Abstract
Early hilar lung cancers are rare but curable lesions if they are properly diagnosed and treated. The Japanese Lung Cancer Society defined early hilar lung cancer as those that fulfilled the tollowing three microscopical citeria;(1) the lesion is localized proximal to segmental bronchi (2) depth of tumor invasion is confined to within the bronchial wall (3) no lymph node metastasis or distant metastasis. In the past 11 years, we have experienced 21 cases of early hilar lung cancer. In addition, there were 8 cases which fulfilled citeria (1) and (3) but had minute invasion into the lung parenchyma beyond. The bronchial wall. We have designated these lesions as semi-early hilar cancer. These 29 cases were analyzed to elucidate the method of early detection of hilar lung cancer.
The site of the detected lesions was the right upper lobe bronchi in 11 cases, right lower in 6, left upper in 5, left lower in 3, right middle in 2, left main bronchus in 1 and one at the bifurcation of the left upper and lower lobe bronchi. Age distribution ranged from, 49 to 72 years old, being 61.7 years on average. Excluding one female case, all were male. There were 28 cases of squamous cell carcinoma and one case of mucoepidermoid carcinoma. Among the 29 cases, there were 3 cases of non-smokers (one female, and two males, 49 and 72 years old). The smoking index ranged from 400 to 3600 (1031±596 on average). Of the 29 cases, 7 were detected by sputum cytology in mass surveys. All of the lesions were finally diagnosed by bronchofiberscopic examination. An other 22 cases presented with sympoms. Their complaints were bloody sputum in 12 cases, dry cough in 5 cases, fever in 3 cases, general malaise in one case and loss of appetite in one case. All of these 22 lesions were finally diagnosed by bronchofiberscopic examination. In only 6 cases, abnormal chest film findings were pointed out by a retrospective study. Malignant cells in sputum were detected in 13 cases. From the clinical analyses of these 29 cases, it was concluded that mass surveys are effective for early detection of hilar lung cancer. For the early detection of hilar lung cancer, sputum cytology as a screening test followed by bronchofiberscopy for definitive diagnosis are recommended in high risk groups. The high risk group includes male and females over 45 year of age with a smoking index of more than 400, a non-smoking wife of a husband with high smoking index, non-smokers over 70 years old and those having a history of bloody sputum.
