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polyposis nail tract Arch a.': The |lioma> :njl 1 Med 2SU :iole hamartoma ). Arch Der- Bronchogenic Carcinoma Edward C. Rosenow, ill, M.D. David T. Carr, M.D, - cholera, so ere believed rrhea, which et: timet the ther allusion c: the "lump hr John H. clinicians Lung cancer rates in the United States four months, and the controls are urged continue to rise and if present trends per* to have the same tests yearly. The John sist there will be nearly 300,000 new Hopkins University and the Memorial cases annually by the year 2000.* Added Sloan-Kettering Cancer Center are carry ! to the well established hazards of ciga- ing-out similar projects. Firm conclu ; rette smoking2 is burgeoning evidence of sions cannot be drawn vet, but compared the harmful effects of many commonly to controls, considerably more of the lung encountered environmental agents and cancers found in the study group art | occupational risk factors.1 Other predis* diagnosed early, while the prognosis is { posing elements have been observed and hopeful. 1 are under investigation-e.g., host deter* minants4 and genetic propensities.**? Histology and Embryology Treatment advances are slow; surviv* I al rates remain low. At present, the most Table 1 lists the World Health Organiza I effective means of controlling lung can* tion classification of malignant pleuro- i cer may be close surveillance of the high pulmonary neoplasms.* Embryologically, , risk patient.TheMayoLungProjectof the the tracheobronchial tree is a ventral , Mayo Foundation* is conducting a con* entodermal foregut derivative, lined by , trolled, prospective lung cancer screen- at least five types of epithelial cells form i inj program in males 43 yean and older ing a pseudostratified mucosal sheath who smoke at least 20 cigarettes per day. resting on a basement membrane. Three The study group has a chest x-ray and types are-columnar cells and indude pooled three-day sputum analysis every mucus-secretinggoblet cells, ciliated cells, and brush cells. The two basal types am Dr. Rosenow is Associate Professor of Medi cine and Physician of Internal Medicine with Specialty in Pulmonary Diseases, Mayo Clinic, Rochester. Minnesota. small, multi-potential cells (probably re serve columnar cells) that lie parallel to the basement membrane and givt the mucosa its pseudostratified appearance. Dr. Carr was Associate Director for Cancer Control and Community Relations. Mayo Clinic Comprehensive Cancer Center; Con sultant in Thoracic Diseases and Internal Medicine: Consultant in Oncology; and Pro fessor of Medicine, Mayo Clinic, Rochester, Minnesota. He is now Professor of Medicine and Head of the Section of Pulmonary Medi cine. M.D. Anderson Hospital aod Tumor Institute. Houston, Texas. In addition to being in reserve for malum columnar cells, they probably harbor the potential for metaplastie squamous epi thelial cells, which form in response to chrooic irritation and are not a normal finding. Another basal cell, identified by electron microscopy, is the Kulchitsky or K-type cell. It is postulated that the vol r*. vo. * july/ausust tare 233 e K type cells may he nciiroccim lcrnial in i 51 !&* tf-6| ? s : 5 teea C u !U C r a we 2 S 3 (*-i gecu vXSrs^xecu.--ji ce ifS 5 ill i *-s M E5 u 8 c <* :*ss S 1|1 ill fill]5 is v T>oh&ai gS 2s - gil || * isgf isiil11 ii *? to Jai,,m K: ?ii Es Ms i\n !si-|ipl * v u & *u v S.K .5 3 t IIs-! Z e 2 *8s i IS {SSi^ O i Jilltfiji -i iit* Ipi es2e*SJs|Ss? > s * rr .9 .9 3*9 5 J 0&2 l ;U`- l-i |'1|,M1sS AU! .SII* .f8fi Ia > .3 u 5 i. V | ^ S- 3 isnr I s *-5 X-e<t ijf255i* C^3t ` i% |i.xi -- w ih. s a c| 8 * 8 5 e? w .3 5 1t5 s a fs w O-- " 32^3SgO 1S:*l^*sjil i2ll |*J. *!S5i SEfs a 3 A - e w *_ w 2 S.*sns I * 'S-5. 5a _ 39 c! s? # s-2 n k| " DOW 06769 I l 00 DOW 06770 allows dearer reporting on groups o f patients. A lung cancer m ay be staged a number o f limes during (he course o f Ih c disease: about a specific p a lie n fs cancer, and stages (T able 5 ). DOW 06771 I I* X 01 5 n ^ ci ii = _K (A a .X X aX * iQ 8 2 2 " 1 <A ! k. I x;s u, 5: x xa ax xo <0 . fi !i & & iI u a ?a DOW 06772 DOW 06773 tarcmomm rn or without .cm formation j andedeno- .r* -turfa i;;h the sub* :he lumen in j hilar mass, .'ntiit merely us with nar* submucosal rself may be of tuns can* *s by far the iih the para* ~ Clinicians *' ' - TABLE 2 / . ;V ^'^.OCCUHRENCE OF FIVE MAJOR TYPES OF ' iS|_UNG CANCERS IN SMOKERS AND NONSMOKERS Typo Epidermoid Small cad Adaisocarcinoma LergaoaS Broncfiioloalvoolar call TOTAL Total 992 940 790 409 69 2929 992 933 492 399 39 2941 11 i I Pewtala Narar amofcar 7 90 13 4 100 3 39 129 101 19 49 IS 4 13 70 397 19 149 ' '^TABLET! ' = ^ABNORMAL RADIOGRAPHIC ` ^r1'j"PATTERNS IN fiOO CASES OF CARCINOMA ' > . -OFTHELUTJGAS RELATED TO HISTOLOGICAL CELL TYPE nisio^ipTNC rinpifip all (2S9 can) Adana CMVMIOfVtS (129 caaaal Large asB carcinoma <97ammi (ruZmO Hilar or ptrihiiar mam or promiMfMi 34 70 40 9 19 17 10 21 32 23 as 79 Parenchymal pulmonary lation Small mam 4j0 cm) Large mam 040 cm) Apical mam Multipia mamas Obstructive pneumonitis. collapse, or conaolldotion 22 2 9 40 9 19 71 3 1 0 OJ 99 90 93 49 9 49 22 11 29 101 302 7 29 29 12 9 19 27 13 41 1 34 112 2 30 33 Intnthoracic aatrapulmonary MadlastInal mam or widening Cheat wall Mon Pleural affusion Elevation of hemidiaphragm 111 000 1 93 121 , 1 21 00 19 09 2 0 9 4 4 9 10 000 023 01 1 9 19 21 946 21 3 101 9 39 39 0 19 13 000 06 9 044 S tingle abnormailty. M mu(tipla abnormalities ftaprintae with permlmlbn from Syrd NS, at al, HadtograpMe aPnorfnailtlaa In carcinoma of die tune at ralatad to Mttoloelaaf call type. Thome 34:(73, IMP. VOL IS. NO. 4 JULY/AUQUST 197* C/> DOW 06774