Management of Occult and Stage 0 Carcinomas In the uncommon situation where malignant cells are identified in a sputum or bronchial washing specimen but the chest radiograph appears normal (TX tumor stage), the lesion must be localized. More than 90% can be localized by meticulous examination of the bronchial tree with a fiberoptic bronchoscope under general anesthesia and collection of a series of differential brushings and biopsies. Often, carcinoma in situ or multicentric lesions are found in these patients. Current recommendations are for the most conservative surgical resection, allowing removal of the cancer and conservation of lung parenchyma, even. | Chapter 085. Neoplasms of the Lung Part 11 Management of Occult and Stage 0 Carcinomas In the uncommon situation where malignant cells are identified in a sputum or bronchial washing specimen but the chest radiograph appears normal TX tumor stage the lesion must be localized. More than 90 can be localized by meticulous examination of the bronchial tree with a fiberoptic bronchoscope under general anesthesia and collection of a series of differential brushings and biopsies. Often carcinoma in situ or multicentric lesions are found in these patients. Current recommendations are for the most conservative surgical resection allowing removal of the cancer and conservation of lung parenchyma even if the bronchial margins are positive for carcinoma in situ. The 5-year overall survival rate for these occult cancers is 60 . Close follow-up of these patients is indicated because of the high incidence of second primary lung cancers 5 per patient per year . One approach to in situ or multicentric lesions uses systemically administered hematoporphyrin which localizes to tumors and sensitizes them to light followed by bronchoscopic phototherapy. Solitary Pulmonary Nodule and Ground Glass Opacity Occasionally when an x-ray or CT scan is done for another purpose a patient will present with an incidental finding of an asymptomatic solitary pulmonary nodule SPN defined as an x-ray density completely surrounded by normal aerated lung with circumscribed margins of any shape usually 1-6 cm in greatest diameter . A decision to resect or follow the nodule must be made. Nodules of this size discovered in CT screening for lung cancer would also be of the size requiring a biopsy for tissue. Approximately 35 of all such lesions in adults are malignant most being primary lung cancer while 1 are malignant in nonsmokers 35 years of age. A complete history including a smoking history physical examination routine laboratory tests chest CT scan fiberoptic bronchoscopy and old chest x-rays or CT .
