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On microscopic evaluation carcinomatous cells are seen below the basement membrane of lactiferous ducts and invade into the surrounding breast stroma. Otherwise, there are no specific histologic characteristics, essentially making it a diagnosis of exclusion. The histopathologic characteristics seen in these lesions ar... |
Small inclusions of special features may be present within an invasive carcinoma NST tissue sample, but will be 'limited' (i.e. <10%). Carcinomas of mixed type will have a specialized pattern or lobular carcinoma in the majority (i.e. at least 50%) of the tumor and a non-specialized pattern in between 10 and 49% of th... |
=== Staging === |
Cancers in general will be staged according their degree of tumor size, lymph node involvement, and evidence of metastasis. There are two types, clinical staging and pathologic staging. Clinical staging uses information derived from physical examination, clinical imaging, and biopsy. Pathologic staging takes place afte... |
==== Tumor size ==== |
In clinical staging, tumor size is determined by clinical imaging. A more accurate measurement of tumor size and observation of extension into adjacent structures can be determined via pathological staging following surgery. |
==== Lymph node involvement ==== |
Absence of cancer cells in the lymph nodes is a good indication that the cancer has not spread systemically. Presence of cancer in the lymph nodes indicates the cancer may have spread. In studies, some women have had presence of cancer in the lymph nodes, were not treated with chemotherapy, and still did not have a s... |
== Grading == |
The appearance of cancer cells under a microscope is another predictor of systemic spread. The more different the cancer cells look compared to normal duct cells, the greater the risk of systemic spread. There are three characteristics that differentiate cancer cells from normal cells. |
Tendency to form tubular structures |
Nuclear size, shape, and staining intensity |
Mitotic rate - Rate of cell division |
The histologic appearance of cancer cells can be scored on these three parameters on a scale from one to three. The sum of these grades is a number between 3 and 9. The score is called a Bloom Richardson Grade (BR) and is expressed [sum of the grades]/9. For example, cells that were graded 2 on all three parameters ... |
A score of 5 and under is considered low. 6 to 7 is considered intermediate. 8 to 9 is considered high. |
=== Lymphovascular invasion === |
Lymphovascular invasion is the presence of cancer cells in lymph channels and/or blood vessels. The presence of lymphovascular invasion increases the probability of systemic spread. |
=== DNA analysis === |
DNA analysis indicates the amount of DNA in cancer cells and how fast the cancer is growing. |
Cells with the normal amount of DNA are called diploid. Cells with too much or too little DNA are called aneuploid. Aneuploid cells are more likely to spread than diploid cells. |
DNA testing indicates the rate of growth by determining the number of cells in the synthetic phase (S phase). An S phase > 10% means a higher chance of spreading. |
The results of DNA testing are considered less reliable predictors of spread than size, histology, and lymph node involvement. |
== Prognosis == |
While prognosis in invasive carcinoma NST is difficult to predict, there are some prognostic factors that help estimate survival. The factors included here tend to be generalizable to most breast cancers, and further information can be found in the main articles on breast cancer and breast cancer screening. |
The prognosis of ductal carcinomas in general depend, in part, on its histological subtype. Mucinous, papillary, cribriform, and tubular carcinomas have longer survival, and lower recurrence rates. The prognosis of the most common form of invasive carcinoma NST is intermediate. Regardless of the histological subtype, t... |
Histologic factors associated with worse prognosis include high histologic grade, hormone receptor negativity, and HER2 negativity. Regarding genetic risk factors, BRCA1-associated breast cancers may have higher rates of lung and brain metastases but a lower rate of bone metastases. Cases detected by screening have fav... |
