Non–small cell lung cancer (NSCLC) accounts for approximately 85% of all lung cancers. Histologically, NSCLC is divided into adenocarcinoma, squamous cell carcinoma (SCC) (see the image below), and large cell carcinoma. Small cell lung cancer (SCLC), previously known as oat cell carcinoma, is considered distinct from other lung cancers, which are called non–small cell lung cancers (NSCLCs) because of their clinical and biologic characteristics.
Non–small cell lung cancer (NSCLC) accounts for approximately 85% of all lung cancers. Histologically, NSCLC is divided into adenocarcinoma, squamous cell carcinoma (SCC) (see the image below), and large cell carcinoma. Small cell lung cancer (SCLC), previously known as oat cell carcinoma, is considered distinct from other lung cancers, which are called non–small cell lung cancers (NSCLCs) because of their clinical and biologic characteristics.
The discovery of malignant cells in pleural fluid
and/or parietal pleura signifies disseminated or
advanced disease and a reduced life expectancy in
patients with cancer.Median survival following
diagnosis ranges from 3 to 12 months and is
dependent on the stage and type of the underlying
malignancy. The shortest survival time is observed
in malignant effusions secondary to lung cancer
and the longest in ovarian cancer, while malignant
effusions due to an unknown primary have an
intermediate survival time.Historically, studies
showed that median survival times in effusions due
to carcinoma of the breast are 5-6 months.
However, more recent studies have suggested
longer survival times of up to 15 months. A
comparison of survival times in breast cancer
effusions in published studies to 1994 calculated
a median survival of 11 months.9
Currently, lung cancer is the most common
metastatic tumour to the pleura in men and breast
cancer in women.Together, both malignancies
account for 50- 65% of all malignant effusions. Lymphomas, tumours of the genitourinary
tract and gastrointestinal tract account for
a further 25% Pleural effusions from an
unknown primary are responsible for 15% of all
malignant pleural effusions.Few studies have
estimated the proportion of pleural effusions due to
mesothelioma: studies from 1975, 1985 and 1987
identified mesothelioma in 1/271, 3/472 and 22/592
patients, respectively, but there are no more recent
data to update this in light of the increasing incidence
of mesothelioma.
Get the facts and more details about lung carcinoid tumor in the above slides.This slide shows more information regarding lung cancer and its various details
Lung cancer: a 2014 update with information about immunotherapiesZeena Nackerdien
In 2006, Dana Reeve – actress, activist, and non-smoker – died of lung cancer. In 2009, Valerie Harper – actress and “Dancing with the Stars” contestant – was diagnosed with lung cancer that has since metastasized to the brain. They are the famous faces of a disease that is the leading cause of cancer deaths. Five-year survival rates for lung cancer, the leading cause of cancer deaths, are very low. Please take a look at some of the ASCO 2014 lung cancer updates on my blog: http://norwalk.patch.com/groups/zeena-nackerdiens-blog/p/american-society-of-clinical-oncology-annual-meeting-2014-key-lung-cancer-abstracts.
The discovery of malignant cells in pleural fluid
and/or parietal pleura signifies disseminated or
advanced disease and a reduced life expectancy in
patients with cancer.Median survival following
diagnosis ranges from 3 to 12 months and is
dependent on the stage and type of the underlying
malignancy. The shortest survival time is observed
in malignant effusions secondary to lung cancer
and the longest in ovarian cancer, while malignant
effusions due to an unknown primary have an
intermediate survival time.Historically, studies
showed that median survival times in effusions due
to carcinoma of the breast are 5-6 months.
However, more recent studies have suggested
longer survival times of up to 15 months. A
comparison of survival times in breast cancer
effusions in published studies to 1994 calculated
a median survival of 11 months.9
Currently, lung cancer is the most common
metastatic tumour to the pleura in men and breast
cancer in women.Together, both malignancies
account for 50- 65% of all malignant effusions. Lymphomas, tumours of the genitourinary
tract and gastrointestinal tract account for
a further 25% Pleural effusions from an
unknown primary are responsible for 15% of all
malignant pleural effusions.Few studies have
estimated the proportion of pleural effusions due to
mesothelioma: studies from 1975, 1985 and 1987
identified mesothelioma in 1/271, 3/472 and 22/592
patients, respectively, but there are no more recent
data to update this in light of the increasing incidence
of mesothelioma.
