Mapping lung squamous cell carcinoma pathogenesis through in vitro and in vivo models.

Lung cancer is the main cause of cancer death worldwide, with lung squamous cell carcinoma (LUSC) being the second most frequent subtype. Preclinical LUSC models recapitulating human disease pathogenesis are key for the development of early intervention approaches and improved therapies. Here, we review advances and challenges in the generation of LUSC models, from 2D and 3D cultures, to murine models. We discuss how molecular profiling of premalignant lesions and invasive LUSC has contributed to the refinement of in vitro and in vivo models, and in turn, how these systems have increased our understanding of LUSC biology and therapeutic vulnerabilities.

Tumor endobronquial solitario debido a sarcoidosis: imagen de broncoscopia de autofluorescencia / Solitary Endobronchial Tumor Due to Sarcoidosis: An Autofluorescence Bronchoscopic

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Papel de las técnicas de imagen en la nueva clasificación TNM del carcinoma broncogénico no microcítico / Role of imaging techniques in the TNM classification of non-small cell bronchogenic carcinoma

La séptima edición de la clasificación TNM para los carcinomas broncogénicos no microcíticos incluye una serie de cambios en los descriptores T y M, particularmente una reclasificación de los derrames malignos pleurales y pericárdicos y de los nódulos tumorales separados, nuevos valores de corte de tamaño tumoral y subdivisiones de las categorías T1-T2 y M1. Revisamos estas correcciones, que generan cambios en el sistema de estadificación que afectan a los estadios II-III. Además, describimos e ilustramos el papel de las diferentes técnicas de imagen en la estadificación tumoral (TC, PET, PET-TC y RM), resaltando sus respectivas indicaciones, ventajas y desventajas, así como su función complementaria (AU)

The Seventh Edition of the TNM Classification for non-small cell bronchogenic carcinomas include a series of changes in the T and M descriptor, in particular a re-classification of malignant pleural and pericardial effusions and of separated tumour nodes, new tumour size cut-off values and sub-divisions of the T1-T2 and M1 categories. We review these corrections that led to the changes in the staging system that affects stages II-III. Furthermore, we describe and illustrate the role of the different imaging techniques in tumour staging (CT, PET, PET-CT and MRI), highlighting their respective indications, advantages and disadvantages, as well their complementary function (AU)

Técnicas endoscópicas en carcinoma broncogénico. Cambios en las últimas décadas / Endoscopic techniques in bronchogenic carcinoma. Changes in recent decades

Mujer de 57 años con antecedentes de hipertensión arterial en tratamiento. Es fumadora habitual desde los 18 años con un consumo acumulado de 70 años/paquete. Fue estudiada en la consulta de neumología por clínica de síndrome constitucional objetivándose en la radiografía de tórax una imagen de lesión pulmonar focal en lóbulo superior derecho de más de 3cm de localización periférica. Se realizó una Tomografia Axial Computarizada (TAC) de tórax en el que se confirmó la existencia de una masa pulmonar de 3,3cm, con adenopatías mediastínicas paratraqueales y subcarinales. Posteriormente se realizó una Tomografía por Emisión de Positrones (PET) en la que se confirmó captación patológica de la masa y de ambas localizaciones ganglionares. ¿Qué estudios adicionales le parecen más adecuados para realizar un correcto diagnóstico y estadificación ganglionar? ¿Es posible solo con la broncoscopia establecer un correcto diagnóstico y estadificación del caso?(AU)

A 57-year old woman with arterial hypertension under treatment. She has smoked since she was 18 years old with an accumulated index of 70 years/pack. She was studied in our Respiratory Department due to constitutional syndrome, the X-ray showing an image of focal pulmonary lesion in the right upper lobe of more than 3cm of peripheral location. The computed tomography (CT) scan confirmed the existence of a 3.3cm mass in the upper right lobe and detected paratracheal and subcarinal mediastinal abnormal lymph nodes. A subsequent Positron Emission Tomography (PET) confirmed pathological uptake of the mass and both lymph node locations. Which additional studies do you consider to be indicated for a correct diagnosis and mediastinal staging? Do bronchoscopy techniques alone establish the final diagnosis and staging of this patient?(AU)

Comparison between young and old patients with bronchogenic carcinoma.

