Pulmonology Book

Cancer

Lymphatic Disorders

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Non-Small Cell Lung CancerAka: Non-Small Cell Adenocarcinoma, Squamous Cell Lung Cancer, Lung Adenocarcinoma, Large Cell Lung Cancer

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  1. See Also
    1. Lung Cancer
  2. Types Non-Small Cell Lung Cancer (75% of Lung Cancers)
    1. Squamous Cell Carcinoma (25%)
      1. Late metastases
      2. Central endobronchial lesions
      3. Presents with Hemoptysis, Pneumonia, Atelectasis
    2. Adenocarcinoma (40%)
      1. Peripheral lesions
      2. Early metastases
      3. Associated with underlying lung disease
      4. Types
        1. Acinar
        2. Bronchioalveolar
        3. Papillary
        4. Solid carcinoma with mucus formation
    3. Large cell carcinoma (10%)
      1. Poorly differentiated tumors
      2. Large peripheral lesions
      3. Types
        1. Neuroendocrine type
        2. Basaloid type
        3. Lymphoepithelial-like
        4. Rhabdoid phenotype
    4. Other uncommon Lung Cancers (<5 of Lung Cancers)
      1. Adenosquamous carcinoma
      2. Carcinoid
      3. Bronchial gland carcinoma
  3. Staging
    1. Stage IA: Local (T1N0M0)
      1. Characteristics
        1. Primary tumor <3 cm
        2. No nodal involvement
        3. No distant metastases
      2. Prognosis
        1. Surgical cure rate: 80%
    2. Stage IB: Local (T2N0M0)
      1. Characteristics
        1. Primary tumor >3 cm
        2. No nodal involvement
        3. No distant metastases
      2. Prognosis
        1. Surgical cure rate: 60%
    3. Stage II: Locally advanced (T2N1M0, T3N0M0)
      1. Characteristics
        1. Primary tumor any size and confined to the lung
        2. Ipsilateral bronchial or hilar node involvement
        3. No distant metastases
      2. Prognosis
        1. Surgical cure rate: 30 to 40%
    4. Stage IIIA: Locally advanced (T1N2M0, T2N2M0, T3N1-2M0)
      1. Characteristics
        1. Ipsilateral mediastinal lymph node involvement or
        2. Primary tumor with local extension
          1. Extension to pleura or chest wall or
          2. Extension to Pericardium or
          3. Extension to diaphragm or
          4. Extension to within 2 cm of carina
      2. Prognosis
        1. Surgical cure rate: 10 to 20%
    5. Stage IIIB: Advanced (T4N1-3M0)
      1. Characteristics
        1. Contralateral lymph node involvement or
        2. Primary tumor with local invasion
          1. Tumor invasion of mediastinum
          2. Malignant Pleural Effusion
      2. Prognosis
        1. Surgical cure rate: <5%
    6. Stage IV: Advanced (T1-4N1-3M1)
      1. Characteristics: Distant Metastases
      2. Prognosis
        1. Surgical cure rate: <5%
  4. Management: Surgical Resection
    1. Most effective non-Small Cell Lung Cancer management
    2. Long-term cancer survivorship associated with resection
    3. Recurrence rate following resection: 50%
    4. Indicated in only 30% of patients (I, II, IIIA)
      1. No significant distant metastases
      2. Locally resectable disease within the chest
  5. Management: Vinorelbine Chemotherapy in Non-Small Cell
    1. Well tolerated chemotherapeutic
    2. Modestly effective with Cisplatin
    3. Prolongs survival
      1. Vinorelbine: 40 week survival
      2. Untreated: 20 week survival
    4. Expensive >$200 per week
    5. References
      1. Med Lett Drugs Ther (1995) 37(955):72
  6. Management: Tarceva (erlotinib)
    1. Monoclonal Antibody targeting tumor growth factors
    2. Prolongs survival by 2 months
    3. Causes Diarrhea, rash and LFT abnormalities
    4. Cost: $2000/month
    5. References
      1. (January 2005) Prescriber's Letter, p. 5
  7. Management: Cranial Irradiation in Small Cell Cancer
    1. Prophylactic cranial irradiation improves survival
    2. Auperin (1999) N Engl J Med 341:476
  8. References
    1. Hainsworth (1997) Am Fam Physician 55(6):2265
    2. Mountain (1986) Chest 89(4 suppl):223S

Carcinoma, Non-Small-Cell Lung (C0007131)