Get the facts and more details about lung carcinoid tumor in the above slides.This slide shows more information regarding lung cancer and its various details
Lung cancer: a 2014 update with information about immunotherapiesZeena Nackerdien
In 2006, Dana Reeve – actress, activist, and non-smoker – died of lung cancer. In 2009, Valerie Harper – actress and “Dancing with the Stars” contestant – was diagnosed with lung cancer that has since metastasized to the brain. They are the famous faces of a disease that is the leading cause of cancer deaths. Five-year survival rates for lung cancer, the leading cause of cancer deaths, are very low. Please take a look at some of the ASCO 2014 lung cancer updates on my blog: http://norwalk.patch.com/groups/zeena-nackerdiens-blog/p/american-society-of-clinical-oncology-annual-meeting-2014-key-lung-cancer-abstracts.
Get the facts on Lung Cancer Symptoms, Treatments, Types, Stages, Signs, etc. Get tips on Lung Cancer. For detail information about lung cancer visit us. - Lung Cancer Symptoms, Signs, Treatment & Causes
the upcoming 8th edition of TNM staging in lung cancer will be published soon. what we need to know about TNM , how it was developed and why? how we can improve our practice for suspected lung cancer patients
While lung cancer remains a very challenging cancer to treat, new treatments that capitalize on advances in our understanding of cancer. It is likely that a more personalized approach to treatment using biological markers and combinations of therapies will provide better results in the future.
7 Things to Know about Non-Small Cell Lung CancerZeena Nackerdien
Lung cancer continues to be the top cancer killer of both men and women. The disease (small cell and non-small cell) is the
second most common non-skin cancer for both genders. This at-a-glance infographic provides some of the facts about the disease and should be read in conjunction with my lung cancer 2014 update (also on SlideShare). Abbreviations are explained within the sources listed at the bottom of the infographic. As usual, please consult a doctor for any medical advice.
Lung Cancer Awareness By Epillo Health Systems EpilloHealth
November is officially lung cancer awareness month. The event started back in 1995 as lung cancer awareness day. As the lung cancer community and the lung cancer movement grew, the awareness activities increased and the day matured into Lung Cancer awareness month. This is a brief presentation for the awareness on Lung Cancer Awareness by the team Epillo.
Bronchopulmonary cancers are common cancers with a poor prognosis. It is the leading cause of death by cancer in Algeria and in the world. Behind this unfavorable prognosis hides numerous disparities according to age, sex, and exposure to risk factors, ranking 4th among incident cancers and developing countries including Algeria, all sexes combined. It ranks 2nd cancers in men and 3rd among women. Whatever the age observed, the incidence of this cancer is higher in men than in women, however the gap is narrowing to the detriment of the latter. The results of scientific research agree to relate trends in incidence and mortality rates to tobacco consumption, including passive smoking. Furthermore, other risk factors are mentioned such as exposure to asbestos in the workplace or to radon for the general population, or even genetic predisposition. However, the weight of these etiological and/or predisposing factors is in no way comparable to that of tobacco in the genesis of lung cancer and the resulting mortality. We provide a literature review in our article on the descriptive and analytical epidemiology of lung cancer.
Presentation about lung cancer, form, types, classification, treatment. A lot of anatomical and histological pictures accompanied with small and precised informations about every type of lung cancer.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
2. INTRODUCTION
Lung cancer is largely a disease of modern man.
Rare before 1900, with fewer than 400 cases
described in the medical literature.
Raymond Pearl's landmark 1938 report conclusively
established the devastating impact smoking has on
longevity.
: Abeloff's Clinical Oncology, 4th ed.
3. Tobacco consumption is the primary cause of
lung cancer.
More than 60% of new lung cancers occur in
- Never smokers (smoked <100 cigarettes per lifetime) or
- Former smoker (smoked 100 cigarettes per lifetime, quit
1 year)
1 in 5 women and 1 in 12 men diagnosed with
lung cancer have never smoked.
: Abeloff's Clinical Oncology, 4th ed
4. Epidemiology
Lung cancer is the most common cause of cancer
death among American men and women.
More than 220,000 individuals will be diagnosed with
lung cancer in the United States in 2010.
Lung cancer is rare below age 40, with rates increasing
until age 80, after which the rate tapers off.
Harrison's Principles of Internal Medicine, 18e
5. The projected lifetime probability of
developing lung cancer is estimated to be
approximately 8% among males and
approximately 6% among females.
