Adenocarcinomas are the most commonly seen type of NSCLC and comprise up to 50% of NSCLC.
While adenocarcinomas are associated with smoking, like other lung cancers, this type is observed as well in nonsmokers who develop lung cancer.
Most adenocarcinomas arise in the outer, or peripheral, areas of the lungs.
Bronchioloalveolar carcinoma is a subtype of adenocarcinoma that frequently develops at multiple sites in the lungs and spreads along the preexisting alveolar walls.
Squamous cell carcinomas were formerly more common than adenocarcinomas; at present, they account for about 30% of NSCLC.
Also known as epidermoid carcinomas, squamous cell cancers arise most frequently in the central chest area in the bronchi.
Large cell carcinomas, sometimes referred to as undifferentiated carcinomas, are the least common type of NSCLC.
Other types of cancers can arise in the lung;
These types are much less common than NSCLC and SCLC and together comprise only 5%-10% of lung cancers:
Bronchial carcinoids account for up to 5% of lung cancers.
These tumors are generally small (3-4 cm or less) when diagnosed and occur most commonly in people under 40 years of age.
Carcinoids generally grow and spread more slowly than bronchogenic cancers, and many are detected early enough to be amenable to surgical resection.
Cancers of supporting lung tissue such as smooth muscle, blood vessels, or cells involved in the immune response can rarely occur in the lung.
Signs and symptoms:
Warning signs of lung cancer are not always present or easy to identify.
A person with lung cancer may have the following kinds of symptoms:
Symptoms related to the cancer
symptoms such as
shortness of breath
chest pain and
coughing up blood (hemoptysis).
If the cancer has invaded nerves, for example, it may cause shoulder pain that travels down the outside of the arm (called Pancoast's syndrome) or paralysis of the vocal cords leading to hoarseness.
Invasion of the esophagus may lead to difficulty swallowing (dysphagia).
If a large airway is obstructed, collapse of a portion of the lung may occur and cause infection(abscesses, pneumonia) in the obstructed area.
Symptoms related to metastasis:
Lung cancer that has spread to the bones may produce excruciating pain at the sites of bone involvement.
Cancer that has spread to the brain may cause a number of neurologic symptoms that may include blurred vision, headaches, seizures, or symptoms of stroke such as weakness or loss of sensation in parts of the body.
Nonspecific symptoms seen with many cancers, including lung cancers, include weight loss, weakness, and fatigue.
Psychological symptoms such as depression and mood changes are also common.
The history and physical examination may reveal the presence of symptoms or signs that are suspicious for lung cancer.
The chest X-ray is the most common first diagnostic step of lung cancer.
CT (computerized tomography, computerized axial tomography, or CAT) scans may be performed on the chest, abdomen, and/or brain to examine for both metastatic and lung tumors.
Magnetic resonance imaging (MRI) scans
Positron emission tomography (PET) scanning
Sputum cytology: The diagnosis of lung cancer always requires confirmation of malignant cells.
Fine needle aspiration
The stage of a cancer is a measure of the extent to which a cancer has spread in the body.
Staging involves evaluation of a cancer's size and its penetration into surrounding tissue as well as the presence or absence of metastases in the lymph nodes or other organs.
Staging is important for determining how a particular cancer should be treated, since lung-cancer therapies are geared toward specific stages.
Staging of a cancer also is critical in estimating the prognosis of a given patient, with higher-stage cancers generally having a worse prognosis than lower-stage cancers.
NSCLC are assigned a stage from I to IV in order of severity:
In stage I, the cancer is confined to the lung.
In stages II and III, the cancer is confined to the chest (with larger and more invasive tumors classified as stage III).
Stage IV cancer has spread from the chest to other parts of the body.
SCLC are staged using a two-tiered system:
Limited-stage (LS) SCLC refers to cancer that is confined to its area of origin in the chest.
In extensive-stage (ES) SCLC, the cancer has spread beyond the chest to other parts of the body.
Treatment for lung cancer can involve surgical removal of the cancer, chemotherapy, or radiation therapy, as well as combinations of these treatments.
This is a term used to describe the use of a small pellet of radioactive material placed directly into the cancer or into the airway next to the cancer which is usually done through a bronchoscope.
Surgical removal of the tumor is generally performed for limited-stage (stage I or sometimes stage II) NSCLC and is the treatment of choice for cancer that has not spread beyond the lung.
About 10%-35% of lung cancers can be removed surgically, but removal does not always result in a cure, since the tumors may already have spread and can recur at a later time.
The prognosis of lung cancer refers to the chance for cure or prolongation of life (survival) and is dependent upon where the cancer is located, the size of the cancer, the presence of symptoms, the type of lung cancer, and the overall health status of the patient.
1.SCLC has the most aggressive growth of all lung cancers, with a median survival time of only two to four months after diagnosis when untreated.
2.In non-small cell lung cancer (NSCLC), results of standard treatment are generally poor in all but the most smallest of cancers that can be surgically removed.
Radiation therapy can produce a cure in a small minority of patients with NSCLC and leads to relief of symptoms in most patients.
In advanced-stage disease, chemotherapy offers modest improvements in survival although rates of overall survival is poor.
Cessation of smoking is the most important measure that can prevent lung cancer.
Minimizing exposure to passive smoking also is an effective preventive measure.
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