Squamous cell carcinoma of the lung overview: Difference between revisions
No edit summary |
|||
Line 69: | Line 69: | ||
===Ultrasound=== | ===Ultrasound=== | ||
On endobronchial and endoscopic ultrasound, characteristic findings of non-small cell lung cancer include: enlarged lymph nodes and local invasion to adjacent bronchial structures and mediastinum. Endobronchial ultrasound is a first-line diagnostic modality for mediastinal staging.<ref name="pmid24484269">{{cite journal |vauthors=Kinsey CM, Arenberg DA |title=Endobronchial ultrasound-guided transbronchial needle aspiration for non-small cell lung cancer staging |journal=Am. J. Respir. Crit. Care Med. |volume=189 |issue=6 |pages=640–9 |year=2014 |pmid=24484269 |doi=10.1164/rccm.201311-2007CI |url=}}</ref> | |||
===Other Imaging Findings=== | ===Other Imaging Findings=== |
Revision as of 19:49, 4 March 2016
Squamous Cell Carcinoma of the Lung Microchapters |
Differentiating Squamous Cell Carcinoma of the Lung from other Diseases |
---|
Diagnosis |
Treatment |
Case Studies |
Squamous cell carcinoma of the lung overview On the Web |
American Roentgen Ray Society Images of Squamous cell carcinoma of the lung overview |
Directions to Hospitals Treating Squamous cell carcinoma of the lung |
Risk calculators and risk factors for Squamous cell carcinoma of the lung overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]
Overview
Squamous cell carcinoma of the lung ( also known as "Squamous cell lung cancer") is a type of non-small cell carcinoma of the lung, and also the second most commonly encountered lung cancer, after lung adenocarcinoma. Squamous cell carcinoma accounts for 30-35% of all lung cancers and it has a strong causal association with smoking. Squamous cell carcinoma of the lung may be classified according to the WHO histological classification system into 4 main types: papillary, clear cell, small cell, and basaloid.[1] Squamous cell carcinoma of the lung arises from the epithelial cells of the lung of the central bronchi to terminal alveoli, which are normally involved in the protection of the airways. Squamous cell carcinoma of the lung has a central location, and usually appears as a hiliar or perihiliar mass. Squamous cell carcinoma of the lung is a rapidly growing cancer which may metastasize to different organs of the body. Genes involved in the pathogenesis of squamous cell carcinoma include EGFR, EML-4, KRAS, HER2, and ALK.[2] On gross pathology, findings include: central necrosis, cavitation, and invasion of peribronchial soft tissue. On microscopic histopathological analysis squamous cell carcinoma of the lung demonstrate large polygonal malignant cells containing keratin and intercellular bridges.
Historical Perspective
In 1987, researchers first establish that a receptor on cancer cells called the epidermal growth factor receptor (EGFR) plays an important role in the growth and spread of squamous cell carcinoma of the lung.[3]
Classification
Squamous cell carcinoma of the lung may be classified according to the WHO histological classification system into 4 main types: papillary, clear cell, small cell, and basaloid.[1]
Pathophysiology
Squamous cell carcinoma of the lung arises from the epithelial cells of the lung of the central bronchi to terminal alveoli, which are normally involved in the protection of the airways. Squamous cell carcinoma of the lung has a central location, and usually appears as a hiliar or perihiliar mass. Squamous cell carcinoma of the lung is a rapidly growing cancer which may metastasize to different organs of the body. Genes involved in the pathogenesis of squamous cell carcinoma include EGFR, EML-4, KRAS, HER2, and ALK.[2] On gross pathology, findings include: central necrosis, cavitation, and invasion of peribronchial soft tissue. On microscopic histopathological analysis squamous cell carcinoma of the lung demonstrate large polygonal malignant cells containing keratin and intercellular bridges.
Causes
Common causes of squamous cell carcinoma of the lung include precursor lesions, such as metaplasia or dysplasia induced by smoking, asbestos exposure, ionizing radiation, atmospheric pollution, and chronic interstitial pneumonitis. Less common causes of non-small cell lung cancer include chromium and nickel exposure, vinyl chloride exposure, and inorganic arsenic exposure.[4]
Differentiating Non Small Cell Carcinoma of the Lung from other Diseases
Squamous cell carcinoma must be differentiated from other diseases that cause chronic cough, weight loss, hemoptysis, and dyspnea among adults such as tuberculosis, pulmonary fungal disease, and secondary metastases.