The incidence of lung cancer varies by racial
and ethnic group, with the highest ageadjusted incidence rates among African Americans.
: Abeloff's Clinical Oncology, 4th ed
6. Demographic data of lung cancer from Indian studies.
S. No
Details
1958 – 1985
1986 - 2001
1.
Total cases
1735
2973
2.
M:F
6.67:1
5.76:1
3.
Mean age (yrs)
52.16
54.6
4.
Urban: Rural
19.6 - 81.6
18.4 - 80.4
5.
Occupation
Farmers
Labourers
Clerks/teachers
Businessmen
Housewives
Others
13.9 - 48%
21.0 - 27.3%
16.7%
21.3%
8.0 - 14.7%
23%
6.
Religion
Hindus
Muslims
Christians
75.1%
18.9%
5.9%
:IACM Journal April-June 2012
7. Lung cancer incidence in United States between 1975 and 2003. Age-adjusted to the
2000 U.S. standard population
: Abeloff's Clinical Oncology, 4th ed
8. Tobacco use and lung cancer mortality in the United States 1900–2002.
*Per 100,000, age-adjusted to the 2000 U.S. standard population
: Abeloff's Clinical Oncology, 4th ed
9. Age-adjusted cancer death rates for selected sites in the United States, adjusted for the 2000
ROBBINS AND COTRAN PATHOLOGIC BASIS OF DISEASE, 7/E
10. RISK FACTORS
Majority (80–90%) by cigarette smoking.
-Cigarette smokers have a tenfold or greater increase in
risk.
-One genetic mutation is induced for every 15 cigarettes
smoked.
- Cigarette smoking increases the risk of all the major
lung cancer cell types.
- Environmental tobacco smoke (ETS) or secondhand
smoke is also an established cause of lung cancer.
Harrison's Principles of Internal Medicine, 18e
11. In Indian patients with lung cancer, history of active
tobacco smoking was found in 87% of males and 85% of
females.
History of passive tobacco exposure is found in 3% in
india. So 90% of all cases in india resulted from tobacco
exposure.
The relative risk of developing lung cancer is
2.64 for beedi smokers
2.23 for cigarette smokers
2.45 as the overall relative risk (RR).
IACM Journal April-June 2012
12. Occupational risk of lung cancer:
S.No
Occupational
carcinogens
Risk
1.
Asbestos
Insulation and shipyard workers,increase in
risk of lung cancer after 10 years of exposure,
with concurrent smoking increases risk 90
fold.
2.
Arsenic
Smelters and vineyard workers,
Upper lobe predominance.
3.
Nickel
Squamous cell carcinoma-MC
4.
Radiation
Uranium mining, Oat cell carcinoma -MC
5.
Haematite mining
Due to radon exposure
6.
Hard rock mining
Chromium exposure,Squamous cell- MC
7.
Chloromethyl
Oat cell -MC
8.
Ethers and mustard
gas
Squamous and undifferentiated -MC
9.
Soots , Tars
Coke oven workers
10
Oils and cokes
Gas house workers, roofers
:IACM Journal April-June 2012
13. Low fruit and vegetable intake during adulthood.
-This observation led to hypotheses that specific
nutrients, in
particular retinoids and carotenoids, might have
chemopreventive effects for lung cancer.
Ionizing radiation
-Increased rates of lung cancer among survivors of the
atom bombs dropped on Hiroshima and Nagasaki
Prolonged exposure to low-level radon in homes
Harrison's Principles of Internal Medicine, 18e
14. Prior lung diseases such as
-chronic bronchitis,
-emphysema, and
- tuberculosis
Air pollution:
Studies from china have shown :
- Coal burning at home is a significant risk factor
for development of lung cancer in non smoking females.
- Coal smoke contains potential carcinogens:
SO2 ,CO , TSP , B(a)P, radon , thoron.
:IACM Journal April-June 2012
15. SMOKING CESSATION
Physicians must promote tobacco abstinence.
Stopping tobacco use before middle age avoids
more than 90% of the lung cancer risk attributable
to tobacco.
Smoking cessation is beneficial in individuals
even with an established diagnosis of lung cancer.
Harrison's Principles of Internal Medicine, 18e
16. Essential elements of smoking cessation
therapy:
The individual must want to stop smoking.
Must be willing to work hard to achieve the goal of
smoking abstinence.
Therapy with :
-an antidepressant (e.g., bupropion) or
- nicotine replacement therapy (varenicline).
