Adenocarcinoma of the lung overview: Difference between revisions
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{{Adenocarcinoma of the lung}} | {{Adenocarcinoma of the lung}} | ||
{{CMG}}; {{AE}} {{SC}} | {{CMG}}; {{AE}} {{Trusha}}, {{Cherry}}, {{SC}} | ||
==Overview== | ==Overview== | ||
Adenocarcinoma of the lung is a common [[Histology|histological]] form of [[lung cancer]]. Adenocarcinoma of the lung may be classified according to WHO into 8 subtypes: [[Adenocarcinoma of the lung pathophysiology|Lepidic]], [[Adenocarcinoma of the lung pathophysiology|acinar]], [[Adenocarcinoma of the lung pathophysiology|papillary]], [[Adenocarcinoma of the lung pathophysiology|micropapillary]], [[Adenocarcinoma of the lung pathophysiology|solid]], [[Adenocarcinoma of the lung pathophysiology|colloid]], [[Adenocarcinoma of the lung pathophysiology|fetal]], [[Adenocarcinoma of the lung pathophysiology|enteric adenocarcinoma]]. Adenocarcinoma of the lung may be [[Classification|classified]] according to IASLC/ATS/ERS into 3 main types: adenocarcinoma in situ, minimally invasive adenocarcinoma, invasive adenocarcinoma. On gross pathology, peripheral multifocal lesions is the characteristic finding of adenocarcinoma of the lung. On [[microscopic]] [[Histopathology|histopathological]] analysis, nuclear atypia, eccentrically placed [[Cell nucleus|nuclei]], abundant [[cytoplasm]], and conspicuous [[Nucleolus|nucleoli]] are characteristic findings of adenocarcinoma of the lung. [[Gene|Genes]] involved in the [[pathogenesis]] of adenocarcinoma of the lung include [[epidermal growth factor receptor|EGFR]], [[HER2]], [[KRAS]], [[anaplastic lymphoma kinase|ALK]], and [[BRAF]]. Common risk factors in the development of adenocarcinoma of the lung include [[smoking]], family history of [[lung cancer]], high levels of [[air pollution]], [[radiation therapy]] to the [[chest]], [[Radon|radon gas]], [[asbestos]], [[Permissible exposure limit|occupational exposure]] to [[Carcinogen|chemical carcinogens]], and [[Respiratory disease|previous lung disease]]. The incidence of adenocarcinoma of the lung is approximately 22.1 per 100,000 individuals worldwide. Adenocarcinoma of the lung affects men and women equally. Patients of all age groups may develop adenocarcinoma of the lung. Common symptoms of adenocarcinoma of the lung include [[dyspnea]], [[hemoptysis]], chronic [[coughing]], [[chest pain]], [[cachexia]], [[dysphonia]], and [[paraneoplastic syndromes]]. Adenocarcinoma of the lung may be classified into several subtypes based on [[TNM]] and [[UICC]] staging system. The predominant therapy for adenocarcinoma of the lung is [[surgical resection]]. [[Adjuvant chemotherapy|Adjunctive chemotherapy]], [[radiation therapy]], and target therapy may be required. Common complications of adenocarcinoma of the lung include [[breathing difficulties]], [[pneumonia]], [[pleural effusion]], [[metastasis]], and [[Horner's syndrome]]. The [[prognosis]] of adenocarcinoma of the lung varies with the staging of tumor; Stage IA have the most favorable [[prognosis]]. The presence of [[metastasis]] is associated with a particularly [[Prognosis|poor prognosis]]. | |||
==Classification== | ==Classification== | ||
Adenocarcinoma of the lung may be classified according to WHO into 5 subtypes: mixed, acinar, papillary, [[bronchioloalveolar carcinoma]], and solid adenocarcinoma. | Adenocarcinoma of the lung may be classified according to WHO into 5 subtypes: mixed, acinar, papillary, [[bronchioloalveolar carcinoma]], and solid adenocarcinoma. Adenocarcinoma of the lung may be classified according to IASLC/ATS/ERS into 6 subtypes: pre-invasive lesions, atypical adenomatous hyperplasia, adenocarcinoma in situ, minimally invasive adenocarcinoma, invasive adenocarcinoma, and variants of invasive adenocarcinoma. Adenocarcinoma of the lung may be classified into several subtypes based on [[TNM]] and [[UICC]] staging system. | ||
==Pathophysiology== | ==Pathophysiology== | ||
