Staging of lung cancer.
1.Undifferentiated carcinoma (small cell carcinoma)
The incidence rate is second only to squamous carcinoma, mostly seen in men, with a younger age of onset, and generally originates from larger bronchi. Centralized lung cancer can be divided into several types, such as oat cell, small round cell and large cell, according to the morphology of tissue cells, among which oat cell is the most common. Undifferentiated carcinoma is highly malignant, fast-growing, and has early lymphatic and hematologic metastasis, and is more sensitive to radiation and chemotherapy.
2.Squamous cell carcinoma (also called squamous carcinoma)
It is the most common among all types of lung cancer, accounting for about 50%. The age of disease is mostly above 50 years old, and men account for most of the cases. Most of them originate in the larger bronchi and are often central lung cancers. Although the degree of differentiation of squamous carcinoma varies, it generally grows more slowly and has a longer course. It is more sensitive to radiation and chemotherapy. It first metastasizes via lymphatic metastasis, and hematogenous metastasis occurs later.
3.Adenocarcinoma
It originates from the mucosal epithelium of the bronchus, and a few originate from the mucous glands of the large bronchus. The incidence is lower than that of squamous and undifferentiated carcinoma, the age of onset is younger, and it is more common in women. Most adenocarcinomas originate in the smaller bronchi and are peripheral type lung cancers. There are usually no obvious clinical symptoms in the early stage, and they are often detected during chest X-ray. It appears as a round or oval mass and is usually slow growing, but sometimes bloodstream metastasis occurs early. Lymphatic metastasis occurs later.
4.Alveolar cell carcinoma
It originates from the bronchial mucosa epithelium and is also called alveolar cell carcinoma of fine bronchus or adenocarcinoma of fine bronchus. It is located around the lung field and has the lowest incidence rate among all types of lung cancer, and is more common in women. It is usually highly differentiated and grows slowly. The cancer cells grow along the alveolar ducts and alveolar walls of the fine bronchi without invading the alveolar septa. Lymphatic and hematogenous metastases occur later, but can spread to other lung lobes or invade the pleura via bronchioles. Alveolar cell carcinomas are morphologically of two types: nodular and diffuse. The former can be a single nodule or multiple nodules; the latter morphology resembles pneumonia lesions. The nodular type with limited scope has better efficacy for surgical resection.
Regarding the prognosis of lung cancer.
The 5-year survival rate of squamous carcinoma is 15.3%, that of adenocarcinoma is 11.6%, and that of small cell undifferentiated carcinoma is 7.7%. With the development of biological high technology in recent years, even the prognosis of the same type of lung cancer is also related to the degree of differentiation.
2. DNA ploidy DNA content of lung cancer specimens detected by flow cytometry has shown that DNA content is an obvious prognostic factor for survival, and studies have shown that different numbers of heteroploid cell subpopulations often exist in lung cancers of the same period, grade and tissue type, and the 5-year survival rate is significantly higher in DNA diploids than in heteroploids.
3. p53 gene p53 gene mutations are seen in 80% of non-small cell lung cancers, and postoperative survival is significantly shorter in those with abnormal p53 gene expression than in those with abnormal meta-p53 expression. The combined analysis of p53 mutation and rasp21 expression showed that patients with both negative p53 mutation and rasp21 expression had longer survival, and p53 mutation and rasp21 expression were more accurate in determining the prognosis and risk of recurrence of NSCLC after surgery.
The prognosis of patients with 43-9F antigen-positive squamous carcinoma was significantly better than that of antigen-negative patients in immunohistochemical studies, but the expression of 43-9F antigen in adenocarcinoma was associated with survival time. The expression of 43-9F amplification is better than N-stage in determining the prognosis of patients with squamous carcinoma, and can reflect the recurrence of the primary tumor.
The shorter the tumor multiplication time, the worse the prognosis of primary lung cancer; the longer the tumor multiplication time, the better the prognosis.
The survival rate of stage I lung cancer, including surgery and non-surgery, was 39.3%, while the survival rate of stage E and E lung cancer was 11.7% and 4%, respectively, and no case of stage III lung cancer survived for 3 years.
7. The impact of lesion invasion and metastatic sites on prognosis Lesion invasion and lymph node metastatic sites have a certain impact on lung cancer patients. Studies have shown that among lung cancers in the same period, such as stage I lung cancer, if there are cancer thrombi in lung vessels and lymphatic vessels, it is easy to recur and metastasize, so the prognosis is poor. The prognosis of mediastinal lymph node metastasis in petri dish stage lung cancer is obviously worse. In contrast, the prognosis of lung cancer with invasion of pleura and chest wall classified as petri dish stage is significantly better, and the 5-year survival rate of the two is 16.7% and 43.2%, respectively. Among the lymph node metastases of lung cancer groups, the metastases of paraoesophageal, inferior pulmonary ligament and inferior ramus lymph nodes were the worst.
The apoptotic index and mitotic apoptotic index depended on the tumor histotype, and high apoptotic index had significantly better 5-year survival rate and tumor-free survival. In squamous carcinoma, high mitosis has a significantly better 5-year prognosis than low mitosis, while in adenocarcinoma and large cell carcinoma patients, the opposite is true. The level of apoptosis index and mitosis before treatment can predict the treatment outcome of patients with squamous carcinoma, and determine the recurrence of adenocarcinoma and large cell carcinoma and predict the occurrence of metastasis.
9.Treatment method The correct treatment plan has a close relationship with the prognosis in any stage of lung cancer. For example, stage I lung cancer is the only factor that affects prognosis among all factors by cox multifactor analysis. The 5-year survival rate of stage I lung cancer with surgical treatment is 3 times higher than that of non-surgical treatment, which is 50% and 12.3%-13.6% respectively, while the 5-year survival rate of combined surgical treatment, mainly postoperative plus chemotherapy, is 64% higher than that of single surgical treatment, and the efficacy of combined treatment is the best in any stage and type of lung cancer.
Among the factors that determine the prognosis of lung cancer, psychosocial factors are a factor that cannot be ignored. In the early stage of the disease, patients have a long period of psychological anger and grief, and they often cannot bear the reality. At first, most of them show rude and unreasonable temperament. Pessimism and disappointment are particularly severe, and most patients experience anhedonic thoughts, disappointment about the future, and especially a series of uncomfortable symptoms. After receiving realistic treatment, not only patients need more courage, but also need society and family to give patients full understanding. Most of them change their appearance due to some side effects of treatment, and some even bring them a lot of inconvenience due to the torture of the disease. This requires the family and society to give them more encouragement and support, give them more care and help, and encourage the patients to establish confidence to overcome the disease. This will enable them to live in a good atmosphere. However, due to various reasons in the society, such as the high cost of medical care, the forced working environment and the lack of awareness of the disease, many patients are unable to seek medical treatment in time, and as a result, the best time for early diagnosis and early treatment is lost.