OBJECTIVE: This study was undertaken to explore the clinicopathological profile of bronchogenic carcinoma in young patients. MATERIALS AND METHODS: The present study was conducted on 799 consecutive histopathologically proven cases of bronchogenic carcinoma that were referred from different parts of Uttar Pradesh. RESULTS: Out of 799 patients, 73 patients (9.1%; 59 males and 14 females) were < or = 40 years of age and were classified as 'young' patients. The mean ages of the subjects in the younger and older patient groups were 36 and 58 years, respectively. Among the older patients, 590 (81.3%) were smokers, and there were 53 (72.6%) smokers among the younger patients. Squamous cell carcinoma was the commonest histological subtype in both the groups, but squamous cell carcinoma was more frequently diagnosed in older patients than in younger patients. CONCLUSION: This study suggests that, regardless of age or sex, lung cancer must be ruled out in all patients who have persistent signs of pulmonary disease and a history of heavy smoking.

[Pain management, let us be simple but efficient]. / Prise en charge de la douleur, soyons simple mais efficace.

The occurrence of pain during the course of bronchial carcinoma is nearly inescapable and often constitutes the main symptom for patients and those close to them. While pain control is held to be a priority of care in cancerology in the future, this goal is not always reached due to insufficient implementation of recommendations, however widely accessible. Our aim is to present the different aspects of pain treatment through the details of both pharmacological and nonpharmacological means.

[Thrombosis and lung cancer]. / Thrombose et cancer bronchique.

This relation is sometimes described as a double association: venous thromboembolism (VTE) can reveal cancer (so-called Trousseau syndrome), but cancer and its treatment are also risk factors for VTE. Lung cancer, frequent and serious, is one of the greatest purveyors of VTE, a disease that pneumologists and oncologists must often confront in diagnosis, prevention, and treatment. This article investigates the epidemiological, prevention, and treatment aspects of VTE in cancer patients, particularly those with lung cancer, but also discusses diagnostic specificities and, briefly, the possible antitumor effect of heparins.

[Fever and infectious complications in patient with lung cancer]. / Fièvre et complications infectieuses chez un patient porteur d'un cancer bronchique.

The respiratory infections are very frequent during lung cancer. Their diagnosis is often difficult because of the various etiologies (cancer, chemotherapy, radiotherapy) and this complexity can make discuss a preliminary bronchial exploration before any therapeutics. When it is about a located infection, germs in cause are often the same that in the community respiratory infections, in particular bacilli Gram negative, and it is thus logical to treat by the penicillin A. In front of an interstitial syndrome, it is necessary to evoke the opportunist infections, which are increasing in patients with cancer because of the multimodality therapeutic and the elongation of the survival. The neutropenic patient must be distinguished because of its specificities. The pulmonary infections lead to an important mortality. According to the patient (advanced age, underlying chronic obstructive pulmonary disease [COPD]) and to the treatment (chemotherapy, pneumonectomy), prevention must be discussed as the pneumococcal and Haemophilus influenzae vaccination.

[Palliative therapy in bronchial carcinoma--implanted delivery system and ports]. / Palliative Therapie des Bronchialkarzinoms: Schmerzpumpen und Ports.

This case report of a 54-year-old patient, with a metastasized non-small cell bronchial carcinoma, shows us the different ways in pain therapy alternatives. We report the possibility of using spinal delivery systems (especially epidural/intrathecal) in palliative therapy, if like in this case oral applicated opioids were not very successful. We discuss the advantages and disadvantages of this method and point out the possible side effects. Finally, we conclude that it has to be decided on a case per case basis, if this therapy is applicable or not.

A new catheter technique for thoracic subarachnoid neurolysis in advanced lung cancer patients.

