Primary Carcinoma of the Lung

¹ Visiting Physician, In Charge of Tuberculosis and Chronic Chest Diseases, Harlem Hospital, New York, New York.
² Assistant Visiting Physician, Department of Medicine, Harlem Hospital, New York, New York.

The incidence, etiology, pathology, diagnosis, complications, and treatment of primary carcinoma of the lung are discussed in the light of the most recent beliefs. A statistical analysis of cases seen on the Chronic Chest Service of Harlem Hospital, New York City, during the five year period 1945-49 inclusive, is given, and summaries of 28 histologically proved cases are presented. It is significant that of these 28 proved cases the average age is 51.8 years. There is a ratio of six males to one female. The average duration of symptoms before seeking medical care is about four months; the average longevity after hospitalization, one and one-half months. The primary lesion was in the right lung more than twice as often as in the left. Over 70 per cent were represented almost equally by the anaplastic and squamous cell types, while about 17 per cent were unclassified and 7 per cent were adenocarcinomas.

Also apparent is the fact that none of the cases were seen early enough to be benefited by any known form of therapy, far less to be cured.

Knowledge of the subject of bronchiogenic carcinoma to date indicates that the best chance for the cure of this disease lies in its early discovery, preferably before there are noticeable symptoms on the part of the patient. Thus, yearly chest x-ray film inspection of all persons and routine chest x-ray films of all hospital admissions should be common medical practice.

Further, there should be less procrastination on the part of patients, physicians and surgeons to proceed with surgical exploration whenever a suspicious lesion presents itself in which the bronchoscopic and cytological studies are inconclusive or negative because of inaccessability, encapsulation or failure to extend to the surface mucosa. Especially, since it is known that between 25 and 30 per cent of the cases fall in this group when first discovered.

It is noteworthy that the incidence percentage of white to Negro in this series roughly parallels the admission percentage to Harlem Hospital of these respective races. The belief is expressed that no apparent racial predilection would be found to exist in primary carcinoma of the lung if sufficiently large segments of the Negro population were studied.