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==Overview==
==Overview==
The vast majority of lung cancers are [[carcinoma]]s—malignancies that arise from [[epithelial cell]]s. There are two main types of lung carcinoma, categorized by the size and appearance of the malignant cells seen by a [[histopathology|histopathologist]] under a [[microscope]]: ''non-small cell'' (80.4%) and  ''small-cell'' (16.8%) lung carcinoma.<ref name="Travis">{{cite journal | last =Travis | first =WD | coauthors =Travis LB, Devesa SS | title =Lung cancer | journal =Cancer | volume =75 | issue =Suppl. 1 | pages =191–202 | date =Jan 1995 | url = | pmid =8000996 | accessdate = }}</ref> This classification, based on simple [[histology|histological]] criteria, has important implications for clinical management and prognosis of the disease.


==Classification==
==Classification==
Lung cancer can be classified into two main categories: small cell lung cancer (SCLC) and non small cell lung cancer (NSCLC).
Lung cancer can be classified into two main categories: small cell lung cancer (SCLC) and non small cell lung cancer (NSCLC).
===Small Cell Lung Cancer===
===Small Cell Lung Cancer===
* [[Small cell carcinoma|Small cell lung carcinoma]] (SCLC, also called "oat cell carcinoma") is less common. It tends to arise in the larger breathing tubes and grows rapidly, becoming quite large.
* The "oat" cell contains dense neurosecretory granules ([[vesicle (biology)|vesicles]] containing [[neuroendocrine]] [[hormone]]s) which give this an endocrine/paraneoplastic syndrome association.<ref name="Rosti">{{cite journal | last=Rosti | first=G | coauthors=Bevilacqua G, Bidoli P et al. | title=Small cell lung cancer | journal=Annals of Oncology | volume=17 | issue=Suppl. 2 | pages=5–10 | date =Mar 2006 | url=http://annonc.oxfordjournals.org/cgi/reprint/17/suppl_2/ii5 | pmid=16608983 | doi=10.1093/annonc/mdj910 | accessdate=2007-09-06 }}</ref>
* While initially more sensitive to chemotherapy, it ultimately carries a worse prognosis and is often metastatic at presentation. This type of lung cancer is strongly associated with smoking.<ref name="Barbone">{{cite journal | last =Barbone | first =F | coauthors=Bovenzi M, Cavallieri F, Stanta G | title =Cigarette smoking and histologic type of lung cancer in men | journal =Chest | volume =112| issue=6 | pages =1474–1479 | publisher =American College of Chest Physicians | date =Dec 1997 | url =http://www.chestjournal.org/cgi/reprint/112/6/1474 | format = PDF | accessdate = 2007-09-07 | pmid = 9404741 }}</ref>
===Non Small Cell Lung Cancer===
===Non Small Cell Lung Cancer===
* The non-small cell lung carcinomas are grouped together because their prognosis and management are similar. There are three main sub-types: [[squamous cell carcinoma|squamous cell lung carcinoma]], [[adenocarcinoma]] and large cell lung carcinoma.
* Accounting for 31.1% of lung cancers,<ref name="Travis"/> squamous cell lung carcinoma usually starts near a central [[bronchus]]. Cavitation and [[necrosis]] within the center of the cancer is a common finding. Well-differentiated squamous cell lung cancers often grow more slowly than other cancer types.<ref name="Cancer Medicine">{{cite book | last =Vaporciyan | first =AA | coauthors =Nesbitt JC, Lee JS et al. | title =Cancer Medicine | publisher=B C Decker Inc. | date =2000 | pages =1227–1292 | isbn =1-55009-113-1 }}</ref>
* Adenocarcinoma accounts for 29.4% of lung cancers.<ref name="Travis"/> It usually originates in peripheral lung tissue. Most cases of adenocarcinoma are associated with smoking. However, among people who have never smoked ("never-smokers"), adenocarcinoma is the most common form of lung cancer.<ref name="Subramanian">{{cite journal | last =Subramanian | first =J | coauthors =Govindan R | title =Lung cancer in never smokers: a review | journal =Journal of Clinical Oncology | volume =25 | issue =5 | pages =561–570 | publisher =American Society of Clinical Oncology | date =February 2007 | pmid =17290066 }}</ref> A subtype of adenocarcinoma, the [[bronchioloalveolar carcinoma]], is more common in female never-smokers, and may have different responses to treatment.<ref name="Raz">{{cite journal | last =Raz | first =DJ | coauthors =He B, Rosell R, Jablons DM | title =Bronchioloalveolar carcinoma: a review | journal =Clinical Lung Cancer | volume =7 | issue =5 | pages =313–322 | publisher =Cancer Information Group | date =Mar 2006 | pmid =16640802 }}</ref>
* Accounting for 10.7% of lung cancers,<ref name="Travis"/> large cell lung carcinoma is a fast-growing form that develops near the surface of the lung.<ref name="Veronesi">{{cite journal | author=Veronesi G | coauthors= Morandi U, Alloisio M et al. | title=Large cell neuroendocrine carcinoma of the lung: a retrospective analysis of 144 surgical cases | journal=Lung Cancer | volume=53 | issue=1 | pages=111–115 | date =Jul 2006 | pmid=16697073 | doi=10.1016/j.lungcan.2006.03.007 }}</ref> It is often poorly [[cellular differentiation|differentiated]] and tends to [[metastasis|metastasize]] early.<ref name="Cancer Medicine"/>