On gross pathology, peripheral multifocal lesions is the characteristic finding of adenocarcinoma of the lung. | On gross pathology, peripheral multifocal lesions is the characteristic finding of adenocarcinoma of the lung. On microscopic [[Histopathology|histopathological]] analysis, nuclear atypia, eccentrically placed [[Cell nucleus|nuclei]], abundant [[cytoplasm]], and conspicuous [[Nucleolus|nucleoli]] are characteristic findings of adenocarcinoma of the lung. Genes involved in the pathogenesis of adenocarcinoma of the lung include [[epidermal growth factor receptor|EGFR]], [[HER2]], [[KRAS]], [[anaplastic lymphoma kinase|ALK]], and [[BRAF]]. | ||
==Cause== | ==Cause== | ||
Adenocarcinoma of the lung may caused by genetic mutations, including [[epidermal growth factor receptor|EGFR]] (7p11), [[KRAS]] (12p12), [[BRAF]] (7q34), and PIK3CA (3q26). | Adenocarcinoma of the lung may caused by [[Mutation|genetic mutations]], including [[epidermal growth factor receptor|EGFR]] (7p11), [[KRAS]] (12p12), [[BRAF]] (7q34), and PIK3CA (3q26). | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Adenocarcinoma of the lung must be differentiated from atypical adenomatous hyperplasia of the lung, adenocarcinoma in situ, [[squamous cell carcinoma of the lung]], [[small cell carcinoma of the lung]], [[malignant mesothelioma]], and metastatic adenocarcinoma. | Adenocarcinoma of the lung must be differentiated from atypical adenomatous hyperplasia of the lung, adenocarcinoma in situ, [[squamous cell carcinoma of the lung]], [[small cell carcinoma of the lung]], [[malignant mesothelioma]], and metastatic adenocarcinoma. | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
The incidence of adenocarcinoma of the lung is approximately 22.1 per 100,000 individuals worldwide. | The incidence of adenocarcinoma of the lung is approximately 22.1 per 100,000 individuals worldwide. Adenocarcinoma of the lung affects men and women equally. Patients of all age groups may develop adenocarcinoma of the lung. | ||
==Risk Factors== | ==Risk Factors== | ||
Common risk factors in the development of lung | Common risk factors in the development of adenocarcinoma of the lung include smoking, family history of [[lung cancer]], high levels of air pollution, [[radiation therapy]] to the chest, radon gas, [[asbestos]], occupational exposure to [[Carcinogens|chemical carcinogens]], and previous [[Respiratory disease|lung disease]]. | ||
==Screening== | ==Screening== | ||
According to the clinical practice guideline by the U.S. Preventive Services Task Force ([[USPSTF]]), screening for lung cancer by low-dose computed tomography (LDCT) is recommended every year among smokers and former smokers who are between 55 to 80 years old and who have smoked 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation). | According to the clinical practice guideline by the U.S. Preventive Services Task Force ([[USPSTF]]), screening for lung cancer by [[Computed tomography|low-dose computed tomography (LDCT)]] is recommended every year among smokers and former smokers who are between 55 to 80 years old and who have smoked 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation). According to the [[clinical practice guideline]] issued by the [[American College of Chest Physicians]] (CHEST) in 2013, screening for lung cancer by [[CT|low-dose CT (LDCT)]] is recommended every year among smokers and former smokers who are age 55 to 74 and who have smoked for 30 pack-years or more and either continue to smoke or have quit within the past 15 years. | ||
==Natural history, Complications, and Prognosis== | ==Natural history, Complications, and Prognosis== | ||
Common complications of adenocarcinoma of the lung include [[breathing difficulties]], [[pneumonia]], [[pleural effusion]], [[metastasis]], and [[Horner's syndrome]]. | Common complications of adenocarcinoma of the lung include [[breathing difficulties]], [[pneumonia]], [[pleural effusion]], [[metastasis]], and [[Horner's syndrome]]. The [[prognosis]] of adenocarcinoma of the lung varies with the [[Cancer staging|staging]] of [[tumor]]; Stage IA have the most favorable [[prognosis]]. The presence of [[metastasis]] is associated with a particularly poor [[prognosis]]. | ||
