Lung tumor
Other carcinoma
Carcinoma-general

Author: Deepali Jain, M.D. (see Authors page)

Revised: 21 December 2016, last major update September 2012

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: carcinoma[title] lung
Cite this page: Carcinoma-general. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/lungtumorcarcinomageneral.html. Accessed December 11th, 2017.
Definition / general
  • 95% of lung tumors are bronchogenic carcinoma
  • Others are bronchial carcinoid, mesenchymal, miscellaneous neoplasms
  • In US, lung cancer is #1 cause of cancer death in men and women; causes 30% of cancer deaths in men
  • 2012: estimated 226,160 new cases in US, 160,000 deaths (National Cancer Institute)
  • Incidence in men is 74 per 100,000 vs. 31 per 100,000 for women
  • Peaks at ages 50-69 years; 2% occur before age 40 years
Cigarette smoking
  • Causes most cases of lung cancer
  • Relative risk of smokers vs. nonsmokers is 10:1, but is 20:1 for > 40 cigarettes/day
  • Risk strongly related to number of cigarettes smoked, described in pack years (number of packs per day x number of years smoking)
  • Cigarette smoking also associated with carcinomas of lip, tongue, pharynx, larynx, esophagus, bladder, pancreas, kidney, floor of mouth
  • 10% of smokers have atypia or hyperplasia of bronchial epithelium
  • Carcinogens in tobacco smoke are benzo [a] pyrene (an initiator) and phenol derivatives (promoters)
  • Usually associated with squamous cell and small cell carcinoma, less likely with adenocarcinoma
Other causes of lung cancer
  • Radiation exposure, uranium (RR with uranium exposure is 4:1 for nonsmokers, 10:1 for smokers vs. general population)
  • Asbestos (RR is 5:1 for nonsmokers, 50-90:1 for smokers vs. general population); causes of death for asbestos workers are: 20% lung cancer, 10% mesothelioma, 10% GI carcinomas
  • Also exposure to arsenic, beryllium, chromate, coal, gold ore, iron, mustard gas, nickel, radon, vinyl chloride
Symptoms
  • Cough, weight loss, chest pain, shortness of breath, increased sputum production
  • Also acanthosis nigricans, hypertrophic pulmonary osteoarthropathy (clubbing), Horner’s syndrome (enophthalmos, ptosis, miosis, anhidrosis) due to apical lung tumors called Pancoast tumors, Lambert-Eaton myasthenic syndrome (muscle weakness due to antibodies to neuronal calcium channel), leukemoid reaction, pain in distribution of ulnar nerve, sensory peripheral neuropathy, superior vena cava syndrome (compression/invasion of SVC causes venous congestion, circulatory compromise, dusky head, arm edema)
Spread and classification
  • Spreads along bronchus distally and proximally, into lung parenchyma to mediastinum or pleura, causing pleural seeding, pleural effusion, involvement of diaphragm and chest wall
  • 50% have nodal involvement at resection (usually hilar, mediastinal and supraclavicular)
  • Also metastases to adrenals (50%), liver (30%), brain, bone
  • Also opposite lung, pericardium, kidneys
Survival (pre-EGFR inhibitors)
  • Overall 5 year survival is 10-15%
  • Only 30% have limited disease at diagnosis making resection for cure an option
  • For stage I non-small cell carcinoma, 5 year survival is 60%
  • Poor prognostic factors: high TNM stage, weight loss > 10% of body weight, age < 40 years or women (usually are high stage), small cell or giant cell subtypes, angiolymphatic invasion, pleural effusion, lack of lymphoplasmacytic reaction
Gross description
  • Arise near hilus
  • Hemorrhage, necrosis, cavities are common
  • 2-5% are multiple
  • Peripheral tumors are usually adenocarcinomas
Microscopic (histologic) description
  • See also specific subtypes
  • Begins with atypia, then warty excrescence, then fungates into lumen, penetrates wall of bronchus growing along broad front to produce a cauliflower like intraparenchymal mass
  • 80% have vascular invasion
Virtual slides

Images hosted on other servers:

Tumor emboli

Positive stains
  • May be positive for neuroendocrine markers but with no neuroendocrine morphology - recommended to either ignore neuroendocrine stain results or to diagnose as tumor with neuroendocrine features
Negative stains
Molecular / cytogenetics description
  • Dominant oncogenes are Kras (see below), c-myc (small cell carcinomas), p53, Rb, 3p suppressor gene
  • High Kras mutation rate in Western countries in lung adenocarcinoma / nonsmall cell lung cancer (25%) but less in Asian countries (0% in China, Onkologie 2008;31:174, 5% in Taiwan, Cancer 2008;113;3199, 11% in Japan, Oncol Rep 2007;18:623)
  • Kras mutations are associated with mucinous versus nonmucinous adenocarcinoma (J Mol Diagn 2007;9:320)
  • In Western patients, similar rate of Kras mutations between never, former and current smokers, although mutations were different (Clin Cancer Res 2008;14:5731)
  • Kras mutations are associated with poor prognosis and EGFR tyrosine kinase resistance (Curr Opin Pharmacol 2008;8:413)
Molecular / cytogenetics images

Images hosted on other servers:

H&E and FISH of Kras mutation