An interesting study of lung cancers at a tertiary care centre

 

 

Abstract              Background: Lung cancer is one of the leading causes of cancer related deaths among both men and women. Non small cell lung carcinomas comprises the majority (about 75%) of lung cancer, has proven difficult to treat due to poorly understood pathological mechanism. Aims and objectives: To study the incidence of lung carcinomas at our institute, And diagnose the lung carcinomas and subtype them by histopathology on bronchoscopic biopsies. Materials and methods: A retrospective and prospective study of bronchial biopsies diagnosed as Non small cell carcinomas by histopathology on hematoxylin and eosin stain in a duration of two years and use IHC markers in a few cases like EGFR and TTF markers. Results: Out of twenty nine (29) cases of lung malignancies majority were Nonsmall cell carcinomas- twenty seven cases (27) ,of which adenocarcinomas were seventeen (17) cases topped the list, followed by squamous cell carcinomas (5) cases, malignant epithelial lesions (3) cases and poorly differentiated carcinomas(2) cases. Conclusions: Histopathology is gold standard in diagnosing lung cancers, non small cell carcinomas of lung are more common.

Key Word: lung, cancer.

 

INTRODUCTION

Lung cancer is the leading cause of cancer death worldwide. It is estimated that about 1 million people die of cancer every year.^1,2 Non-small cell lung carcinoma (NSCLC) accounts for 80-85% of all lung carcinomas, and adenocarcinoma is the predominant histologic type. The prognosis of these patients remains poor, with an overall 5-year survival rate of less than 15% despite the advanced therapeutic options available.³ Recent studies suggest the existence of two distinct molecular pathways in the carcinogenesis of lung adenocarcinomas, one associated with smoking and activation of the k-ras oncogene and the other not associated with smoking and activation of epidermal growth factor receptor (EGFR).Histopathology is gold standard in diagnosing lung carcinomas on bronchial biopsies.

 

MATERIALS AND METHODS

A retrospective and prospective study of lung biopsies diagnosed as Non-small cell carcinomas in two years (2017-2018) period. Paraffin blocks of all the cases of poorly differentiated NSCLC reported between 2017 and 2018 were retrieved from the archives of the Pathology Department of Asram medical College and were included in the study. Five-micron-thick paraffin sections were cut and immunostained for TTF-1, p-63, EGFR in few cases and the tumors were sub typed. ⁴ Clinical characteristics and treatment details were collected from the patient's medical records.

 

RESULTS

Out of twenty nine (29) cases of lung malignancies majority were non-small cell carcinomas (27) -93% and small cell carcinomas were two (2) cases- 7%. (FIG: 1) Out of (27) non-small cell carcinomas there were adenocarcinomas seventeen (17) cases- 63% topped the list, followed by squamous cell carcinomas (5) 18% , malignant epithelial lesions (3) 11% and poorly differentiated carcinomas(2) 7 %cases. (FIG: 3)There were 14 males (52%) and 13 females (48%) of 27 NSCLCS. (FIG: 2)

DISCUSSION

The incidence of lung carcinoma in India is on the rise. NSCLC accounts for 80-85% of all lung carcinomas, and adenocarcinoma is the predominant histologic type with a male predominance (M: F ratio: 1.7:1) similar to our study. Non small cell carcinoma accounted for majority of lung carcinomas and some of our patients presented with advanced disease at the time of diagnosis in our study^9.Adenocarcinoma is one of the most common histological subtypes of NSCLC^10,11. Tobacco smoking continues to be the leading cause of lung cancer worldwide. However, an increase in the incidence of adenocarcinoma among non-smokers and women is noted in North America and Europe. Some of patients with squamous cell carcinoma were smokers. Globally, the overall lifetime risk of lung cancer is about 1 in 13 for men and 1 in 16 for women. Males were more commonly affected in our study. The risk is significantly higher for smokers and lower for non-smokers. Unfortunately, despite the therapeutic advances, the prognosis of patients with lung cancer (5-year overall survival rate of 15%) has not changed dramatically in the past 30 years.^5,6,7 Currently, diagnostic and treatment approaches to lung carcinoma, mainly adenocarcinoma, are undergoing a revolution. The classification of lung carcinoma is going beyond small cell carcinoma and non-small cell carcinoma. Precise subcategorization of NSCLC into adenocarcinoma and squamous cell carcinoma has a direct impact on patient management and prognosis. Presence of EGFR mutations in adenocarcinoma is a predictor of responsiveness to EGFR tyrosine kinase inhibitors. The diagnosis of lung carcinoma is a multidisciplinary process requiring correlation with clinical, radiologic, molecular and surgical information.⁸ Conclusions- Histopathology is gold standard in diagnosing lung cancers, non small cell carcinomas of lung are more common. Immunohistochemistry was useful in diagnosing some cases.

 

REFERENCES

1. Rawat J, Sindhwani G, Gaur D, Dua R, Saini S. Clinico-pathological profile of lung cancer in Uttarakhand. Lung India 2009; 26: 74-6.
2. Kumar BS, Abhijit M, Debasis D, Abinash A, Ghoshal AG, Kumar DS. Clinicopathological profile of lung cancer in a tertiary medical centre in India: Analysis of 266 cases. J Dent Oral Hyg2011; 3: 30-3.
3. de Mello RA, Marques DS, Medeiros R, Araujo AM. Epidermal growth factor receptor and K-ras in non-small cell lung cancer-molecular pathways involved and targeted therapies. World J Clin Oncol 2011; 2: 367-76.
4. Engel KB, Moore HM. Effects of preanalytical variables on the detection of proteins by immunohistochemistry in formalin fixed paraffin Embedded Tissue. Arch Pathol Lab Med 2011; 135: 537-43.
5. Cagle PT, Dacic S, Allen TC. Genomic pathology: Challenges for implementation. Arch Pathol Lab Med 2011; 135: 967-8.
6. Cagle PT, Allen TC. Lung cancer genotype-based therapy and predictive biomarkers: Present and future. Arch Pathol Lab Med 2012; 136: 1482-9.
7. Cagle PT, Chirieac LR. Advances in treatment of lung cancer with targeted therapy. Arch Pathol Lab Med 2012; 136: 504-9.
8. Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger K, Yatabe Y, et al. International Association for the study of lung cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary Classification of lung adenocarcinoma. J Thorac Oncol 2011; 6: 244-85.
9. Crinò L, Weder W, van Meerbeeck J and Felip E. Early stage and locally advanced (non-metastatic) non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010; 21 Suppl 5: v103-v115.
10. Youlden DR, Cramb SM and Baade PD. The International Epidemiology of Lung Cancer: geographical distribution and secular trends. J Thorac Oncol 2008; 3: 819-831. [4] Couraud S, Zalcman G, Milleron B, Morin F and Souquet PJ. Lung cancer in never smokers--a review. Eur J Cancer 2012; 48: 1299-131.
11. Dearden S, Stevens J, Wu YL and Blowers D. Mutation incidence and coincidence in non small-cell lung cancer: meta-analyses by ethnicity and histology (mutMap).

 

 

 

 

 

 

 

 

 

 

 

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