1. Case Report Anterior Mediastinal Mass in a Young Marijuana Smoker: A Rare Case of Small-Cell Lung Cancer Jiten P. Kothadia 1, Saurabh Chhabra 2, AlanMarcus 3, MichaelMay 3, Biren Saraiya 2, and Salma K. Jabbour 1 1. Department of Radiation Oncology, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08901, USA 2. Division of Medical Oncology 3. Department of Pathology Hindawi Publishing Corporation Case Reports in Medicine Volume 2012, Article ID 754231, 4 pages Received 14 December 2011; Accepted 30 January 2012

2. INTRODUCTION Cannabis is most widely consumed illicit drug worldwide Perceived to be harmless Link of cannabis smoking to lung cancer is inconclusive Tobacco smoke and cannabis have similar toxic irritants Research on effects of cannabis are mainly on mental health, very little on pulmonary effects Current research in not very extensive and contradictory

3. CASE PRESENTATION 22 year old male Bilateral lymphadenopathy (swollen lymph nodes) Fatigue Sore throat Treated for upper respiratory tract infection One month prior Cough Exertional dyspnea (shortness of breath with exercise) Chest pain Hoarseness Solid food dysphagia (difficulty swallowing) Facial and neck swelling No family history Smoked 1 joint three times a week for three years but no cigarettes

4. CASE PRESENTATION Initial chest radiograph showed a large right hilar with right paratracheal soft tissue mass

5. CASE PRESENTATION Chest computed tomography (CT) demonstrated a large anterior mediastinal mass

6. CASE PRESENTATOIN Positron emission tomography (PET) scan showing a hypermetabolic mediastinal mass

7. CASE PRESENTATION Patient was diagnosed with Small Cell Lung Cancer No sign of the cancer outside his chest Treated with urgent radiation therapy, cisplatin (chemotheraphy) and etoposide (anti-cancer medication) Patient was free of disease for 16 months Subsequently experience metastatic disease in the liver and para-aortic lymph notes

8. DISCUSSION Marijuana is the most commonly used illicit drug in the USA In 2009, there were 16.7 million pastmonth (current) users 6.6% of the US population delta-9-tetradydrocannabinol (THC) Perceived to be safe Greater potential to cause lung cancer than cigarette smoke Similar to tobacco smoke 50-70% more carcinogentic hydrocarbons

9. DISCUSSION Blunts combine nicotine and other chemicals Less densely packed, no filters, smaller butt size Higher concentrations of smoke are inhaled Inhale more deeply and hold breath longer Absorb more CO than cigarettes Regular marijuana smokers long term pulmonary consequences Chronic cough Airway inflammation and injury Dysregulated growth of respiratory cells Molecular abnormalities in respiratory tracts

10. DISCUSSION Very rare to have SCLC this young 0.03 cases per 1000 reported in patients younger than 39 No cigarette smoking No genetic predisposition Study of one joint per day (New Zealand) Increase risk of cancer 8% Equals 20 cigarettes per day

11. LIMITATIONS Only one case Contradicting studies Smoking marijuana without tobacco Need larger studies to evaluate association

12. SIGNIFICANCE Physicians and patients need to be aware Smoking cannabis may be associated with lung cancer Dispel myths Youths who smoke cannabis and cigarettes More and more users avoiding inhalation Vaporizers - heats the cannabis before it combusts Eating it – ‘cannabutter’ Marijuana butter Marijuana vaporizers