====WHO/IASLC Histologic Classification of NSCLC====
====WHO/IASLC Histologic Classification of NSCLC====
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The vast majority of lung cancers are [[carcinoma]]s—malignancies that arise from [[epithelial cell]]s. There are two main types of lung carcinoma, categorized by the size and appearance of the malignant cells seen by a [[histopathology|histopathologist]] under a [[microscope]]: ''non-small cell'' (80.4%) and  ''small-cell'' (16.8%) lung carcinoma.<ref name="Travis">{{cite journal | last =Travis | first =WD | coauthors =Travis LB, Devesa SS | title =Lung cancer | journal =Cancer | volume =75 | issue =Suppl. 1 | pages =191–202 | date =Jan 1995 | url = | pmid =8000996 | accessdate = }}</ref> This classification, based on simple [[histology|histological]] criteria, has important implications for clinical management and prognosis of the disease.


==== Non-small cell lung carcinoma (NSCLC) ====
==== Non-small cell lung carcinoma (NSCLC) ====
The non-small cell lung carcinomas are grouped together because their prognosis and management are similar. There are three main sub-types: [[squamous cell carcinoma|squamous cell lung carcinoma]], [[adenocarcinoma]] and large cell lung carcinoma.


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Accounting for 31.1% of lung cancers,<ref name="Travis"/> squamous cell lung carcinoma usually starts near a central [[bronchus]]. Cavitation and [[necrosis]] within the center of the cancer is a common finding. Well-differentiated squamous cell lung cancers often grow more slowly than other cancer types.<ref name="Cancer Medicine">{{cite book | last =Vaporciyan | first =AA | coauthors =Nesbitt JC, Lee JS et al. | title =Cancer Medicine | publisher=B C Decker Inc. | date =2000 | pages =1227–1292 | isbn =1-55009-113-1 }}</ref>
Adenocarcinoma accounts for 29.4% of lung cancers.<ref name="Travis"/> It usually originates in peripheral lung tissue. Most cases of adenocarcinoma are associated with smoking. However, among people who have never smoked ("never-smokers"), adenocarcinoma is the most common form of lung cancer.<ref name="Subramanian">{{cite journal | last =Subramanian | first =J | coauthors =Govindan R | title =Lung cancer in never smokers: a review | journal =Journal of Clinical Oncology | volume =25 | issue =5 | pages =561–570 | publisher =American Society of Clinical Oncology | date =February 2007 | pmid =17290066 }}</ref> A subtype of adenocarcinoma, the [[bronchioloalveolar carcinoma]], is more common in female never-smokers, and may have different responses to treatment.<ref name="Raz">{{cite journal | last =Raz | first =DJ | coauthors =He B, Rosell R, Jablons DM | title =Bronchioloalveolar carcinoma: a review | journal =Clinical Lung Cancer | volume =7 | issue =5 | pages =313–322 | publisher =Cancer Information Group | date =Mar 2006 | pmid =16640802 }}</ref>
Accounting for 10.7% of lung cancers,<ref name="Travis"/> large cell lung carcinoma is a fast-growing form that develops near the surface of the lung.<ref name="Veronesi">{{cite journal | author=Veronesi G | coauthors= Morandi U, Alloisio M et al. | title=Large cell neuroendocrine carcinoma of the lung: a retrospective analysis of 144 surgical cases | journal=Lung Cancer | volume=53 | issue=1 | pages=111–115 | date =Jul 2006 | pmid=16697073 | doi=10.1016/j.lungcan.2006.03.007 }}</ref> It is often poorly [[cellular differentiation|differentiated]] and tends to [[metastasis|metastasize]] early.<ref name="Cancer Medicine"/>
==== Small cell lung carcinoma (SCLC) ====