==Diagnosis== | ==Diagnosis== | ||
=== | ===Diagnostic Study of Choice=== | ||
[[Biopsy]] is helpful in the diagnosis of adenocarcinoma of the lung. | |||
===History and Symptoms=== | ===History and Symptoms=== | ||
Common symptoms of adenocarcinoma of the lung include [[dyspnea]], [[hemoptysis]], chronic [[coughing]], [[chest pain]], [[cachexia]], [[dysphonia]], and [[paraneoplastic syndromes]]. | Common symptoms of adenocarcinoma of the lung include [[dyspnea]], [[hemoptysis]], chronic [[coughing]], [[chest pain]], [[cachexia]], [[dysphonia]], and [[paraneoplastic syndromes]]. | ||
===Physical Examination=== | ===Physical Examination=== | ||
Common physical examination findings of adenocarcinoma of the lung include [[tachypnea]], decreased [[breath sounds]], and [[ | Common physical examination findings of adenocarcinoma of the lung include [[tachypnea]], decreased [[breath sounds]], and [[lethargy]]. | ||
=== Laboratory Findings === | |||
=== Electrocardiogram === | |||
===X Ray=== | ===X Ray=== | ||
Chest x-ray may be helpful in the diagnosis of adenocarcinoma of the lung. Findings on x-ray suggestive of adenocarcinoma of the lung include [[mass]], widening of the [[mediastinum]], [[atelectasis]], consolidation, and [[pleural effusion]]. | Chest x-ray may be helpful in the diagnosis of adenocarcinoma of the lung. Findings on [[X-rays|x-ray]] suggestive of adenocarcinoma of the lung include [[mass]], widening of the [[mediastinum]], [[atelectasis]], [[Consolidation (medicine)|consolidation]], and [[pleural effusion]]. | ||
=== Echocardiography and Ultrasound === | |||
Ultrasound may be helpful in the diagnosis of [[pleural effusion]] among patients with adenocarcinoma of the lung. | |||
===CT=== | ===CT=== | ||
Chest CT scan may be helpful in the diagnosis of adenocarcinoma of the lung. Finding on CT scan suggestive of adenocarcinoma of the lung is a lung nodule with a rounded or irregular region of increased attenuation. | [[Computed tomography|Chest CT scan]] may be helpful in the diagnosis of adenocarcinoma of the lung. Finding on [[Computed tomography|CT scan]] suggestive of adenocarcinoma of the lung is a [[Pulmonary nodule|lung nodule]] with a rounded or irregular region of increased [[attenuation]]. | ||
===MRI=== | ===MRI=== | ||
There are no MRI findings associated with adenocarcinoma of the lung. | There are no MRI findings associated with adenocarcinoma of the lung. | ||
===Other Imaging Findings=== | ===Other Imaging Findings=== | ||
Other diagnostic studies for adenocarcinoma of the lung include [[Bone scan|bone scintigraphy]], [[PET scan]], and pulmonary ventilation/perfusion scan. | Other diagnostic studies for adenocarcinoma of the lung include [[Bone scan|bone scintigraphy]], [[PET scan]], and [[Ventilation/perfusion scan|pulmonary ventilation/perfusion scan]]. | ||
===Other Diagnostic Studies=== | ===Other Diagnostic Studies=== | ||
Other diagnostic studies for adenocarcinoma of the lung include molecular | Other diagnostic studies for adenocarcinoma of the lung include molecular testing and [[endoscopy]]. | ||
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==Treatment== | ==Treatment== | ||
===Medical Therapy=== | ===Medical Therapy=== | ||
The predominant therapy for adenocarcinoma of the lung is [[surgical resection]]. Adjunctive chemotherapy, radiation, and target tharapy may be required. | The predominant therapy for adenocarcinoma of the lung is [[surgical resection]]. Adjunctive [[chemotherapy]], [[radiation therapy]], and target tharapy may be required. | ||
=== Interventions === | |||
===Surgery=== | ===Surgery=== | ||