Subarachnoid neurolytic block (dorsal rhizotomy) was carried out in patients suffering from severe pain unresponsive to analgesic therapy. An intrathecal catheter technique was performed in 20 patients with lung cancer. Visual analog scale (VAS) for pain, patient satisfaction, and complications were recorded at 24 hours, 1 week, and 1, 2, and 3 months after procedure. VAS and patient satisfaction significantly decreased at measured time points (P < 0.05). Duration of procedure was 20.3 +/- 6.4 minutes; no significant complications were reported. This new intrathecal catheter technique for dorsal rhizotomy in advanced lung cancer patients was an easily performed, effective, and safe technique in this setting.

Ventilation-perfusion scintigraphy to predict postoperative pulmonary function in lung cancer patients undergoing pneumonectomy.

OBJECTIVE: The American College of Chest Physicians (ACCP) recommends using quantitative perfusion scintigraphy to predict postoperative lung function in lung cancer patients with borderline pulmonary function tests who will undergo pneumonectomy. However, previous scintigraphic data were gathered on small cohorts more than a decade ago, when surgical populations were significantly different with respect to age and sex compared with typical lung cancer patients undergoing pneumonectomy in 2005. We therefore revisited the use of V/Q scintigraphy in pneumonectomy patients in predicting postoperative pulmonary function and the appropriateness of current clinical guidelines. CONCLUSION: Contrary to ACCP guidelines, we found that ventilation scintigraphy alone provided the best correlation between the predicted and actual postoperative values and recommend its use to predict postoperative lung function. However, scintigraphic techniques may underestimate postoperative lung function, so caution is required before unnecessarily preventing a patient from undergoing surgery that offers a potential cure.

Endobronchial stent for malignant airway obstructions.

BACKGROUND: Endobronchial stents are used to treat symptomatic patients with benign or malignant airway obstructions. OBJECTIVES: To evaluate the safety and outcome of airway stent insertion for the treatment of malignant tracheobronchial narrowing. METHODS: The files of all patients with malignant disease who underwent airway stent insertion in our outpatient clinic from June 1995 to August 2004 were reviewed for background data, type of disease, symptoms, treatment, complications and outcome. RESULTS: Airway stents were used in 34 patients, including 2 who required 2 stents at different locations, and one who required 2 adjacent stents (total, 37 stents). Ages ranged from 36 to 85 years (median 68). Primary lung cancer was noted in 35% of the patients and metastatic disease in 65%. Presenting signs and symptoms included dyspnea (82%), cough (11.7%), hemoptysis (9%), pneumonia (5.9%), and atelectasis (3%). The lesions were located in the left mainstem bronchus (31%), trachea (26%), right mainstem bronchus (26%), subglottis (14.3%), and bronchus intermedius (2.9%). Conscious sedation alone was utilized in 73% of the patients, allowing for early discharge. Eighteen patients (50%) received brachytherapy to the area of obstruction. Complications included stent migration (one patient) and severe or minimal bleeding (one patient each). Ninety-four percent of the patients reported significant relief of their dyspnea. Three of the four patients who had been mechanically ventilated before the procedure were weaned after stent insertion. Median survival from the time of stent placement was 6 months (range 0.25-105 months). CONCLUSION: Stent placement can be safely performed in an outpatient setting with conscious sedation. It significantly relieves the patient's symptoms and may prolong survival.

Preoperative assessment for lung cancer surgery.

PURPOSE OF REVIEW: Pulmonary resection remains the only curative treatment option for lung cancer surgery. This review summarizes recent advances in the preoperative functional evaluation of the patient with lung cancer. RECENT FINDINGS: The workup of patients with bronchogenic carcinoma covers three areas: tumor type, tumor extent, and patient cardiopulmonary reserves. Significant advances have been made in the latter two areas. Traditionally lobectomy was regarded as the minimum resection for lung cancer; new studies are challenging this view and suggesting that segmentectomy is acceptable for stage Ia cancers < or =20 mm. An important change relating to cardiopulmonary reserves of the patient is the shift in emphasis toward early exercise testing and, in particular, the use of stair climbing as a surrogate marker of maximal oxygen consumption. New studies confirm the benefit of combined lung volume reduction surgery and lung cancer surgery in certain patients who might otherwise be excluded from surgery because of poor lung function. SUMMARY: Advances in the preoperative workup of lung cancer patients and in surgical techniques are permitting resections in previously inoperable patients. A new, simplified algorithm for the preoperative workup of lung cancer patients assessing the value of stair climbing as a surrogate marker of maximal oxygen consumption is proposed.

