warning of a subsequent appearance numbers of similar tumors of undeniable occupational derivation is pro- : large Asbestosis carcinoma of the lung is not q rather Medico and Social Aspects were : included in any group of occupational tumors recognized by any country Acsentral | : The evidence presented is sufficiently serious and the number of persons Lamous exposed to the suspected causative agent large enough to indicate a thorough | and extensive clinical statistical and experimental investigation of the ; and incidence and causative interrelation of asbestosis and pulmonary carcinoma In on two view of the fact that several of the states with many large asbestos plants do during ith ex- { not include asbestosis among compensatory occupational discases this study is even more urgent Such a condition militates against an effective hygienic { control of an important industrial hazard and impedes the collection of Cinected There i pertinent and essential information in regard to the incidence nature and potentialities of an occupational disease growing steadily in general sig- finitely nificance Workers dying from asbestosis should be subjected to a mortem clusion mn examination including a histological study of the pulmonary lesions as m ~ Mary multiple neoplastic manifestations in asbestosis may be mistaken for tubercu i losis Lynch stances Sanitary Measures The following measures may be taken to eliminate or 4g an in- reduce the existing hazard caused by the inhalation of asbestos dust humidi- en cs thus fication of the asbestos matter and the air to decrease the production of dust sure to introduction of a closed production system wherever possible establishment ET entire erved in of an extensive and efficient exhaust ventilation frequent cleaning of the TT of air currents caused workrooms to remove the accumulated dust prevention RTE tric de- by moving machinery parts construction of rooms machinery and pipelin~ s SE accumulation of dust separa- Lynch offering little opportunity for deposition and t1anteisosuuse ; tion of operations in which the production of dust can be eliminated entirely ee from those in which this is not possible wearing of respirators by workers ee rations engaged in dusty operations and mechanization of operations under elimina- hich as- tion of human labor to reduce the number of workers exposed The dust n subse- in store rooms for raw material in rooms in ation of hazard is most pronounced which the raw fibers are handled and in spinning weaving mixing and { Lynch i { vailable filling rooms ce with ar 4 slayed a \ Occupational siderosis of the lung is of the black type which is caused : L 4 q E 7 : . : pete ee nner LETT CFTR a POE ET cape epee aarns eee me ATE A pm me eee Nee TO 2 NR NTs