- Clonidine and nortriptyline are recommended as secondline treatments
Harrison's Principles of Internal Medicine, 18e
17. Inherited Predisposition to Lung
Cancer
Environmental carcinogens can induce or facilitate the
transformation from bronchoepithelial cells to the
malignant phenotype.
Certain genetic polymorphisms of the P450 enzyme
system, specifically CYP1A1, or chromosome fragility are
associated with the development of lung cancer.
Harrison's Principles of Internal Medicine, 18e
18. First-degree relatives of lung cancer probands have a two- to
threefold excess risk of lung cancer and other cancers, many
of which are not smoking-related.
Individuals with inherited mutations in RB
(retinoblastoma) and p53 (Li-Fraumeni syndrome)
genes may develop lung cancer.
Harrison's Principles of Internal Medicine, 18e
19.
Three genetic loci for lung cancer risk have been
identified :
-5p15 (TERT-CLPTM1L),
-15q25(CHRNA5-CHRNA-3 nicotinic acetylcholine
receptor subunits), and
-6p21 (BAT3-MSH5).
A rare germline mutation (T790M) involving the
epidermal growth factor receptor (EGFR) maybe be linked
to lung cancer susceptibility in never smokers.
Harrison's Principles of Internal Medicine, 18e
20. Pathology
The term lung cancer is used for tumors
arising from the respiratory epithelium
(bronchi, bronchioles, and alveoli).
Harrison's Principles of Internal Medicine, 18e
21. 2004 World Health Organization Classification of
Malignant Epithelial Tumors
Squamous cell carcinoma
Papillary
Clear cell
Small cell
Basaloid
Small cell carcinoma
Combined small cell carcinoma
Adenocarcinoma
Mixed pattern
Acinar
Papillary
Bronchioloalveolar
Mucinous
:Fishman’s Pulmonary Diseases and Disorders
Nonmucinous
22. Mixed
Solid with mucin production
Fetal adenocarcinoma
Mucinous (colloid) carcinoma
Mucinous cystadenocarcinoma
Signet ring
Clear cell
Large cell carcinoma
Large cell neuroendocrine carcinoma
Basaloid carcinoma
Lymphoepithelioma-like carcinoma
Clear cell carcinoma
Large cell carcinoma, rhabdoid phenotype
:Fishman’s Pulmonary Diseases and Disorders 4th Edition
24. These four histologies account for approximately
90% of all epithelial lung cancers.
1.Small Cell Lung Cancer (SCLC)
2.Adenocarcinoma
3.Squamous Cell Carcinoma
Non Small Cell Lung
Cancer(NSCLC)
4.Large Cell Carcinoma
:Harrison's Principles of Internal Medicine, 18e
25. Epithelial cell lung cancers
WESTERN COUNTRIES
Squamous
Large
INDIA-1986-2001
Others
Adeno
Small
:Harrison's Principles of Internal Medicine, 18e
Squamous
Large
Adeno
:IACM Journal April-June 2012
26. Among women and young adults (<60 years),
adenocarcinoma tends also to be the most common
form of lung cancer.
In lifetime never smokers, all histologic forms of
lung cancer can be found, although adenocarcinoma
tends to predominate.
The incidence of small cell carcinoma is also on the
decline.
:Harrison's Principles of Internal Medicine, 18e
27. LUNG CANCER IN INDIA
Non-small-cell lung cancer constitutes 75 - 80% of lung cancers.
More than 70 % of them are in Stages III and IV, thus
curative surgery can not be done in these cases.
Small-cell lung carcinoma constitute 20% of all lung cancers .
Extensive stage in 70% of patients at the time of diagnosis.
While in many Western countries adenocarcinoma has become
the commonest lung cancer.
In India it is still squamous cell carcinoma in both males and
females
:IACM Journal April-June 2012
28. Small cell carcinoma
Poorly differentiated
neuroendocrine tumor.
Highly prevalent in smokers.
Incidence rates are higher among men than women.
Central mass with endobronchial growth.
:Abeloff's Clinical Oncology, 4th ed
29. May produce specific peptide hormones such as
- adrenocorticotrophic hormone (ACTH),
- arginine vasopressin (AVP),
-atrial natriuretic factor (ANF), and
-gastrin-releasing peptide (GRP).