[[Small cell carcinoma|Small cell lung carcinoma]] (SCLC, also called "oat cell carcinoma") is less common. It tends to arise in the larger breathing tubes and grows rapidly, becoming quite large.
The "oat" cell contains dense neurosecretory granules ([[vesicle (biology)|vesicles]] containing [[neuroendocrine]] [[hormone]]s) which give this an endocrine/paraneoplastic syndrome association.<ref name="Rosti">{{cite journal | last=Rosti | first=G | coauthors=Bevilacqua G, Bidoli P et al. | title=Small cell lung cancer | journal=Annals of Oncology | volume=17 | issue=Suppl. 2 | pages=5–10 | date =Mar 2006 | url=http://annonc.oxfordjournals.org/cgi/reprint/17/suppl_2/ii5 | pmid=16608983 | doi=10.1093/annonc/mdj910 | accessdate=2007-09-06 }}</ref>
While initially more sensitive to chemotherapy, it ultimately carries a worse prognosis and is often metastatic at presentation. This type of lung cancer is strongly associated with smoking.<ref name="Barbone">{{cite journal | last =Barbone | first =F | coauthors=Bovenzi M, Cavallieri F, Stanta G | title =Cigarette smoking and histologic type of lung cancer in men | journal =Chest | volume =112| issue=6 | pages =1474–1479 | publisher =American College of Chest Physicians | date =Dec 1997 | url =http://www.chestjournal.org/cgi/reprint/112/6/1474 | format = PDF | accessdate = 2007-09-07 | pmid = 9404741 }}</ref>
==== Metastatic cancers ====
The lung is a common place for [[metastasis]] from tumors in other parts of the body.  These cancers are identified by the site of origin, thus a breast cancer metastasis to the lung is still known as breast cancer. They often have a characteristic round appearance on chest x-ray.<ref name="Seo">{{cite journal | last =Seo | first =JB | coauthors=Im JG, Goo JM et al. | title =Atypical pulmonary metastases: spectrum of radiologic findings | journal =Radiographics | volume =21 | issue=2 | pages =403–417 | date =2001 | url =http://radiographics.rsnajnls.org/cgi/content/full/21/2/403 | accessdate = 2007-09-10 | pmid = 11259704 }}</ref>


Primary lung cancers themselves most commonly metastasize to the [[adrenal gland]]s, liver, brain, and bone.<ref name="Cancer Medicine"/>
===Metastatic Cancersa===
* The lung is a common place for [[metastasis]] from tumors in other parts of the body.  These cancers are identified by the site of origin, thus a breast cancer metastasis to the lung is still known as breast cancer. They often have a characteristic round appearance on chest x-ray.<ref name="Seo">{{cite journal | last =Seo | first =JB | coauthors=Im JG, Goo JM et al. | title =Atypical pulmonary metastases: spectrum of radiologic findings | journal =Radiographics | volume =21 | issue=2 | pages =403–417 | date =2001 | url =http://radiographics.rsnajnls.org/cgi/content/full/21/2/403 | accessdate = 2007-09-10 | pmid = 11259704 }}</ref>


==References==
==References==

Revision as of 14:00, 9 June 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Kim-Son H. Nguyen, M.D., M.P.A., Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, Cafer Zorkun, M.D., Ph.D. [2]

Overview

The vast majority of lung cancers are carcinomas—malignancies that arise from epithelial cells. There are two main types of lung carcinoma, categorized by the size and appearance of the malignant cells seen by a histopathologist under a microscope: non-small cell (80.4%) and small-cell (16.8%) lung carcinoma.[1] This classification, based on simple histological criteria, has important implications for clinical management and prognosis of the disease.

