Pathological Treatment in Bronchial Carcinoma

Bronchial carcinoma is divided into small cell carcinoma and non small cell carcinoma, a division based on the characteristics of the disease and its response to treatment.

Studies of mean doubling times of carcinomas indicate that development from the initial malignant change to presentation takes many years, for adenocarcinoma it takes approximately 15 years, for squamous carcinoma 8 years and for small cell carcinoma 3 years.

Squamous or Epidermoid carcinoma is the commonest carcinoma in this group, accounting for approximately 40% of all carcinomas. It occasionally cavitates, and widespread metastases occur relatively late.

Large cell carcinoma represents a less well differentiated tumour that metastasizes early. It accounts for 25% of all tumours. Adenocarcinoma arises peripherally from mucous glands in the small bronchi and often produces a subpleural mass.

Invasion of the pleura and the dediastinal lymph nodes is common, as are metastases to the brain and bones. Adenocarcinoma accounts for approximately 10 percent of all bronchial carcinomas and frequently arises in or around scar tissue.

It is the commonest bronchial carcinoma associated with asbestos and is proportionally more common in non smokers, in women, in the elderly and in the Far East.

Alveolar cell carcinoma (bronchiolar carcinoma) accounts for only 1-2% of lung tumours and occurs either as a peripheral solitary nodule or as diffuse nodular lesions of multicentric origin. Occasionally this tumour is associated with expectoration of very large volumes of mucoid sputum.

Small cell carcinoma: This tumour, often called oat-cell carcinoma, accounts for 20-30 percent of all lung cancers. It arises from endocrine cells. These cells are members of the APUD system, which explains why many polypeptide hormones are secreted by these tumours.

Some of these polypeptides act in an autocrine fashion, i.e. they feed back on the cells and cause cell growth. Small cell carcinoma is now considered to be a systemic disease. Although the tumour is rapidly growing and highly malignant, it is the only one of the bronchial carcinomas that responds to chemotherapy.

The following gives the death rates from lung cancer (age standardized) per 100000 according to tobacco consumption:

Non-Smokers 10
Ex-Smokers 43

Continuing Smokers
Any tobacco 104
Pipe / Cigar 58
Cigarette 140

Number of Cigarettes
1-14 per day 78
15-24 per day 127
25 or more 251

Common Cell types of Bronchial Carcinoma:

Squamous 50%
Small Cell 25%
Adenocarcinoma 15%
Large Cell 10%

Bronchial carcinomas arise from the bronchial epithelium or mucous glands. When the tumour obstructs a large bronchus it causes pulmonary collapse and infection and symptoms arise early.

A tumour of a peripheral bronchus may however attain a very large size without producing symptoms. Such tumour, which is usually of the squamous type, may undergo central necrosis and cavitations when it may have similar radiographic features to a lung abscess.

 

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