Lung cancer classification
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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
Primary lung cancer can be classified into two main categories: small cell lung cancer (SCLC) and non small cell lung cancer (NSCLC).
| Lung cancer | |||||||||||||||
Small cell lung cancer (~15%) | Non small cell lung cancer (~85%) Squamous cell carcinoma (25% of lung cancers) | ||||||||||||||
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 Histological Classification of Tumors of the Lung [8]
Malignant Epithelial Tumors
- Squamous cell carcinoma
- Papillary
- Clear cell
- Small cell
- Basaloid
- Small cell carcinoma
- Combined small cell carcinoma
- Adenocarcinoma
- Adenocarcinoma, mixed subtype
- Acinar adenocarcinoma
- Papillary adenocarcinoma
- Bronchioloalveolar carcinoma
- Nonmucinous
- Mucinous
- Mixed nonmucinous and mucinous or indeterminate
- Solid adenocarcinoma with mucin production
- Fetal adenocarcinoma
- Mucinous (“colloid”) carcinoma
- Mucinous cystadenocarcinoma
- Signet ring adenocarcinoma
- Clear cell adenocarcinoma
- Large cell carcinoma
- Large cell neuroendocrine carcinoma
- Combined large cell neuroendocrine carcinoma
- Basaloid carcinoma
- Lymphoepithelioma-like carcinoma
- Clear cell carcinoma
- Large cell carcinoma with rhabdoid phenotype
- Adenosquamous carcinoma
- Sarcomatoid carcinoma
- Pleomorphic carcinoma
- Spindle cell carcinoma
- Giant cell carcinoma
- Carcinosarcoma
- Pulmonary blastoma
- Carcinoid tumor
- Typical carcinoid
- Atypical carcinoid
- Salivary gland tumors
- Mucoepidermoid carcinoma
- Adenoid cystic carcinoma
- Epithelial-myoepithelial carcinoma
- Preinvasive lesions
- Squamous carcinoma in situ
- Atypical adenomatous hyperplasia
- Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia
- Mesenchymal tumors
- Epithelioid haemangioendothelioma
- Angiosarcoma
- Pleuropulmonary blastoma
- Chondroma
- Congenial peribronchial myofibroblastic tumor
- Diffuse pulmonary lymphangiomatosis
- Inflammatory myofibroblastic tumor
- Lymphangioleiomyomatosis
- Synovial sarcoma
- Monophasic
- Biphasic
- Pulmonary artery sarcoma
- Pulmonary vein sarcoma
Benign Epithelial Tumors
- Papillomas
- Squamous cell papilloma
- Exophytic
- Inverted
- Glandular papilloma
- Mixed squamous cell and glandular papilloma
- Adenomas
- Alveolar adenoma
- Papillary adenoma
- Adenomas of the salivary gland type
- Mucous gland adenoma
- Pleomorphic adenoma
- Others
- Mucinous cystadenoma
Lymphoproliferative Tumors
- Marginal zone B-cell lymphoma of the MALT type
- Diffuse large B-cell lymphoma
- Lymphomatoid granulomatosis
- Langerhans cell histiocytosis
Miscellaneous Tumors
- Harmatoma
- Sclerosing hemangioma
- Clear cell tumor
- Germ cell tumors
- Teratoma, mature
- Immature
- Other germ cell tumors
- Intrapulmonary thymoma
- Melanoma
Metastatic Tumors
- The lung is a common organ 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.[9]
References
- ↑ 1.0 1.1 1.2 1.3 Travis, WD (Jan 1995). "Lung cancer". Cancer. 75 (Suppl. 1): 191–202. PMID 8000996. Unknown parameter
|coauthors=ignored (help) - ↑ 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) - ↑ 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) - ↑ 4.0 4.1 Vaporciyan, AA (2000). Cancer Medicine. B C Decker Inc. pp. 1227–1292. ISBN 1-55009-113-1. Unknown parameter
|coauthors=ignored (help) - ↑ 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) - ↑ 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) - ↑ 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) - ↑ Travis, William (2004). Pathology and genetics of tumours of the lung, pleura, thymus, and heart. Lyon: IARC Press. ISBN 9283224183.
- ↑ 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)