Surgery is the mainstay of treatment for adenocarcinoma of the lung. | [[Surgery]] is the mainstay of treatment for adenocarcinoma of the lung. | ||
===Primary Prevention=== | ===Primary Prevention=== | ||
Effective measures for the primary prevention of adenocarcinoma of the lung include | Effective measures for the primary prevention of adenocarcinoma of the lung include [[smoking cessation]], eliminating secondhand smoke, reducing or eliminating exposure to [[radon]], and reducing or eliminating [[Occupational exposure limit|occupational exposure]] to [[Carcinogens|lung carcinogens]]. | ||
=== Secondary Prevention === | |||
==References== | ==References== | ||
Latest revision as of 13:55, 23 October 2019
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Adenocarcinoma of the Lung Microchapters |
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Differentiating Adenocarcinoma of the Lung from other Diseases |
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Adenocarcinoma of the lung overview On the Web |
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American Roentgen Ray Society Images of Adenocarcinoma of the lung overview |
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Risk calculators and risk factors for Adenocarcinoma of the lung overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2], Sudarshana Datta, MD [3], Shanshan Cen, M.D. [4]
Overview
Adenocarcinoma of the lung is a common histological form of lung cancer. Adenocarcinoma of the lung may be classified according to WHO into 8 subtypes: Lepidic, acinar, papillary, micropapillary, solid, colloid, fetal, enteric adenocarcinoma. Adenocarcinoma of the lung may be classified according to IASLC/ATS/ERS into 3 main types: adenocarcinoma in situ, minimally invasive adenocarcinoma, invasive adenocarcinoma. On gross pathology, peripheral multifocal lesions is the characteristic finding of adenocarcinoma of the lung. On microscopic histopathological analysis, nuclear atypia, eccentrically placed nuclei, abundant cytoplasm, and conspicuous nucleoli are characteristic findings of adenocarcinoma of the lung. Genes involved in the pathogenesis of adenocarcinoma of the lung include EGFR, HER2, KRAS, ALK, and BRAF. Common risk factors in the development of adenocarcinoma of the lung include smoking, family history of lung cancer, high levels of air pollution, radiation therapy to the chest, radon gas, asbestos, occupational exposure to chemical carcinogens, and previous lung disease. The incidence of adenocarcinoma of the lung is approximately 22.1 per 100,000 individuals worldwide. Adenocarcinoma of the lung affects men and women equally. Patients of all age groups may develop adenocarcinoma of the lung. Common symptoms of adenocarcinoma of the lung include dyspnea, hemoptysis, chronic coughing, chest pain, cachexia, dysphonia, and paraneoplastic syndromes. Adenocarcinoma of the lung may be classified into several subtypes based on TNM and UICC staging system. The predominant therapy for adenocarcinoma of the lung is surgical resection. Adjunctive chemotherapy, radiation therapy, and target therapy may be required. Common complications of adenocarcinoma of the lung include breathing difficulties, pneumonia, pleural effusion, metastasis, and Horner's syndrome. The prognosis of adenocarcinoma of the lung varies with the staging of tumor; Stage IA have the most favorable prognosis. The presence of metastasis is associated with a particularly poor prognosis.
Classification
Adenocarcinoma of the lung may be classified according to WHO into 5 subtypes: mixed, acinar, papillary, bronchioloalveolar carcinoma, and solid adenocarcinoma. Adenocarcinoma of the lung may be classified according to IASLC/ATS/ERS into 6 subtypes: pre-invasive lesions, atypical adenomatous hyperplasia, adenocarcinoma in situ, minimally invasive adenocarcinoma, invasive adenocarcinoma, and variants of invasive adenocarcinoma. Adenocarcinoma of the lung may be classified into several subtypes based on TNM and UICC staging system.
