Special types of lung cancer

Objective: Pancoast tumors, carcinoids, and multifocal non-small cell lung cancer (NSCLC) represent a spectrum of lung cancers that require unique consideration with regard to preoperative workup, indications for resection, and surveillance. This chapter seeks to define these important attributes to help guide clinicians who manage these patients. Design and Methods: An exhaustive search of all current peer-reviewed data was performed to define evidence-based recommendations regarding optimal management for these lung cancer subsets. Primary Results: Current data support a survival advantage with trimodality therapy for resectable Pancoast tumors, particularly for patients without N2 disease. Carcinoid tumors are considered malignant but exhibit less aggressive behavior than solid NSCLC. Most are typical carcinoids, are located centrally, and are more common in younger patients. Concern for atypical carcinoids should prompt workup for distant disease. Multifocal lung cancers represent a spectrum of disease that should be managed according to the feasibility of resection, patient fitness, and consideration for whether there is synchronous disease, locally metastatic cancer, or multiple sites of ground-glass nodules. Principle Conclusions: These special cases of lung cancer require a thoughtful workup and case-specific management. Treatment and surveillance recommendations are similar to other surgically managed NSCLC, with unique consideration for surgery based on location, the extent of disease, and patient fitness. We recommend all such cases should be discussed in the context, a multidisciplinary tumor board before considering surgical resection.