Journal of Surgical Oncology 33: 124-125 (1986)

Lung Cancer in Men Aged 40 or Younger

DEBA P. SARMA, MD, AND VIRGIL J. BYERS, BS

From the Department of Pathology, Veterans Administration Medical Center and Louisiana State University Medical Center, New Orleans

Twenty-nine cases of lung cancer occurring in men aged 40 or less were examined at autopsy. Histologic types of cancer and metastatic patterns in this group of patients were similar to those seen in middle-aged or elderly patients except for a lower occurrence of lymphatic spread in the younger group.

KEY WORDS: lung cancer in young people, malignancy in young people, lung neoplasm

INTRODUCTION In the United States, lung cancer, is the leading cause

of cancer death among men, predominantly affecting the middle-aged and elderly. Younger men, however, may also develop lung cancer in a significant number of cases.

This study was undertaken to review the histologic types and metastatic patterns of lung cancer occurring in men aged 40 or younger and to compare the findings to those seen in older patients.

MATERIALS, METHODS, AND RESULTS The records of all patients autopsied over a 20-year

period (from January 1960 to December 1979) at the New Orleans Veterans Administration Medical Center were reviewed. A total of 5,594 autopsies were done, including 786 patients who died of lung cancer. Among these patients, 29 were 40 years of age or younger. Histologic types of cancer of this age group are shown in Table I. Metastases in various locations as noted at the autopsy are shown in Table 11.

TABLE I. Histologic Types of Lung Cancer in 29 Young Men

Cell type No. of cases Percentage

Epidermoid carcinoma 8 28 Small cell carcinoma 8 28 Adenocarcinoma 7 24 Large cell carcinoma 4 14 Others 2 7

Mixed adeno-squamous 1 carcinoma

Malignant mesothelioma 1

DISCUSSION The 29 cases of lung cancer among men of 40 years of

age or younger constituted 3.7% of all lung cancer pa- tients autopsied during the 20-year period. This observa- tion is similar to that noted in another autopsy study, by Luomanen and Watson [ 19681. However, Beeler and Irey 119501 had noted seven lung cancers (14%) occurring in patients of 39 years of age or younger among a total of 50 cases of lung cancer at autopsy. When cases are collected from clinical records, frequency of lung cancer in patients under 40 years of age appears to be much greater [Rivkin and Salyer, 1958; Hood et al, 19651 than that noted in the autopsy series. The youngest patient in our series was 32 years old.

Histologic type of lung cancers in young men (Table I) is quite comparable to that observed among the patients of all ages studied at autopsy [Auerbach et al, 1975; Matthews MJ and Gordon PR, 19771. The frequency of adenocarcinoma of lung has been reported to be much higher in young people. Whereas adenocarcinoma was noted in 24% of cases in the present study, a frequency of 35% [Rivkin and Salyer, 19581, 37.3% [Neuman et al, 19561, 41 % [Anderson et al, 19541, and 50%; [Luo- manen and Watson, 19681 has been reported by various observers.

Metastasis was noted at autopsy in 100% of the cases in our study (Table II). Lymphatic spread to lymph nodes was noted in 55% of our cases. This is much lower than 87-89% involvement of lymph nodes at autopsy of lung

Accepted for publication March 19, 1985. Address reprint request to Deba P. Sarma, MD, 1601 Perdido Street, New Orleans, LA 70146.

@ 1986 Alan R. Liss, Inc.

Lung Cancer in Young Men 125

TABLE 11. Metastases of Lung Cancer in Young Men

Epidermoid Small cell Large cell Total Ca Ca Adeno Ca Ca Others

Number of patients 29 8 8 7 4 2 Any metastasis 29 8 8 7 4 2 Lymph nodes 16 4 5 5 2 Other lung 10 3 3 2 2 Liver 16 4 6 5 1 Adrenal glands 17 3 6 4 3 1 Brain 13 2 5 3 2 1 Bone 13 3 3 5 2 Kidneys 12 4 5 1 2 Heart, pericardium 10 2 4 2 1 1 Stomach, intestines 7 1 4 1 Chest wall, skeletal 5 1 1 2 1

Diaphragm 4 1 2 Thyroid 4 1 2 1 Pancreas 4 1 3 Spleen 3 1 1 Spinal cord 3 1 1

-

- -

- -

1 - -

muscle 1 - -

- - - - -

- 1 1

- - -

cancer patients of all ages [Luomanen and Watson, 1968;

be due to differ- Anderson AE, Buechner HA, Yager I, Ziskind MM: Bronochogenic ence in sampling of lymph nodes at autopsy. Blood-borne carcinoma in young men. Am J Med 16:404415, 1954. metastases were rather frequent in adrenal glands (59%), Auerbach 0, Garfinkel L, Parks VR: Histologic types of lung cancer liver (55%), brain (45%), and kidneys (41 %). various in relation to smoking habits, year of diagnosis and sites of metas-

tases. Chest 67:382-387, 1975. organs with metastasis in OUT CaSeS are similar to those Beeler TT, Irey NS: Bronchogenic carcinoma. A clinicopathologic noted for lung cancers of all ages. This is also true where study of fifty autospied cases. Dis Chest 18:61-80, 1950.

Hood RH, Campbell DC, Dooley BN, Dooling JA: Bronchogenic

cancer is examined [Auerbach et al, 19751. Luomanen RK, Watson WL: Autopsy findings. In Watson WL (ed): From our study, we conclude that lung cancer occur- “Lung Cancer. A study of five thousand Memorial Hospital cases.”

St. Louis: C.V. Mosby, 1968, pp 504-510. ring in young men is similar in histoWc types and Matthews MJ, Gordon PR: Morphology of pulmonary and pleural metastatic spread to those seen in middle-aged and el- malignancies. In Straus MJ: (ed): “Lung Cancer. Clinical Diag- derly populations except for a lower frequency of lym- nosis and Treatment.” New York: Grune and Stratton, 1977, pp

Neuman HW, Ellis FH, McDonald JR: Bronchogenic carcinoma in phatic spread among the younger group. persons under forty years of age. N Engl J Med 254502-507,

we thank M ~ . R~~~ Holliday for excellent secretarial Rivkin LM, Salyer JM: Bronchogenic carcinoma in men under 40

REFERENCES et 19751* In part, it

the pattern Of individual types Of lung carcinoma in young people. Dis Chest 48:469470, 1965,

49-69.

ACKNOWLEDGMENTS 1956.

years of age. Dis Chest. 34521-524, 1958. assistance.