Classification

Lung cancer can be classified into two main categories: small cell lung cancer (SCLC) and non small cell lung cancer (NSCLC).

Small Cell Lung Cancer

  • Small cell lung carcinoma (SCLC, also called "oat cell carcinoma") is less common. It tends to arise in the larger breathing tubes and grows rapidly, becoming quite large.
  • The "oat" cell contains dense neurosecretory granules (vesicles containing neuroendocrine hormones) which give this an endocrine/paraneoplastic syndrome association.[2]
  • While initially more sensitive to chemotherapy, it ultimately carries a worse prognosis and is often metastatic at presentation. This type of lung cancer is strongly associated with smoking.[3]

Non Small Cell Lung Cancer

  • The non-small cell lung carcinomas are grouped together because their prognosis and management are similar. There are three main sub-types: squamous cell lung carcinoma, adenocarcinoma and large cell lung carcinoma.
  • Accounting for 31.1% of lung cancers,[1] squamous cell lung carcinoma usually starts near a central bronchus. Cavitation and necrosis within the center of the cancer is a common finding. Well-differentiated squamous cell lung cancers often grow more slowly than other cancer types.[4]
  • Adenocarcinoma accounts for 29.4% of lung cancers.[1] It usually originates in peripheral lung tissue. Most cases of adenocarcinoma are associated with smoking. However, among people who have never smoked ("never-smokers"), adenocarcinoma is the most common form of lung cancer.[5] A subtype of adenocarcinoma, the bronchioloalveolar carcinoma, is more common in female never-smokers, and may have different responses to treatment.[6]
  • Accounting for 10.7% of lung cancers,[1] large cell lung carcinoma is a fast-growing form that develops near the surface of the lung.[7] It is often poorly differentiated and tends to metastasize early.[4]

WHO/IASLC Histologic Classification of NSCLC

  • Squamous cell carcinoma
    • Papillary
    • Clear cell
    • Small cell
    • Basaloid
  • Adenocarcinoma
    • Acinar
    • Papillary
    • Bronchioloalveolar carcinoma
      • Nonmucinous
      • Mucinous
      • Mixed mucinous and nonmucinous or indeterminate cell type
    • Solid adenocarcinoma with mucin
    • Adenocarcinoma with mixed subtypes
    • Variants
      • Well-differentiated fetal adenocarcinoma
      • Mucinous (colloid) adenocarcinoma
      • Mucinous cystadenocarcinoma
      • Signet ring adenocarcinoma
      • Clear cell adenocarcinoma
  • Large cell carcinoma
    • Variants
      • Large cell neuroendocrine carcinoma (LCNEC)
      • Combined LCNEC
      • Basaloid carcinoma
      • Lymphoepithelioma-like carcinoma
      • Clear cell carcinoma
      • Large cell carcinoma with rhabdoid phenotype
  • Adenosquamous carcinoma
  • Carcinomas with pleomorphic, sarcomatoid, or sarcomatous elements
  • Carcinomas with spindle and/or giant cells
    • Spindle cell carcinoma
    • Giant cell carcinoma
    • Carcinosarcoma
    • Pulmonary blastoma
  • Carcinoid tumor
    • Typical carcinoid
    • Atypical carcinoid
  • Carcinomas of salivary gland type
    • Mucoepidermoid carcinoma
    • Adenoid cystic carcinoma
    • Others
  • Unclassified carcinoma
Frequency of histological types of lung cancer[1]
Histological type Frequency (%)
Non-small cell lung carcinoma 80.4
Small cell lung carcinoma 16.8
Carcinoid[8] 0.8
Sarcoma[9] 0.1
Unspecified lung cancer 1.9


