Pattern of lung cancer in elderly

The aim of the study was to evaluate the clinical spectrum of the lung cancer in the Indian patients.

All the patients above the age 60 years referred to the chest clinic of Apollo Hospitals, during the period 1989-2000 were evaluated for lung cancer with fibreoptic bronchoscopy, fluoroscopic guided transbronchial lung biopsy, transbronchial, needle aspiration and/or CT guided percutaneous fine needle aspiration biopsy. Retrospective data of 1400 patients was analyzed statistically.

There were 512 patients (439 males, 73 females) with confirmed primary lung cancer. There were 62% ex-smokers, 10% current smokers and 28% non-smokers amongst males, whereas amongst females there were 10% ex-smokers and 90% non-smokers. Cough of more than 3 weeks duration was the commonest symptom seen in 85% (n = 435) followed by fever and weight loss. Radiologically the commonest feature was collapse-consolidation in 77% (n = 397). Central endobronchial tumours were seen in 204 patients (39.8%), whereas peripheral tumours were seen in 308 (60.2%). The diagnostic yield of transbronchial lung biopsy alone was as high as 48%, whereas the yield on CT guided percutaneous fine needle aspiration biopsy alone ranged from 32%-40%. There was no statistical difference in histological subtypes (non-small cell or small cell lung cancer) in the various groups studied. However, in those patients above the age of 80 years (group C) small cell lung cancer was more frequently seen.

Primary lung cancer should always be suspected in elderly Indian subjects with unexplained cough and other constitutional symptoms of weight loss and fever.