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INTRODUCTION

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Chest medicine is inextricably intertwined with cancer medicine as a result of the propensity for cancer therapy or the disease itself to affect the lungs. Pulmonary complications in the cancer patient may manifest as injury to the pulmonary interstitium, alveolar-capillary membrane, pleura, pulmonary circulation, or airways, or, alternatively, may involve multiple intrathoracic structures. This chapter will review cancer-related pulmonary complications, including lung toxicities associated with aggressive chemotherapy and radiotherapy regimens, noninfectious lung disorders arising in the post–stem cell transplant setting, and cancer-related pleural disease, pulmonary vascular disease, and sleep disorders. The focus of this review is to identify, discuss, and provide practical algorithms for the diagnosis and treatment of these complications with emphasis on those issues in which early diagnosis may have a significant impact on patient management and outcome.

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CHEMOTHERAPY-INDUCED LUNG INJURY

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Injury to the lung due to cancer therapy results in stereotyped histopathologic disease patterns and syndromes (Tables 55-1 and 55-2). Lung toxicity has been described following exposure to conventional chemotherapy as well as molecularly targeted agents and immune modulators. Interstitial and alveolar lung injury patterns are the most frequent. Pleural effusions, pulmonary vascular disease, and, less frequently, drug-induced granulomatous disease and lymphadenopathy have also been described. In addition to direct lung injury, chemotherapy-induced immune suppression may predispose patients to life-threatening pneumonias.

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Table Graphic Jump Location
Table 55-1Histopathologic Patterns of Lung Injury Following Conventional Chemotherapy

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