These hormones may be associated with distinctive
paraneoplastic syndromes
:Abeloff's Clinical Oncology, 4th ed
31. Small cell carcinoma with islands of small deeply
basophilic cells and areas of necrosis
:ROBBINS AND COTRAN PATHOLOGIC BASIS OF
DISEASE, 7/E
32. A fine-needle aspirate of an enlarged lymph node shows clusters of tumor
cells from a small cell carcinoma, with molding and nuclear atypia
characteristic of this tumor
:ROBBINS AND COTRAN PATHOLOGIC BASIS
OF DISEASE, 7/E
33. Squamous cell carcinomas
Identical to extrapulmonary (i.e., head and neck)
squamous cell carcinomas .
Occur centrally .
Classically associated with a history of smoking.
Pattern is that of an infiltrating nest of tumor cells with
central necrosis , resulting in cavitation.
:Abeloff's Clinical Oncology, 4th ed
34. Keratin can usually be seen when present.
Important variants-papillary pattern
-basaloid variant
Differential diagnosis
-reactive processes that may result in squamous
metaplasia with reactive atypia such as that
observed with infection or radiation-induced injury.
:Abeloff's Clinical Oncology, 4th ed
36. Cavitation within a squamous cell carcinoma.
:Fishman’s Pulmonary Diseases and Disorders 4th Edition
37. A sputum specimen shows an orange-staining, keratinized squamous
carcinoma cell with a prominent hyperchromatic
nucleus (arrow)
:ROBBINS AND COTRAN PATHOLOGIC BASIS OF DISEASE, 7/E
38. Adenocarcinomas
- Peripheral lung locations.
- Associated with a history of smoking.
- It is the most common type of lung cancer occurring
never smokers.
- Histologically, the tissue may contain :
glands,
papillary structure,
bronchioloalveolar pattern,
cellular mucin, or
solid pattern if poorly differentiated.
: Abeloff's Clinical Oncology, 4th ed
39. - Solid and micropapillary patterns in
adenocarcinomas may predict a worse prognosis.
- Variants of adenocarcinomas include
-signet-ring,
-clear cell,
Primarily descriptive
-mucinous,
-fetal adenocarcinomas.
Distinct
Rare
Young smokers
Better Prognosis
: Abeloff's Clinical Oncology, 4th ed
41. Peripheral adenocarcinoma of the lung with pleural puckering.
:Fishman’s Pulmonary Diseases and Disorders 4th Edition
42. Bronchioloalveolar carcinoma (BAC)
subtype of adenocarcinoma
grows along the alveoli without invasion.
present radiographically as a single mass, as a
diffuse multinodular lesion, as a fluffy infiltrate.
on CT scans as a "ground-glass" opacity (GGO).
:Harrison's Principles of Internal Medicine, 18e
43. Bronchioloalveolar carcinoma, mucinous type. Tall columnar cells with abundant mucinous cytoplasm
line the alveolar septa
:Fishman’s Pulmonary Diseases and Disorders 4th Edition
44. Large cell carcinomas
-fewer than 10% of lung cancer.
- occur peripherally.
- poorly differentiated carcinomas
- sheets of large malignant cells, often with
associated necrosis.
- Cytologically, the tumor is also arranged in
syncytial groups and single cells.
:Harrison's Principles of Internal Medicine, 18e
45. Variants of large cell carcinoma:
- basaloid carcinoma- present as an endobronchial
lesion and may resemble a high-grade
neuroendocrine tumor,
- lymphoepithelioma-like carcinoma- similar to the
same-named tumor of other sites and is EpsteinBarr virus–related.
:Harrison's Principles of Internal Medicine, 18e
46. Large cell carcinoma, featuring pleomorphic, anaplastic
tumor cells and absence of squamous or glandular
differentiation.
:ROBBINS AND COTRAN PATHOLOGIC BASIS
OF DISEASE, 7/E
47. Immunohistochemistry
The diagnosis of lung cancer rests on the morphologic or cytologic features
correlated with clinical and radiographic findings.
Immunohistochemistry may be used :
1. To verify neuroendocrine differentiation within a tumor, with markers
such as neuron-specific enolase (NSE), CD56 or neural cell adhesion molecule
(NCAM), synaptophysin, chromogranin, and Leu7.
2. Helpful in differentiating primary from metastatic adenocarcinomas. For
example:Thyroid transcription factor 1 (TTF-1), is positive in more than 70% of
pulmonary adenocarcinomas and is a reliable indicator of primary lung
cancer, provided a thyroid primary has been excluded.
