Preneoplasia of lung cancer.
Preneoplasia of lung cancer.
复制标题
DOI：
10.3233/cbm-2011-0166
复制
发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Brambilla E
中科院分区：
文献类型：
--
作者：
Gazdar AF;Brambilla E
与其他上皮癌一样，肺癌在几年或几十年的时间内通过一系列渐进的形态学变化伴随着在组织学正常上皮中开始的分子改变而发展。然而，肺癌的发展呈现出某些独特的特征，使这种评估变得复杂。在解剖学上，呼吸树可分为具有不同大体和组织学解剖结构以及不同功能的中央和外周室。此外，肺癌有三种主要形式和许多次要形式。许多这些形式主要出现在中央或外周室。鳞状细胞癌和小细胞癌主要发生在中央室，而腺癌主要发生在外周。大细胞癌不是一个单一的实体，而是由其他类型的低分化形式组成，可能还有一些真正未分化的“干细胞样”肿瘤。鳞状细胞癌的多阶段起源，因为它们的中心位置，可以更密切地跟踪比周围发生的腺癌。鳞状细胞癌发生于一系列反应性、化生性、癌前病变和浸润前病变之后。然而，长期观察表明，并非所有肿瘤都遵循明确的组织学过程，并且临床过程，特别是早期病变，难以预测。外周腺癌被认为是由称为非典型腺瘤性增生的前驱病变引起的，并且在变成侵袭性之前可能具有广泛的原位生长。小细胞癌被认为是由严重的分子损伤的上皮细胞引起的，而没有经历可识别的癌前病变。在侵袭性癌症发病之前发生的分子变化是广泛的。正如本章所述，它们包括了除浸润和转移之外的所有六个经典癌症特征，根据定义，浸润和转移发生在癌前病变之外。对浸润前肺癌的研究已经提供了许多有价值的生物学信息，对临床治疗产生了影响。
As with other epithelial cancers, lung cancer develops over a period of several years or decades via a series of progressive morphological changes accompanied by molecular alterations that commence in histologically normal epithelium. However the development of lung cancer presents certain unique features that complicates this evaluation. Anatomically the respiratory tree may be divided into central and peripheral compartments having different gross and histological anatomies as well as different functions. In addition, there are three major forms of lung cancer and many minor forms. Many of these forms arise predominantly in either the central or peripheral compartments. Squamous cell and small cell carcinomas predominantly arise in the central compartment, while adenocarcinomas predominantly arise peripherally. Large cell carcinomas are not a single entity but consist of poorly differentiated forms of the other types and, possibly, some truly undifferentiated “stem cell like” tumors. The multistage origin of squamous cell carcinomas, because of their central location, can be followed more closely than the peripherally arising adenocarcinomas. Squamous cell carcinomas arise after a series of reactive, metaplastic, premalignant and preinvasive changes. However, long term observations indicate that not all tumors follow a defined histologic course, and the clinical course, especially of early lesions, is difficult to predict. Peripheral adenocarcinomas are believed to arise from precursor lesions known as atypical adenomatous hyperplasias and may have extensive in situ growth before becoming invasive. Small cell carcinomas are believed to arise from severely molecularly damaged epithelium without going through recognizable preneoplastic changes. The molecular changes that occur prior to the onset on invasive cancers are extensive. As documented in this chapter, they encompass all of the six classic Hallmarks of Cancer other than invasion and metastasis, which by definition occur beyond preneoplasia. A study of preinvasive lung cancer has yielded much valuable biologic information that impacts on clinical management.