1. Metastasis
1.1. Liver
1.2. Adrenal
1.3. Brain (especially small and large cell)
2. LUNG METASTASIS
2.1. Spread
2.1.1. 1- Pulmonary arteries
2.1.1.1. Renal cell (RCC)
2.1.1.2. Sarcoma
2.1.1.3. Trophoblastic
2.1.1.4. Testis
2.1.1.5. Thyroid
2.1.2. 2- Lymphatics (celiac, posterior mediastinal and paraesophageal then to lungs)
2.1.2.1. Breast (Unilateral)
2.1.2.2. Stomach (Bilateral)
2.1.2.3. Pancreas
2.1.2.4. Larynx
2.1.2.5. Cervix
2.1.3. 3- Direct extension
2.2. Calcified mets
2.2.1. Bone tumors
2.2.1.1. Osteosarcoma
2.2.1.2. Chondrosarcoma
2.2.2. Mucinous tumors
2.2.2.1. Ovarian
2.2.2.2. Thyroid
2.2.2.3. Pancreas
2.2.2.4. Colon
2.2.2.5. Stomach
2.2.3. Post therapy
2.3. GIANT METS
2.3.1. Head & Neck Ca
2.3.2. Testicular & Ovarian Ca
2.3.3. Soft tissue Ca
2.3.4. Breast Ca
2.3.5. Renal Ca
2.3.6. Colon Ca
3. Location
3.1. Lung
3.2. Pleural
3.3. Mediastinal
3.4. Airway
3.5. Chest wall
4. Histology
4.1. Malignant
4.1.1. Bronchogenic carcinoma
4.1.1.1. Small cell 20-25% (Neruoendocrine tumor type 3); most aggressive
4.1.1.1.1. Oat cell
4.1.1.1.2. Intermediate cell type
4.1.1.1.3. Combined oat cell carcinoma
4.1.1.2. Non-Small cell
4.1.1.2.1. Adenocarcinoma 40% most common; KRAS mutation
4.1.1.2.2. Squamous cell carcinoma 25-40%
4.1.1.2.3. Large cell carcinoma 1% (type of neuroendocrine tumors ?)
4.1.2. Lymphoma
4.1.3. Metastases
4.1.4. Sarcoma (rare)
4.2. Low grade (previously bronchial adenoma)
4.2.1. Carcinoid (90%)
4.2.1.1. Type 1: local tumor
4.2.1.2. Type 2: Atypical (10-20%) metastasizes to regional lymph nodes ( and rarely liver)
4.2.2. Adenoid cystic carcinoma (previously cylinderoma, resembles salivary gland tumor)(6%)
4.2.3. Mucoepidermoid carcinoma (3%)
4.2.4. Pleomorphic carcinoma (1%)
4.3. Benign (rare)
4.3.1. Hamartoma (most common)
4.3.2. Papilloma
4.3.3. Leiomyoma
4.3.4. Hemangioma
4.3.5. Chemodectoma
4.3.6. Pulmonary blastoma (malignant but the book put it in benign >_>" )
4.3.7. Chondroma
4.3.8. Multiple pulmonary fibroleiomyomas
4.3.9. Pseudolymphoma
5. Small cell staging
5.1. Limited
5.1.1. confined to one lung with ipsilateral lymph node metastasis (can be encompassed by a single radiation port)
5.2. Extensive
5.2.1. 2/3 of the patients present at this stage