Lung resection for bronchogenic carcinoma after pneumonectomy: a safe and worthwhile procedure.

OBJECTIVES: Patients treated surgically for lung cancer can develop either a metachronous cancer or a recurrence. The appearance of a new cancer on the remaining lung after a pneumonectomy poses unique treatment problems, and surgery is often considered contraindicated. We report on the outcome of resections for lung cancer after pneumonectomy performed for lung cancer. METHODS: We reviewed the records of patients who underwent a resection of bronchogenic carcinoma on the remaining lung from 1990 to 2002. RESULTS: There were 14 patients (13 males and 1 female) with a median age of 64 years (range 51-74). Median preoperative Fev1 was 1.45 (range 1.35-2.23), corresponding to 59% of predicted Fev1 (range 46-80%). Resection was performed between 11 and 264 months after pneumonectomy (median 35.5). The resections performed were: one wedge resection in 11 patients, two wedge resections in two patients and two segmentectomies in two other patients; one patient underwent a third resection. Diagnosis was metachronous cancer in 12 patients and metastasis in two patients. Complications occurred in three patients (21%), while operative mortality was nil. Mean hospital stay was 10.5 days (6-25). Two patients received chemotherapy (one after local recurrence, one after the third resection). Overall 1, 3 and 5 year survivals were 57, 46 and 30%, respectively (median 21 months). For patients with a metachronous cancer they were 69, 55 and 37% (median 57 months), respectively, while neither patient with a metastatic tumor survived 1 year (P=0.03). CONCLUSIONS: Limited lung resection on a single lung is a safe procedure associated with acceptable morbidity and mortality rates. In patients with a metachronous lung cancer, long-term survival with a good quality of life can be obtained with limited resection on the residual lung.

[Clinical and morphologic correlations in bronchoalveolar cancer]. / Kliniko-morfologicheskie paralleli pri bronkhioloal'veoliarnom rake lëgkogo.

Bronchioloalveolar carcinoma is a variety of lung adenocarcinoma featuring peculiar morphological pattern, period of latency, long symptom-free course, no association with smoking, younger age of victims and prevalent frequency in women. While there are no reliable diagnostic criteria, radical surgery has good prognosis (3-year overall or relapse-free survival is 88.9 and 66.7%, respectively). Prognostically significant are such morphological subtypes as mucigenous and non-mucigenous carcinoma. The study included patients with stage I and II carcinoma. Regional dissemination incidence was significantly lower than in other varieties of lung adenocarcinoma.

Effect of exercise on lung-perfusion scanning in patients with bronchogenic carcinoma.

The aim of this study was to determine whether perfusion-scintillation scanning, used as a predictive pre-operative index of lung functionality in patients with lung cancer, is affected by the level of pulmonary blood flow (PBF). Twenty patients with primary lung cancer underwent spirometry and a radionuclide-perfusion scan (macroaggregated albumin particles labelled with 99mTechnetium) both at rest and during the last minute of a ramp-like increase in work rate until exhaustion. On average, the perfusion of the lung with the tumour was significantly reduced by the same magnitude at rest and during exercise (mean+/-SD: -9+/-6% versus -10+/-4% of the cardiac output), regardless of the extent of the tumour. However, subject-by-subject analysis revealed that in two patients, a larger decrease in the perfusion of the lung with the tumour was observed during exercise than at rest (-11% and -17%, respectively). This leads to an underestimation of predictive postoperative functional parameters if resting values are used in these patients. The use of perfusion scintigraphy at rest therefore gives a clear picture of the functionality of the lung before resection in most patients requiring surgery.