Carcinoma

Carcinoma is a type of cancer that starts in cells that make up the skin or the tissue lining
organs, such as the liver or kidneys. Like other types of cancer, carcinomas are abnormal cells
that divide without control.
Example:
Examples of carcinomas include prostate cancer, breast cancer, lung cancer, and colorectal
cancer.

Cancer diagnosis

Your doctor may use one or more approaches to diagnose cancer:

 Physical exam. Your doctor may feel areas of your body for lumps that may
indicate cancer. During a physical exam, your doctor may look for abnormalities,
such as changes in skin color or enlargement of an organ, that may indicate the
presence of cancer.

 Laboratory tests. Laboratory tests, such as urine and blood tests, may help your
doctor identify abnormalities that can be caused by cancer. For instance, in people
with leukemia, a common blood test called complete blood count may reveal an
unusual number or type of white blood cells.
 Imaging tests. Imaging tests allow your doctor to examine your bones and internal
organs in a noninvasive way. Imaging tests used in diagnosing cancer may include
a computerized tomography (CT) scan, bone scan, magnetic resonance imaging
(MRI), positron emission tomography (PET) scan, ultrasound and X-ray, among
others.

 Biopsy. During a biopsy, your doctor collects a sample of cells for testing in the
laboratory. There are several ways of collecting a sample. Which biopsy procedure
is right for you depends on your type of cancer and its location. In most situations,
a biopsy is the only way to definitively diagnose cancer.

In the laboratory, doctors look at cell samples under the microscope. Normal cells
look uniform, with similar sizes and orderly organization. Cancer cells look less
orderly, with varying sizes and without apparent organization.

Lung Carcinoma (Adenocarcinoma)

Non-small cell lung carcinoma with glandular differentiation, mucin production, or pneumocyte
marker expression.

Epidemiology
 Most prevalent non-small cell lung carcinoma
 Most common type of lung cancer in male non smokers
 African Americans > Caucasians 
 Age 60 – 70

Sites
 Upper lobe > lower lobe
 Peripheral > central 
 Metastasis: brain (often only site) > bone > liver > adrenal
 Risk for brain metastasis increases with tumor size and lymph node stage
Pathophysiology
 Toxic cellular exposures → genetic mutations → proliferation of endobronchial cells
 Genetic events were characterized by TCGA project

Etiology
 Smoking greatest risk factor, including secondhand smoke 
 Radon from soil, usually in residential areas
 Cooking oil fumes, particularly in Asia
 Asbestos exposure, usually occupational (ship building, construction) 
 Prognosis and histologic pattern distribution according to the new IASLC/ATS/ERS
classification
AIS and MIA had 100% disease free survival rate in all studies except for the study from Yeh et
al. Among invasive adenocarcinoma subtypes, LEP-predominant invasive adenocarcinoma has
better prognosis as compared with other subtypes. In contrast, MIP and SOL-predominant
subtypes generally have poorer prognosis than the others. In all studies, ACI and PAP subtypes
account for the majority of histologic subtype distribution. In most studies their survival rates are
similar or lower than those of AIS/MIA or LEP subtypes and higher than those of SOL or MIP
subtypes.
AIS, adenocarcinoma in situ; MIA, minimally invasive adenocarcinoma; DFS, disease-free
survival; LEP, lepidic; MIP, micropapillary; SOL, solid; ACI, acinar; PAP, papillary
†Russell et al was the only study included that used a study endpoint of overall survival (OS).
*5-yr DFS rate could not be applied because of a small number of patients in MIP group.

Clinical features
 Cough, (productive if mucinous adenocarcinoma hemoptysis, dyspnea, weight loss, chest pain
 Paraneoplastic / endocrine syndromes are much less common than in small cell lung carcinoma
 Hypertrophic pulmonary osteoarthropathy with clubbing of the fingers, symmetric
polyarthritis, periostitis of the long bones
 Diagnosis
 Histological, based on morphology and staining pattern

Radiology description
 Well defined borders, lobulated or spiculated; presence of air bronchograms
 Solid, dense areas have solid or acinar patterns
 Ground glass opacities are mucinous subtype or lepidic pattern.

Treatment
 For stages I, II, IIA: surgical resection (preferred) + adjuvant chemotherapy (platinum based) and
radiation
 Inoperable or metastatic: chemotherapy variable radiation