Epidemiology and Demographics
Squamous cell carcinoma of the lung accounts for 30-35% of all lung cancers, and is the second most commonly encountered lung cancer, after lung adenocarcinoma.[5] Squamous cell carcinoma of the lung accounts for about 27.4% of all cancer deaths. The incidence of lung squamous-cell carcinoma increases with age; the median age at diagnosis is 70 years.[6] Squamous cell carcinoma is most frequently diagnosed among people among 65 to 74 years old. Males are more commonly affected with squamous cell carcinoma of the lung than females. The male to female ratio is approximately 1.8 to 1. Squamous cell carcinoma of the lung usually affects black individuals more frequently. Black race has a higher incidence compared to the white race to develop squamous cell lung carcinoma.[5]
Risk Factors
Common risk factors in the development of squamous cell carcinoma of the lung are 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.[7]
Screening
According to the U.S. Preventive Services Task Force (USPSTF), screening for lung cancer by low-dose computed tomography is recommended every year among smokers who are between 55 to 80 years old and who have history of smoke 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).
Natural History, Complications and Prognosis
If left untreated, squamous cell carcinoma of the lung progression occurs slowly and is then followed by local invasion to lymph nodes and distant metastasis.[8] Squamous cell carcinoma of the lung is a locally aggressive tumor, commonly occurs in adult patients between 65 to 74 years. Common sites of metastasis include liver, adrenal gland, bone, and brain. Complications of squamous cell carcinoma of the lung, include: pneumonia, pleural effusion, metastasis, and Horner's syndrome. The 5-year survival rate of patients with squamous cell carcinoma of the lung, depends on the stage at diagnosis. The average survival rate ranges from 49% to 16%.[8] Features associated with worse prognosis are the presence of genetic and histologic factors (such as, presence of necrosis), performance status, tumor size, presence of lymphatic invasion, invasion to the pulmonary artery, presence of satellite lesions, and presence of regional or distant metastases. Prognosis is generally regarded as poor, the 5-year recurrence rate of non-small cell lung cancer is 24%.[8]
Diagnosis
Staging
According to the American Joint Committee on Cancer (AJCC) staging system, TNM system classifies squamous cell carcinoma of the lung by 3 factors, T for tumor, N for nodes, M for metastasis.[9]
History and Symptoms
The hallmark of squamous cell carcinoma of the lung is chronic cough, weight loss, and hemoptysis. A positive history of smoking may be suggestive of squamous cell carcinoma of the lung. Symptoms related with squamous cell carcinoma of the lung will vary depending on the size and location of the tumor. Common symptoms of squamous cell carcinoma of the lung may also include shortness of breath, fatigue, and chest pain.[10][11] Less common symptoms of squamous cell carcinoma of the lung, include: bone pain, fatigue, dizziness, dysphagia, and numbness in extremities.
Physical Examination
Physical examination findings of squamous cell carcinoma of the lung will depend on the location of the tumor. Non-small cell lung cancer with central location may cause crackling sounds, focal wheezing, voice hoarseness, and tachypnea. Peripheral location can present with pleurisy findings, such as reduced chest expansion. Common physical examination of patients with squamous cell carcinoma of the lung, include: crackling or bubbling noises, decreased/absent breath sounds, whispered pectoriloquy, and tachypnea.[12]
Laboratory Findings
Laboratory findings associated with squamous cell carcinoma of the lung, include: elevation of LDH or serum tumor markers. Routine laboratory studies for squamous cell carcinoma of the lung, include: complete blood count, electrolytes, calcium, alkaline phosphatase, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, creatinine, albumin, and lactate dehydrogenase.[13]
Chest X Ray
CT
MRI
Ultrasound
On endobronchial and endoscopic ultrasound, characteristic findings of non-small cell lung cancer include: enlarged lymph nodes and local invasion to adjacent bronchial structures and mediastinum. Endobronchial ultrasound is a first-line diagnostic modality for mediastinal staging.[14]
Other Imaging Findings
Other imaging findings of squamous cell carcinoma of the lung, include: PET/CT and pulmonary angiography.[15]
Other Diagnostic Studies
Other diagnostic modalities for squamous cell carcinoma of the lung, include: thoracotomy, bronchoscopy, mediastinoscopy, and transthoracic percutaneous fine needle aspiration.[14] Common biopsy findings associated with squamous cell carcinoma of the lung, include: prominent nucleoli, eosinophilic cytoplasm, and intracellular bridges. Different types of lung tissue biopsy, include: bronchoscopy biopsy, open biopsy, and video-assisted thoracoscopic surgery.[16]
Biopsy
Biopsy findings associated with squamous cell carcinoma of the lung include: prominent nucleoli, eosinophilic cytoplasm, and intracellular bridges. Different sub-types of lung tissue biopsy for squamous cell carcinoma of the lung, include: needle biopsy, open biopsy, and video-assisted thoracoscopic surgery.[16]
Treatment
Medical Therapy
Radiation Therapy
Surgery
Primary Prevention
Primary prevention of squamous cell carcinoma of the lung includes avoidance of smoking, smoking exposure, exposure to asbestos, and other high risk occupational jobs.[17]
Secondary Prevention
The secondary prevention of squamous cell carcinoma of the lung is based on the stage of squamous cell carcinoma of the lung at diagnosis. Secondary prevention include chest CT imaging along with periodic evaluation of alert signs in second-hand smokers or active smokers.[18]
References
- ↑ 1.0 1.1 Non-Small Cell Lung Cancer Treatment –for health professionals. National Cancer Institute – Physician Data Query PDQ. http://www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq#link/_361_toc Accessed on February 3, 2016.