3. Cytokeratins 7 and 20 used in combination can help narrow the
differential diagnosis.
:Harrison's Principles of Internal Medicine, 18e
48. Common Immunohistochemical Markers Used in the
Diagnosis of Lung Tumors
:Harrison's Principles of Internal Medicine, 18e
Histology
Positive Immunohistochemical Markers
Squamous cell carcinoma
Cytokeratin (CK) cocktail, e.g., AE1/AE3
CK5/6 , CK7 rare
Adenocarcinoma
Cytokeratin cocktail, e.g., AE1/AE3
CK7 , TTF-1
Neuroendocrine markers rare, e.g., CD56,
NSE
Large cell carcinoma
Cytokeratin , TTF-1 rare
Neuroendocrine markers rare (e.g., CD56,
NSE)
Large cell neuroendocrine
carcinoma
Cytokeratin cocktail, e.g., AE1/AE3
TTF-1 , CD56 , Chromogranin
Synaptophysin
Small cell carcinoma
Cytokeratin cocktail (tends to be patchy)
TTF-1 , CD56 , Chromogranin
Synaptophysin
49. Molecular Pathogenesis
The exact cell of origin for lung cancers is not known.
In Lung adenocarcinoma , type II epithelial cells give
rise to tumors.
In SCLC, cells of neuroendocrine origin have been
implicated as precursors.
Lung cancer cells harbor multiple chromosomal
abnormalities ,including mutations, amplifications,
insertions, deletions, and translocations.
The earliest set of oncogenes found to be aberrant was
the MYC family of transcription factors (MYC, MYCN,
and MYCL).
:Harrison's Principles of Internal Medicine, 18e
50. Genes Somatically Altered in Different Histologic
Subtypes of Lung Cancer
Histology
Oncogene
Tumor-Suppressor
genes
Adenocarcinoma
EGFR
KRAS
ALK
TP53
CDKN2A/B(p16, p14)
LKB1
Squamous cell
carcinoma
EGFR
PIK3CA
IGF-1R
TP53
TP63
Small cell carcinoma
MYC
BCL-2
TP53
RB1
FHIT
Large cell carcinoma
(not well studied)
:Harrison's Principles of Internal Medicine, 18e
51. Early Detection and Screening
Low-dose, noncontrast, thin-slice helical or spiral
chest CT has emerged as a possible new tool for lung
cancer screening.
A major challenge confronting advocates of CT
screening is the high false-positive rate.
It appears that nodules:
<5 mm are unlikely to be cancerous and
5–10 mm in diameter are of uncertain significance.
:Harrison's Principles of Internal Medicine, 18e
52. Two additional screening studies are ongoing:
1.The National Lung Cancer Screening Trial (NLST), a
prospective comparison of spiral CT and standard chest
x-ray in 50,000 current or ex-smokers
2.Study in Europe comparing CT scanning with standard
of care in subjects with a history of heavy smoking.
:Harrison's Principles of Internal Medicine, 18e
53. Clinical Manifestations
Symptoms and Signs
Range of Frequency
Cough
8-75%
Weight loss
0-68%
Dyspnea
3-60%
Chest pain
20-49%
Hemoptysis
6-35%
Bone pain
6-25%
Clubbing
0-20%
Fever
0-20%
Weakness
0-10%
SVCO
0-4%
Dysphagia
0-2%
Wheezing and stridor
0-2%
:Harrison's Principles of Internal Medicine, 18e
54. Clinical findings suggestive of metastatic disease:
Symptoms elicited in history
Constitutional : weight loss > 10 lb
Musculoskeletal ; focal skeletal
pain
Neurologic: headache , syncope ,
seizures , extremity weakness
Signs found on physical examination
Lymphadenopathy(>1cm)
Hoarsness , superior vena cava
syndrome
Bone tenderness
Hepatomegaly (13> cm span)
Focal neurologic signs , papilledems
Soft – tissue mass
Routine laboratory tests
Hematocrit:<40% in men , <35% in
women
Elevated alkaline phosphatase , GGT
,SGOT and calcium levels
:Harrison's Principles of Internal Medicine, 18e
56. Paraneoplastic syndromes
SIADH – Small cell – Hyponatremia
Resolves within 1–4 weeks of initiating chemotherapy.