Pathophysiology
On gross pathology, peripheral multifocal lesions is the characteristic finding of adenocarcinoma of the lung. On microscopic histopathological analysis, nuclear atypia, eccentrically placed nuclei, abundant cytoplasm, and conspicuous nucleoli are characteristic findings of adenocarcinoma of the lung. Genes involved in the pathogenesis of adenocarcinoma of the lung include EGFR, HER2, KRAS, ALK, and BRAF.
Cause
Adenocarcinoma of the lung may caused by genetic mutations, including EGFR (7p11), KRAS (12p12), BRAF (7q34), and PIK3CA (3q26).
Differential Diagnosis
Adenocarcinoma of the lung must be differentiated from atypical adenomatous hyperplasia of the lung, adenocarcinoma in situ, squamous cell carcinoma of the lung, small cell carcinoma of the lung, malignant mesothelioma, and metastatic adenocarcinoma.
Epidemiology and Demographics
The incidence of adenocarcinoma of the lung is approximately 22.1 per 100,000 individuals worldwide. Adenocarcinoma of the lung affects men and women equally. Patients of all age groups may develop adenocarcinoma of the lung.
Risk Factors
Common risk factors in the development of adenocarcinoma of the lung include smoking, family history of lung cancer, high levels of air pollution, radiation therapy to the chest, radon gas, asbestos, occupational exposure to chemical carcinogens, and previous lung disease.
Screening
According to the clinical practice guideline by the U.S. Preventive Services Task Force (USPSTF), screening for lung cancer by low-dose computed tomography (LDCT) is recommended every year among smokers and former smokers who are between 55 to 80 years old and who have smoked 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation). According to the clinical practice guideline issued by the American College of Chest Physicians (CHEST) in 2013, screening for lung cancer by low-dose CT (LDCT) is recommended every year among smokers and former smokers who are age 55 to 74 and who have smoked for 30 pack-years or more and either continue to smoke or have quit within the past 15 years.
Natural history, Complications, and Prognosis
Common complications of adenocarcinoma of the lung include breathing difficulties, pneumonia, pleural effusion, metastasis, and Horner's syndrome. The prognosis of adenocarcinoma of the lung varies with the staging of tumor; Stage IA have the most favorable prognosis. The presence of metastasis is associated with a particularly poor prognosis.
Diagnosis
Diagnostic Study of Choice
Biopsy is helpful in the diagnosis of adenocarcinoma of the lung.
History and Symptoms
Common symptoms of adenocarcinoma of the lung include dyspnea, hemoptysis, chronic coughing, chest pain, cachexia, dysphonia, and paraneoplastic syndromes.
Physical Examination
Common physical examination findings of adenocarcinoma of the lung include tachypnea, decreased breath sounds, and lethargy.
Laboratory Findings
Electrocardiogram
X Ray
Chest x-ray may be helpful in the diagnosis of adenocarcinoma of the lung. Findings on x-ray suggestive of adenocarcinoma of the lung include mass, widening of the mediastinum, atelectasis, consolidation, and pleural effusion.
Echocardiography and Ultrasound
Ultrasound may be helpful in the diagnosis of pleural effusion among patients with adenocarcinoma of the lung.
CT
Chest CT scan may be helpful in the diagnosis of adenocarcinoma of the lung. Finding on CT scan suggestive of adenocarcinoma of the lung is a lung nodule with a rounded or irregular region of increased attenuation.
MRI
There are no MRI findings associated with adenocarcinoma of the lung.
Other Imaging Findings
Other diagnostic studies for adenocarcinoma of the lung include bone scintigraphy, PET scan, and pulmonary ventilation/perfusion scan.
Other Diagnostic Studies
Other diagnostic studies for adenocarcinoma of the lung include molecular testing and endoscopy.
Treatment
Medical Therapy
The predominant therapy for adenocarcinoma of the lung is surgical resection. Adjunctive chemotherapy, radiation therapy, and target tharapy may be required.
Interventions
Surgery
Surgery is the mainstay of treatment for adenocarcinoma of the lung.
Primary Prevention
Effective measures for the primary prevention of adenocarcinoma of the lung include smoking cessation, eliminating secondhand smoke, reducing or eliminating exposure to radon, and reducing or eliminating occupational exposure to lung carcinogens.