- ↑ 2.0 2.1 Heist RS, Sequist LV, Engelman JA (2012). "Genetic changes in squamous cell lung cancer: a review". J Thorac Oncol. 7 (5): 924–33. doi:10.1097/JTO.0b013e31824cc334. PMC 3404741. PMID 22722794.
- ↑ Timeline of lung cancer. http://cancerprogress.net/timeline/lung-cancer Accessed on February 17, 2016
- ↑ National Cancer Institute: PDQ® Non-Small Cell Lung Cancer Treatment. Bethesda, MD: National Cancer Institute. Date last modified January 22. http://www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq. Accessed February 23, 2015
- ↑ 5.0 5.1 Meza R, Meernik C, Jeon J, Cote ML (2015). "Lung cancer incidence trends by gender, race and histology in the United States, 1973-2010". PLoS ONE. 10 (3): e0121323. doi:10.1371/journal.pone.0121323. PMC 4379166. PMID 25822850.
- ↑ Subramanian J, Morgensztern D, Goodgame B, Baggstrom MQ, Gao F, Piccirillo J, Govindan R (2010). "Distinctive characteristics of non-small cell lung cancer (NSCLC) in the young: a surveillance, epidemiology, and end results (SEER) analysis". J Thorac Oncol. 5 (1): 23–8. doi:10.1097/JTO.0b013e3181c41e8d. PMID 19934774.
- ↑ Lung cancer. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/lung/risks/?region=ab#Outdoor_air_pollution Accessed February 3, 2016
- ↑ 8.0 8.1 8.2 Soares M, Darmon M, Salluh JI, Ferreira CG, Thiéry G, Schlemmer B, Spector N, Azoulay E (2007). "Prognosis of lung cancer patients with life-threatening complications". Chest. 131 (3): 840–6. doi:10.1378/chest.06-2244. PMID 17356101.
- ↑ Stages of non–small cell lung cancer. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/lung/staging/?region=ab
- ↑ Non small cell lung cancer. Wikipedia. https://en.wikipedia.org/wiki/Non-small-cell_lung_carcinoma Accessed on February 24, 2016
- ↑ Raz DJ, Zell JA, Ou SH, Gandara DR, Anton-Culver H, Jablons DM (2007). "Natural history of stage I non-small cell lung cancer: implications for early detection". Chest. 132 (1): 193–9. doi:10.1378/chest.06-3096. PMID 17505036.
- ↑ Hyde L, Hyde CI (1974). "Clinical manifestations of lung cancer". Chest. 65 (3): 299–306. PMID 4813837.
- ↑ Spira A, Ettinger DS (2004). "Multidisciplinary management of lung cancer". N. Engl. J. Med. 350 (4): 379–92. doi:10.1056/NEJMra035536. PMID 14736930.
- ↑ 14.0 14.1 Kinsey CM, Arenberg DA (2014). "Endobronchial ultrasound-guided transbronchial needle aspiration for non-small cell lung cancer staging". Am. J. Respir. Crit. Care Med. 189 (6): 640–9. doi:10.1164/rccm.201311-2007CI. PMID 24484269.
- ↑ Shim SS, Lee KS, Kim BT, Chung MJ, Lee EJ, Han J, Choi JY, Kwon OJ, Shim YM, Kim S (2005). "Non-small cell lung cancer: prospective comparison of integrated FDG PET/CT and CT alone for preoperative staging". Radiology. 236 (3): 1011–9. doi:10.1148/radiol.2363041310. PMID 16014441.
- ↑ 16.0 16.1 Squamous cell carcinoma of the lung. Libre Pathology http://librepathology.org/wiki/Squamous_cell_carcinoma_of_the_lung Accessed on March 1, 2016
- ↑ Khuri FR (2003). "Primary and secondary prevention of non-small-cell lung cancer: the SPORE Trials of Lung Cancer Prevention". Clin Lung Cancer. 5 Suppl 1: S36–40. PMID 14641993.
- ↑ Tominaga S (2000). "[Prevention of lung cancer--primary and secondary prevention]". Nippon Rinsho (in Japanese). 58 (5): 1149–52. PMID 10824565.