DRG Category: 165

Mean LOS: 9.9 days

Description SURGICAL: Major Chest Procedures without CC or Major CC

DRG Category: 181

Mean LOS: 5.6 days

Description MEDICAL: Respiratory Neoplasms with CC

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Lung cancer is second only to prostate cancer as a leading cause of cancer death in men and second only to breast cancer as a leading cause of cancer death in women. Annually, more than 200,000 people are diagnosed with lung cancer and 160,000 die from the disease. Lung cancer accounts for 28% of all cancer deaths. Lung cancer accounts for more deaths than prostate, breast, and colon cancer combined. The 1-year survival rate remains approximately 41%, and the 5-year survival rate is 15%. Only 16% of lung cancers are found at an early, localized stage, when the 5-year survival rate is 49%. The survival rate for lung cancer has not improved over the past 10 years.

There are two major types of lung cancer: small cell lung cancer (SCLC) and non–small cell lung cancer (NSCLC). Sometimes a lung cancer shows characteristics of both types and is labeled small cell/large cell carcinoma. Both types have the capacity to synthesize bioactive products and produce paraneoplastic syndromes such as syndrome of inappropriate antidiuretic hormone (SIADH), Cushing's syndrome, and Eaton-Lambert syndrome of neuromuscular disorder.

SCLC accounts for 13% of all lung cancers and is almost always caused by smoking. SCLC is characterized by small, round to oval cells generally beginning in the neuroendocrine cells of the bronchoepithelium of the lungs. They start multiplying quickly into large tumors and can spread to the lymph nodes and other organs. At the time of diagnosis, approximately 70% have already metastasized, often to the brain. SCLC is sometimes called small cell undifferentiated carcinoma and oat cell carcinoma.

NSCLC accounts for almost 87% of all lung cancers and includes three subtypes: squamous cell carcinoma, adenocarcinoma, and large cell undifferentiated carcinoma. Squamous cell carcinoma, also associated with smoking, tends to be located centrally, near a bronchus, and accounts for approximately 25% to 30% of all lung cancers. Adenocarcinoma, accounting for 40% of all large cell carcinoma, is usually found in the outer region of the lung. One type of adenocarcinoma, bronchioloalveolar carcinoma, tends to produce a better prognosis than other types of lung cancer and is sometimes associated with areas of scarring. Large cell undifferentiated carcinoma starts in any part of the lung, grows quickly, and results in a poor prognosis owing to early metastasis; approximately 10% to 15% of lung cancers are large cell undifferentiated carcinoma.

The hilus of the lung, close to the larger divisions of the bronchi, is the most frequent site of lung cancer. Abnormal cells divide and accumulate over time. As the cells grow into a carcinoma, they make the bronchial lining irregular and uneven. The tumor may penetrate the lung wall and surrounding tissue or grow into the opening (lumen) of the bronchus. In more than 50% of patients, the tumor spreads into the lymph nodes and then into other organs.

Systemic effects of the lung tumor that are unrelated to metastasis may affect the endocrine, hematologic, neuromuscular, and dermatologic systems. These changes may cause connective tissue and vascular abnormalities, referred to as paraneoplastic syndromes. In lung cancer, the most common endocrine syndromes are SIADH, Cushing's syndrome, and gynecomastia. Complications of lung cancer include emphysema, bronchial obstruction, atelectasis, pulmonary abscesses, pleuritis, bronchitis, and compression on the vena cava.