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==Overview== | ==Overview== | ||
Revision as of 21:13, 2 March 2016
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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 carcinomas 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
The primary cause of non-small cell lung cancer is DNA damage and genetic mutations in EGFR, KRAS, ALK, HER2, ROS-1, and BRAF genes.[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
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.[5]
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
Diagnosis
Staging
According to the American Joint Committee on Cancer (AJCC) staging system, TNM system classifies squamous cell carcinoma of the lung by several factors, T for tumor, N for nodes, M for metastasis.[6]
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 . Symptoms related with squamous cell carcinoma will vary depending on the size and location of the tumor. Common symptoms of squamous cell carcinoma may also include shortness of breath, fatigue, and chest pain.[7][8]
Physical Examination
Physical examination findings of Squamous cell carcinoma of the lung will depend on the size of the tumor. The majority of squamous cell carcinoma of the lung have a central location, this may cause focal wheezing, voice hoarseness, and tachypnea.
Laboratory Findings
Laboratory findings associated with squamous cell carcinoma, include:
Chest X Ray
On conventional radiography, characteristic findings of squamous cell carcinoma of the lung, include: rounded or spiculated mass, bulky hilum (representing the tumor and local nodal involvement) and lobar collapse.[9]
CT
Computed tomography is the method of choice for the diagnosis of squamous cell carcinoma of the lung. On CT, characteristic findings of squamous cell carcinoma of the lung, include: ground-glass opacity, rounded or spiculated mass, local nodal involvement, intraluminar obstruction, and lobar collapse.[9][10]
MRI
On MRI, characteristic features for the diagnosis of squamous cell carcinoma of the lung
Other Imaging Findings
Other imaging findings of squamous cell carcinoma of the lung, include: PET/CT and pulmonary angiography.[11]
Other Diagnostic Studies
Other diagnostic modalities for squamous cell carcinoma of the lung, include: thoracotomy, bronchoscopy, mediastinoscopy, and transthoracic percutaneous fine needle aspiration.[12] 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.[13]
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.[14]
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.[15]
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
- ↑ Non-small cell lung cancer. https://en.wikipedia.org/wiki/Non-small-cell_lung_carcinoma Accessed on February 3 2016
- ↑ 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
- ↑ 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.
- ↑ 9.0 9.1 Rosado-de-Christenson ML, Templeton PA, Moran CA (1994). "Bronchogenic carcinoma: radiologic-pathologic correlation". Radiographics. 14 (2): 429–46, quiz 447–8. doi:10.1148/radiographics.14.2.8190965. PMID 8190965.
- ↑ Parker MS, Chasen MH, Paul N (2009). "Radiologic signs in thoracic imaging: case-based review and self-assessment module". AJR Am J Roentgenol. 192 (3 Suppl): S34–48. doi:10.2214/AJR.07.7081. PMID 19234288.
- ↑ 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.
- ↑ 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.
- ↑ 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.