White women have the highest rate of breast carcinoma, followed by Black, Asian/Pacific Islander, and Hispanic women. However, Black women are most likely to have greater severity of disease and triple-receptor negativity at time of diagnosis. Compared to other populations, they tend to have reduced chance of cure and ... |
In 2003, one study found the five-year survival rate of invasive carcinoma NST was approximately 85%. In general, greater tumor size and presence of lymph node metastasis predicts higher risk of recurrence after initial diagnosis and treatment. In one study, the lifetime risk of recurrence was 20% for smaller (<2 cm) t... |
== Treatment == |
The treatment of invasive carcinoma NST is often similar to management plans for other invasive breast carcinomas. The treatment options offered to an individual patient are determined by the form, stage and location of the cancer, and also by the age, history of prior disease and general health of the patient. Not all... |
Management options for patients with invasive breast carcinomas include surgery, radiotherapy, and systemic adjuvant medical therapy. Surgical treatment ranges from radical mastectomy to breast conserving procedures such as lumpectomy. Patients at risk for local recurrence of disease may be offered radiotherapy. Patien... |
Treatment of non-metastatic invasive breast cancer can vary based on staging, usually early stage (stages I and II) versus locally advanced (stage III). Patients with early stage disease may be offered surgery, including breast conserving therapy. This may be followed by radiotherapy for those at risk of local recurren... |
Prophylactic treatment may be an option for those with genetic predisposition to breast cancer. The National Comprehensive Cancer Network (NCCN) guidelines recommend bilateral prophylactic mastectomy and bilateral salpingo-oophorectomy for women who are carriers of germline BRCA1/2 mutation. At the age of 35 to 40 year... |
== See also == |
Atypical ductal hyperplasia |
Collagenous spherulosis |
Male breast cancer |
== References == |
== External links == |
Infiltrating Ductal Carcinoma Archived 2010-06-25 at the Wayback Machine |
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8b665f4e940924f280b8e1ef328457cd2ee8169f1c5625f2ef531f45f1071aa5 wp-invasive-carcinoma-nst.txt |
TITLE: Squamous-cell carcinoma of the lung |
REVID: 1322594337 |
Squamous-cell carcinoma (SCC) of the lung is a histologic type of non-small-cell lung carcinoma (NSCLC). It is the second most prevalent type of lung cancer after lung adenocarcinoma and it originates in the bronchi. Its tumor cells are characterized by a squamous appearance, similar to the one observed in epidermal ce... |
== Signs and symptoms == |
Squamous-cell lung carcinoma share most of the signs and symptoms with other forms of lung cancer. These include worsening cough, including hemoptysis, chest pain, shortness of breath and weight loss. Symptoms may result from local invasion or compression of adjacent thoracic structures such as compression involving th... |
== Causes == |
=== Risk factors === |
Squamous-cell carcinoma of the lung is closely correlated with a history of tobacco smoking, more so than most other types of lung cancer. According to the Nurses' Health Study, the relative risk of SCC is approximately 5.5, both among those with a previous duration of smoking of 1 to 20 years, and those with 20 to 30 ... |
== Mechanism == |
=== Pathogenesis === |
It most often arises centrally in larger bronchi, and while it often metastasizes to locoregional lymph nodes (particularly the hilar nodes) early in its course, it generally disseminates outside the thorax somewhat later than other major types of lung cancer. Large tumors may undergo central necrosis, resulting in cav... |
Large scale studies such as The Cancer Genome Atlas (TCGA) have systematically characterized recurrent somatic alterations likely driving lung squamous-cell carcinoma initiation and development. |
==== Gene mutations and copy number alterations ==== |
Squamous-cell lung carcinoma is one of the tumor types with the highest number of mutations since smoking, the main driver of the disease, is a strong mutagenic factor. |
Inactivating mutations in lung SCC affect many tumor suppressor genes such as TP53 (mutated in 81% of cases), MLL2 (20%), CDKN2A (15%), KEAP1 (12%) and PTEN (8%). Recurrent loss-of-function mutations have been observed also in NOTCH1 (8%), suggesting a tumor suppressive role in lung SCC for this gene, that has also bee... |
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