Non-small cell lung carcinoma (NSCLC)

Sub-types of non-small cell lung cancer[1]
Histological sub-type Frequency of all lung cancers (%)
Squamous cell lung carcinoma 31.1
Adenocarcinoma Adenocarcinoma (not otherwise specified) 23.2
Bronchioloalveolar carcinoma 3.0
Adenosquamous carcinoma 1.2
Papillary adenocarcinoma 0.7
Mucoepidermoid carcinoma[10] 0.1
Adenoid cystic carcinoma[11] 0.04
Other specified adenocarcinoma 1.1
Large cell carcinoma 10.7
Giant cell and spindle cell carcinoma 0.4
Other/unspecified non-small cell lung carcinoma 8.9


Metastatic Cancersa

  • The lung is a common place for metastasis from tumors in other parts of the body. These cancers are identified by the site of origin, thus a breast cancer metastasis to the lung is still known as breast cancer. They often have a characteristic round appearance on chest x-ray.[12]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Travis, WD (Jan 1995). "Lung cancer". Cancer. 75 (Suppl. 1): 191–202. PMID 8000996. Unknown parameter |coauthors= ignored (help)
  2. ↑ Rosti, G (Mar 2006). "Small cell lung cancer". Annals of Oncology. 17 (Suppl. 2): 5–10. doi:10.1093/annonc/mdj910. PMID 16608983. Retrieved 2007-09-06. Unknown parameter |coauthors= ignored (help)
  3. ↑ Barbone, F (Dec 1997). "Cigarette smoking and histologic type of lung cancer in men" (PDF). Chest. American College of Chest Physicians. 112 (6): 1474–1479. PMID 9404741. Retrieved 2007-09-07. Unknown parameter |coauthors= ignored (help)
  4. ↑ 4.0 4.1 Vaporciyan, AA (2000). Cancer Medicine. B C Decker Inc. pp. 1227–1292. ISBN 1-55009-113-1. Unknown parameter |coauthors= ignored (help)
  5. ↑ Subramanian, J (February 2007). "Lung cancer in never smokers: a review". Journal of Clinical Oncology. American Society of Clinical Oncology. 25 (5): 561–570. PMID 17290066. Unknown parameter |coauthors= ignored (help)
  6. ↑ Raz, DJ (Mar 2006). "Bronchioloalveolar carcinoma: a review". Clinical Lung Cancer. Cancer Information Group. 7 (5): 313–322. PMID 16640802. Unknown parameter |coauthors= ignored (help)
  7. ↑ Veronesi G (Jul 2006). "Large cell neuroendocrine carcinoma of the lung: a retrospective analysis of 144 surgical cases". Lung Cancer. 53 (1): 111–115. doi:10.1016/j.lungcan.2006.03.007. PMID 16697073. Unknown parameter |coauthors= ignored (help)
  8. ↑ Morandi, U (2006). "Bronchial typical carcinoid tumors". Seminars in Thoracic and Cardiovascular Surgery. 18 (3): 191–198. PMID 17185178. Unknown parameter |coauthors= ignored (help)
  9. ↑ Etienne-Mastroianni, B (Dec 2002). "Primary sarcomas of the lung: a clinicopathologic study of 12 cases". Lung Cancer. 38 (3): 283–289. PMID 12445750. Unknown parameter |coauthors= ignored (help)
  10. ↑ Sánchez-Mora, N (Jan 2007). "Mucoepidermoid tumors of the bronchus. Ultrastructural and immunohistochemical study". Histology and Histopathology. 22 (1): 9–13. PMID 17128406. Unknown parameter |coauthors= ignored (help)
  11. ↑ Moran, CA (Mar 1994). "Primary adenoid cystic carcinoma of the lung. A clinicopathologic and immunohistochemical study of 16 cases". Cancer. 73 (5): 1390–1397. PMID 7509254. Unknown parameter |coauthors= ignored (help)
  12. ↑ Seo, JB (2001). "Atypical pulmonary metastases: spectrum of radiologic findings". Radiographics. 21 (2): 403–417. PMID 11259704. Retrieved 2007-09-10. Unknown parameter |coauthors= ignored (help)

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