Re: [MOL]Correction on Bronchoalveloar, Important! [00160] Medicine On Line


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Re: [MOL]Correction on Bronchoalveloar, Important!



Pat you are absolutely correct.  As they say "the proof is in the pudding",
here is the proof taken from Onco Link Univ. of Pa.  I bet I don't get SCLC
and NSCLC mixed up again!!!!!

Bronchoalveolar carcinoma is one of the subtypes of adenocarcinoma in
non-small cell carcinoma of the lung. It represents approximately 10 to 25%
of the adenocarcinoma of lung cases. Cigarette smoking does not appear to
correlate with this type of cancer.

Information from PDQ -- for Health Professionals


Non-small cell lung cancer
208/00039

** GENERAL INFORMATION **

(Separate summaries containing information on prevention of lung cancer and
screening for lung cancer are also available in PDQ.)

Non-small cell lung cancer (NSCLC) is a heterogeneous aggregate of at least
3
distinct histologies of lung cancer including epidermoid or squamous
carcinoma,
adenocarcinoma, and large cell carcinoma.  These histologies are often
classified together because, when localized, all have the potential for cure
with surgical resection.  Systemic chemotherapy can produce objective
partial
responses and palliation of symptoms for short durations in patients with
advanced disease.  Local control can be achieved with radiation in a large
number of patients with unresectable disease, but cure is seen only in a
small
minority of patients.

At diagnosis, patients with NSCLC can be divided into 3 groups that reflect
the
extent of disease and treatment approach.  The first group of patients has
tumors that are surgically resectable (generally stages I and II).  This is
the
group with the best prognosis, depending on a variety of tumor and host
factors.  Patients with resectable disease who have medical
contraindications
to surgery can be considered for curative radiation therapy.  The second
group
includes patients with either locally (T3-T4) or regionally (N2-N3) advanced
lung cancer who have a diverse natural history.  This group is treated with
radiation therapy or, more commonly, with radiation therapy in combination
with
chemotherapy or other therapy modalities.  Selected patients with T3 or N2
disease can be treated effectively with surgical resection alone.  The final
group of patients have distant metastases (M1) found at the time of
diagnosis.
This group can be treated with radiation therapy or chemotherapy for
palliation
of symptoms from the primary tumor.  Patients with good performance status,
women, and patients with distant metastases confined to a single site appear
to
live longer than others.[1]  Cisplatin-based chemotherapy has been
associated
with short-term palliation of symptoms and a small survival advantage.
Currently no single chemotherapy regimen can be recommended for routine use.

For operable patients, prognosis is adversely influenced by the presence of
pulmonary symptoms, large tumor size (>3 centimeters), and presence of the
erbB-2 oncoprotein.[1-6]  Other factors that have been identified as adverse
prognostic factors in some series of patients with resectable non-small cell
lung cancer include mutation of the K-ras gene, vascular invasion, and
increased numbers of blood vessels in the tumor specimen.[3,7,8]

Since treatment is not satisfactory for almost all patients with NSCLC, with
the possible exception of a subset of pathologic stage I (T1, N0, M0)
patients
treated surgically, eligible patients should be considered for clinical
trials.


Cellular classification
Prior to initiating treatment of any patient with lung cancer, a review of
pathologic material by an experienced lung cancer pathologist is critical
since some cases of small cell lung cancer (which responds well to
chemotherapy) can be confused on microscopic examination with non-small cell
carcinoma.[1] Nonsquamous cell cancers may be more likely to recur after
surgical resection of early stage I tumors than other types of non-small
cell lung cancers.[2] Bronchoalveolar carcinoma represents 10% to 25% of
adenocarcinomas and sometimes has a distinct presentation and biologic
behavior.[3-5] Bronchoalveolar cancer may present as a more diffuse lesion
than other types of cancer; 30% to 40% of patients undergoing an attempt at
surgical resection present with an infiltrate on their chest radiograph.
Bronchoalveolar cancer is more common in women and in patients who do not
smoke cigarettes than other histologic types of lung cancer.

Histologic classification of non-small cell lung cancer: - squamous cell
(epidermoid) carcinoma - spindle cell variant - adenocarcinoma - acinar -
papillary - bronchoalveolar [4,5] - solid tumor with mucin - large cell
carcinoma - giant cell - clear cell - adenosquamous carcinoma

> Lillian,
> I'm confused (normal for me).I was under the impression that
> broncholoalveolar (BAC) is adenocarcinoma which is subdivision of
non-small
> cell lung cancer. I thought that is what the Drs at one time said but I am
> known to have "chemo fog" when I'm not even the one taking chemo.  I do
> remember being told that it is slow growing, but Daddy's has mestasticized
> to other lung.  Could you please set me straight? Thanks! Pat Kimmi-Kansas


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