Bronchial adenocarcinoma: the value of attempts to exclude other primary tumors for randomized studies in an...

To collect an unselected total bronchial carcinoma population as a basis for randomized therapy studies during 1971-1976, 537 patients with suspected bronchial carcinoma were investigated. Of these, 109 were found to have an adenocarcinoma in the lung. Of the 109, 10 had been initially diagnosed as not having adenocarcinoma; 11 had a history of previous carcinoma, and 1 was found not to have bronchial primary on physical examination. The remaining 87 patients were studied with all available methods with the purpose of ruling out all non-bronchial adenocarcinomas as soon as possible. The primary tumor was definitely diagnosed in 86% of the 87 adenocarcinomas. The main non-bronchial tumors were colorectal and renal carcinoma; the main tumors definitely missed were carcinomas of the pancreas. An investigation to rule out non-bronchial primary adenocarcinomas in randomized therapy studies should include: (1) a history of any previous operations on primary carcinomas, histologic comparisons, (2) a careful physical examination, (3) renal investigation, (4) colorectal investigation, (5) gynecologic investigation, and (6) a careful search for symptoms of primary tumors in other organs, especially the pancreas. It is probable, however, that in 10% of cases the condition of the patient will not allow completion of all the investigations, or the real primary tumor will be definitely missed before autopsy.