This document provides an overview of lung cancer pathology and diagnosis. It discusses the epidemiology, pathogenesis, clinical presentation, pathology, classification, diagnostic evaluation, and immunohistochemistry of lung cancer. Key points include that lung cancer is commonly caused by smoking and air pollution. Pathologically, lung cancers are classified as small cell lung cancer and non-small cell lung cancer, which includes squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. Diagnosis involves imaging, sputum cytology, biopsy, histopathology, and immunohistochemistry to identify diagnostic and predictive markers.
This document provides an overview of lung cancer pathology and diagnosis. It discusses the epidemiology, pathogenesis, clinical presentation, pathology, classification, diagnostic evaluation, and immunohistochemistry of lung cancer. Key points include that lung cancer is commonly caused by smoking and air pollution. Pathologically, lung cancers are classified as small cell lung cancer and non-small cell lung cancer, which includes squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. Diagnosis involves imaging, sputum cytology, biopsy, histopathology, and immunohistochemistry to identify diagnostic and predictive markers.
This document provides an overview of lung cancer pathology and diagnosis. It discusses the epidemiology, pathogenesis, clinical presentation, pathology, classification, diagnostic evaluation, and immunohistochemistry of lung cancer. Key points include that lung cancer is commonly caused by smoking and air pollution. Pathologically, lung cancers are classified as small cell lung cancer and non-small cell lung cancer, which includes squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. Diagnosis involves imaging, sputum cytology, biopsy, histopathology, and immunohistochemistry to identify diagnostic and predictive markers.
This document provides an overview of lung cancer pathology and diagnosis. It discusses the epidemiology, pathogenesis, clinical presentation, pathology, classification, diagnostic evaluation, and immunohistochemistry of lung cancer. Key points include that lung cancer is commonly caused by smoking and air pollution. Pathologically, lung cancers are classified as small cell lung cancer and non-small cell lung cancer, which includes squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. Diagnosis involves imaging, sputum cytology, biopsy, histopathology, and immunohistochemistry to identify diagnostic and predictive markers.
www.intercancer.com EPIDEMIOLOGY • Distribution: • Globally: –Most frequently diagnosed Ca –Leading cause of cancer death • Regionally: –Important cause of cancer morbidity –Paucity of data, mostly undiagnosed. –More emphasis has been on other Cancers-B,C,P,AM, C • 40- 70 years, peak incidence in 50’s • Determinants: • Environmental factors: Tobacco (Cigarette) smoking, Air pollution, industrial hazards (asbestos, Uranium, Chromium) Ionizing radiation
• Genetic factors: Stepwise accumulation of ‘Driver’ mutations
– Genetic polymorphisms in P450, DNA repair genes – Chr’ deletions with loss of function mutations- TP53, RB,CDKN2A,FGFR1 – Oncogenic gain of function mutations- TRK-EGFR,ALK,ROS,MET, RET; KRAS International Cancer Institute 2020. www.intercancer.com PATHOGENESIS
• Tobacco smoking is a key risk factor- Intensity &
Duration • Initiation of a stepwise path to neoplastic transformation
A) Sq Metaplasia Squamous Scc in Situ Invasive SCC
BCH/GCH Dysplasia Microinvasive B) AAH AIS Invasive ADC adenocarcinoma International Cancer Institute 2020. www.intercancer.com International Cancer Institute 2020. www.intercancer.com International Cancer Institute 2020. Sequence of events:- www.intercancer.com CLINICAL PRESENTATION:
+ Weight loss
International Cancer Institute 2020.
www.intercancer.com PATHOLOGY & CLASSIFICATION
• Lung cancer broadly classified into:
Small Cell Lung Cancer Non- Small Cell Lung Cancer- SCC, ADC,LCC
• 2015 WHO classification of Lung tumors
Includes other non Carcinoma lesions
International Cancer Institute 2020.
www.intercancer.com International Cancer Institute 2020. www.intercancer.com Squamous Cell Carcinoma
• Commonest histologic type
• Highly associated with tobacco smoking • Chr’ Del 3p,9p,17p with loss of fxn mutations • Precursor lesions- Sq. metaplasia, Dysplasia, CIS • Gross types: Central (Hilar), Diffuse, Peripheral (nodular) • Keratinization, Intercellular bridges • P40, P63, CK5/6 positive in IHC International Cancer Institute 2020. www.intercancer.com Central (Hilar) Diffuse
Peripheral (nodular) International Cancer Institute 2020. www.intercancer.com Histologic features
Intercellular bridges Keratinization with pearls
International Cancer Institute 2020.
www.intercancer.com IHC
H&E P40 IHC staining
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www.intercancer.com ADENOCARCINOMA
• Mostly in NEVER (NON)smokers, Females
• Oncogenic gain of fxn mutations- EGFR,ALK,KRAS • Precursors are AAH & AIS • Gross: Peripheral tumour with central scar • Gland forming malignant cells, 5 main patterns-: • Early metastasis • TTF1 and Napsin A positive on IHC • DDX: Metastasis International Cancer Institute 2020. www.intercancer.com International Cancer Institute 2020. www.intercancer.com AAH AIS, Mucinous
International Cancer Institute 2020.
AIS www.intercancer.com ADC, Lepidic predominant International Cancer Institute 2020. www.intercancer.com Invasive Mucinous (Colloid) Clear cell ADC
International Cancer Institute 2020.
www.intercancer.com Small cell carcinoma
• Arises from “Kulchtisky” cells
• Central, highly aggressive • Hilar and mediastinal node involvement • myc amplification • Associated with Paraneoplastic syndromes
International Cancer Institute 2020.
www.intercancer.com Small cell carcinoma
Small, round blue cells, crush
artefacts, necrosis, mitosis Neuroendocrine features
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www.intercancer.com Large cell carcinoma Diagnosis of exclusion: “an undifferentiated malignant epithelial tumor that lacks the cytologic features of small-cell carcinoma and glandular or squamous differentiation.” Composed of large neoplastic epithelial cells
Neuroendocrine features
International Cancer Institute 2020.
www.intercancer.com DIAGNOSTIC EVALUATION:
• History and physical examination
• Chest Imaging- CXR, CT • Sputum, BAL, Brushings Cytology • Image guided biopsy and histology • Immunohistochemistry • TTF1,NapsinA, P40, P63,CK5/6,Chromogranin • PD-L1, EGFR,……etc • Molecular studies—EGFR, KRAS, ROS etc… International Cancer Institute 2020. www.intercancer.com Sputum
BW CXR
Core needle biopsy
& Histopathology International Cancer Institute 2020. www.intercancer.com IHC
Diagnostic markers & Predictive markers
International Cancer Institute 2020.
www.intercancer.com International Cancer Institute 2020. www.intercancer.com Questions and Comments?
International Cancer Institute 2020.
www.intercancer.com REFERENCES
• Robbins & Cotram Pathologic basis of Disease 9th Edition
• https://www.webpathology.com/ • IHC for Diagnosis and Prediction in NSCLC: Adv Anat Pathol Volume 25, Number 6 • Classification of Lung tumors by Dr Kamal B. S • https://www.diomedia.com/ Rosen • The 2015 World Health Organization Classification of Lung Tumors • Globocan 2018
A Study To Evaluate The Effectiveness of Competency Programme On Central Venous Catheter Care in Terms of Knowledge and Practice Among I C U Nurses at Selected Hospital at Meerut
A Study To Evaluate The Effectiveness of Competency Programme On Central Venous Catheter Care in Terms of Knowledge and Practice Among I C U Nurses at Selected Hospital at Meerut