Definition (MSH)A heterogeneous aggregate of at least three distinct histological types of lung cancer, including SQUAMOUS CELL CARCINOMA; ADENOCARCINOMA; and LARGE CELL CARCINOMA. They are dealt with collectively because of the shared properties of poor response to conventional chemotherapy and the potential for cure with surgical resection in a fraction of patients.
Definition (CSP)heterogeneous group of lung cancers which include epidermoid or squamous carcinomas, adenocarcinomas, and large cell carcinomas.
Definition (NCI)A group of lung cancers that includes squamous cell carcinoma, adenocarcinoma, and large cell carcinoma.
Definition (NCI)A group of at least three distinct histological types of lung cancer, including squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. Non-small cell lung carcinomas have a poor response to conventional chemotherapy. --2002
ConceptsNeoplastic Process (T191)
MSHD002289
EnglishNon Small Cell Lung Carcinoma, non-oat cell lung cancer, Non-Small Cell Cancer of Lung, Non-Small Cell Cancer of the Lung, Non-Small Cell Carcinoma of Lung, Non-Small Cell Carcinoma of the Lung, Non-small cell lung cancer, Non-Small Cell Lung Carcinoma, Non-Small-Cell Lung Carcinoma, Non-Small-Cell Lung Carcinomas, NONSMALL CELL LUNG CANCER, NONSMALL CELL LUNG CARCINOMA, NSCLC, NSCLC - Non-small cell lung cancer
Spanishcancer pulmonar de celulas no pequenas
Parent ConceptsCarcinoma (C0007097), Lung Neoplasms (C0024121), Carcinoma of lung (C0684249), Non-small cell carcinoma (C1266002), Common Carcinoma (C1333128), Malignant neoplasm of lung (C0242379), adult solid tumor (C0280099), Primary malignant neoplasm of lung (C1306460)
SourcesCSP, MSH, NCI, NDFRT, OMIM, PDQ, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Squamous cell carcinoma of lung (C0149782)

Definition (NCI)A carcinoma arising from malignant squamous bronchial epithelial cells and characterized by the presence of keratinization and/or intercellular bridges. Cigarette smoking and arsenic exposure are strongly associated with squamous cell lung carcinoma. (NCI05)
ConceptsNeoplastic Process (T191)
EnglishEpidermoid carcinoma of lung, Epidermoid Cell Carcinoma of Lung, Epidermoid Cell Carcinoma of the Lung, Epidermoid Cell Lung Carcinoma, epidermoid lung cancer, SCC - Squamous cell carcinoma of lung, Squamous cell carcinoma of lung, Squamous Cell Carcinoma of the Lung, squamous cell lung cancer, Squamous Cell Lung Carcinoma
Spanishcarcinoma de celulas escamosas de pulmon, carcinoma epidermoide de pulmon, carcinoma escamoso de pulmon
Parent ConceptsSquamous cell carcinoma (C0007137), Carcinoma of lung (C0684249), cellular diagnosis, non-small cell lung cancer (C0279877), Carcinoma of lung parenchyma (C0345957), Primary malignant neoplasm of lung (C1306460)
SourcesCOSTAR, NCI, PDQ, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Adenocarcinoma of lung (C0152013)

Definition (NCI)A carcinoma characterized by the presence of malignant glandular epithelial cells. There is a male predilection with a male to female ratio of 2:1. Usually lung adenocarcinoma is asymptomatic and is identified through screening studies or as an incidental radiologic finding. If clinical symptoms are present they include shortness of breath, cough, hemoptysis, chest pain, and fever. Tobacco smoke is a known risk factor. (NCI05)
ConceptsNeoplastic Process (T191)
EnglishADENOCARCINOMA LUNG, Adenocarcinoma of lung, adenocarcinoma of the lung, Lung Adenocarcinoma, non-oat cell adenocarcinoma of the lung
Spanishadenocarcinoma del pulmon
Parent ConceptsCarcinoma, Non-Small-Cell Lung (C0007131), Non-Small Cell Adenocarcinoma (C1335060), cellular diagnosis, non-small cell lung cancer (C0279877), Malignant neoplasm of lung (C0242379), Malignant neoplasm of thorax (C0153661)
SourcesCOSTAR, CST, DXP, NCI, OMIM, PDQ, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Large cell carcinoma of lung (C0345958)

Definition (NCI)A poorly differentiated non-small cell lung carcinoma composed of large polygonal cells without evidence of glandular or squamous differentiation. There is a male predilection. (NCI05)
ConceptsNeoplastic Process (T191)
Englishanaplastic large cell lung cancer, Anaplastic Lung Carcinoma, Large cell carcinoma of lung, Large Cell Carcinoma of the Lung, large cell lung cancer, Large Cell Lung Carcinoma, Large Cell Undifferentiated Lung Carcinoma, undifferentiated large cell lung cancer
Spanishcarcinoma de celulas grandes de pulmon
Parent ConceptsCarcinoma, Non-Small-Cell Lung (C0007131), Carcinoma, Large Cell (C0206704), cellular diagnosis, non-small cell lung cancer (C0279877), Carcinoma of lung parenchyma (C0345957)
SourcesNCI, PDQ, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Non-Small Cell Adenocarcinoma (C1335060)

Definition (NCI)(ADD-in-o-KAR-sin-O-ma) A type of cancer that begins in the glandular cells that line certain internal organs and most commonly affects the lungs. It is diagnosed by the way the cells appear under a microscope.
ConceptsNeoplastic Process (T191)
EnglishNon-Small Cell Adenocarcinoma, Nonsmall Cell Adenocarcinoma
Parent ConceptsAdenocarcinoma (C0001418), Non-small cell carcinoma (C1266002)
SourcesNCI
Derived from the NIH UMLS (Unified Medical Language System)



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