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Thoracic Cancers

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    Female survivors of Hodgkin lymphoma

    There is an increased lifetime risk of breast cancer in female survivors of Hodgkin lymphoma who were treated with radiation to the chest area; however, breast cancer is also seen in patients who were treated for any cancer that was treated with chest irradiation.[9,15,16,17,18] Carcinomas are more frequent than sarcomas. Mammograms with adjunctive breast magnetic resonance imaging (MRI) should start at age 25 years or 10 years postexposure to radiation therapy (whichever came last). (Refer to the PDQ summary on the Late Effects of Treatment for Childhood Cancer for more information about secondary breast cancers.) Breast tumors may also occur as metastatic deposits from leukemia, rhabdomyosarcoma, other sarcomas, or lymphoma (particularly in patients who are infected with the human immunodeficiency virus).

    (Refer to the PDQ summary on adult Breast Cancer Treatment for more information.)

    Lung Cancer

    Primary lung tumors are rare in children and histologically quite diverse.[1] When epithelial cancers of the lung occur, they tend to be of advanced stage with prognosis dependent on both histology and stage.[19]

    The majority of pulmonary malignant neoplasms in children are due to metastatic disease, with an approximate ratio of primary malignant tumors to metastatic disease of 1:5.[20] While primary pulmonary tumors are rare in children, the majority of these tumors are malignant. In a review of 383 primary pulmonary neoplasms in children, 76% were malignant and 24% were benign.[21] These tumors may respond to the ALK inhibitor crizotinib in the presence of ALK translocations.[22][Level of evidence: 3iiiDiv]

    The most common malignant primary tumors of the lung, bronchial tumors and pleuropulmonary blastoma, are discussed below.

    Bronchial Tumors

    Histology

    Bronchial tumors are a heterogeneous group of primary endobronchial lesions, and although adenoma implies a benign process, all varieties of bronchial tumors on occasion display a malignant behavior. There are three histologic types:[23,24,25,26,27,28]

    • Carcinoid tumor (most frequent). Carcinoid tumors account for 80% to 85% of all bronchial tumors in children.[23,24,25,26,27]
    • Mucoepidermoid carcinoma.
    • Adenoid cystic carcinoma (least frequent).
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