Demeclocycline can be a useful
ACTH-producing tumors – Small cell-Hypokalemia
No changes in body habitus. Metyrapone and ketoconazole
not effective.
Treatment is effective management of underlying SLCS
:Harrison's Principles of Internal Medicine, 18e
59. Neurologic–
Myopathic syndromes - 1%
Myasthenic Eaton-Lambert syndrome and retinal
blindness (SCLC).
Peripheral neuropathies,
Subacute cerebellar degeneration,
Cortical degeneration, and
Polymyositis
All lung cancer
types
60. Hematologic manifestations – 1-8%
-Migratory venous thrombophlebiti (Trousseau'ssyndrome),
-Nonbacterial Thrombotic (marantic) endocarditis with
arterial emboli,
-Disseminated intravascular coagulation
-Thrombotic disease complicating cancer is usually a poor
prognostic sign.
Renal manifestations – 1%
- Nephrotic syndrome and
- Glomerulonephritis
:Harrison's Principles of Internal Medicine, 18e
61. Eaton-Lambert syndrome.
-Autoimmune responses(anti–voltage-gated calcium channel
antibodies)
-Proximal muscle weakness, usually in lower extremities,
-Occasional - autonomic dysfunction
-Rarely - cranial nerve symptoms
-Frequently - depressed deep tendon reflexes
-In contrast to patients with myasthenia gravis, strength
improves with serial effort.
-Chemotherapy is the initial treatment of choice.
:Harrison's Principles of Internal Medicine, 18e
62. lung cancer-Metastasis
Adrenals - ~50% of cancers
Liver – 30-50%
Brain – 20%
Bone – 20%
:Harrison's Principles of Internal Medicine, 18e
63. The Solitary Pulmonary Nodule:A Systematic
Approach
A single discrete pulmonary opacity that is
surrounded by normal lung tissue.
Not associated with adenopathy or atelectasis.
Lesions larger than 3cm are almost always
malignant.
Solitary pulmonary nodules must be 3cmor less in
diameter.
Prompt diagnosis and resection are usually
advisable
:Fishman’s Pulmonary Diseases and Disorders 4th Edition
64. Factors influencing assessment of a solitary pulmonary nodule.
FACTOR
BENIGN
Pts
Malignant
Pts
1.Growth rate
No growth on 2 serial xrays at 3 mths interval
10
Definite growth on serial
X-rays
10
2.Calcification
a)Laminated
b)Dense
central core
c) Diffuse
Nodular
d) Punctate
central
10
10
Uncalcified
4
3.Age
<30yrs
9
>40yrs
4
4.Margin of lesion
Sharply defined
5
Ill defined
5
5.Size
Not a useful factor
0
Larger than 3.5cms
5
6.Density
Dense lesion <2cm
4
Low density <2cm
4
7.H/O malignancy
None
0
+ve
5
8.Documented
hemoptysis
None
0
+ve
5
10
10
IACM :Journal Vol.13 April-June 2012
65. Satisfies 1 of the Lesion rates 10 or
‘10 point’ items more on the ‘Malig
for benign ds.
nancy Scale’
Patient
considered to
have benign
nodule
Find out nature
of the lesion.
Thoracotomy is
indicated
Malignant
points minus
benign points
if <10
Fine needle
aspiration
biopsy
(without
resorting to
thoracotomy)
Plan specific
therapy
Accuracy of assessment was 77.7% in the series of the author(Jain DG ,1988)
IACM :Journal Vol.13 April-June 2012
67. Approach to solitory pulmonary nodule
New nodule identified on
standard CT scanning
Benign calcification pattern
on CT or stability for 2 yr on
archival films
yes
No further
testing
No
Risk factor
for surgery
No
Does probability of cancer
warrant further investigation ?
Harrison's Principles of Internal Medicine, 18e
68. :Harrison's Principles of Internal Medicine, 18e
Yes
Moderate
probability of
cancer(10-60%)
Low probability
of cancer
Serial highresolution CT
3, 6, 12, and 24 mo
No
-ve
test
Additional testing
-PET if nodule> 1 cm
in diamete
-Contrast- enhanced
CT, depending on
intitutional expertise
-Trans thoracic fineneedle aspiration
biopsy if nodule is
peripherallly located
-Bronchoscopy if air
bronchus sign present
+ve
test
Video-assisted
thoracoscopic surgery;
-examination of
mediastinal lymph
nodes and frozen
section folllowed by
lobectomy if nodule is
malignant