Many lung cancer patients will be confused when they get the pathology report, and they are too professional to understand. Pathology is the “gold standard” for lung cancer diagnosis and is the most important report. Pathology generally includes not only the disease stage of the patient, but also the pathological classification, as well as the degree of cancer cell differentiation.
All malignant solid tumors have a stage, and the common people often say that the early, middle and late stages are relatively broad stages. The most commonly used clinical staging system for non-small cell lung cancer is the American Joint Committee on Cancer (AJCC) TNM system, which is divided into stages I, II, III, and IV. The staging method for small cell lung cancer is based on the staging criteria for small cell lung cancer developed by the American Veterans Hospital and the International Association for the Study of Lung Cancer, which are divided into limited stage and extensive stage.
Strictly speaking, pathological classification is the classification of cancer cells under the microscope. As a general category of diseases, lung cancer is actually very complex in pathological types. Roughly divided into small cell lung cancer and non-small cell lung cancer, non-small cell lung cancer includes adenocarcinoma, squamous cell carcinoma, sarcomatoid carcinoma, large cell carcinoma, salivary gland tumor, etc. Small cell lung cancer is divided into oat cells according to different cell types type, intermediate cell type, compound oat cell type.
As the most common type of adenocarcinoma, its pathological classification can be subdivided, including precancerous lesions such as atypical adenomatous hyperplasia and adenocarcinoma in situ. Solid adenocarcinoma includes minimally invasive adenocarcinoma, invasive non-mucinous adenocarcinoma, and invasive mucinous adenocarcinoma, of which the most common is invasive non-mucinous adenocarcinoma, which is further divided into adherent, acinar, papillary, and solid types. , Micronipples, etc.
With the development of molecular biology, in addition to cell typing under the microscope, lung cancer typing also requires molecular typing. In adenocarcinoma, molecular typing is particularly important to provide the basis for targeted therapy.
So, for the prognosis of lung cancer, is the stage more important or the pathological type more important?
In general, staging is more important. Staging means the sooner or later the diagnosis and diagnosis, and the chance of radical surgery. Early detection, early diagnosis, and early treatment lead to higher cure rates and longer survival. Even the most malignant small cell lung cancer and carcinosarcoma, if the stage is very early and complete surgical resection, have a great possibility of cure. However, the median survival time after diagnosis of extensive-stage (advanced) small cell lung cancer is only 9-10 months, and under the premise of active treatment, the 5-year survival rate is only 1%.
WHO is staging based on prognosis. This means that if we determine the stage of a tumor, we will predict the survival period of the patient. However, the pathological type also affects the prognosis of patients, and its importance is self-evident. For example, small cell lung cancer has a worse prognosis than lung adenocarcinoma, micropapillary adenocarcinoma has a worse prognosis than acinar type, and the overall prognosis of EGFR mutation-negative patients is worse than that of EGFR-positive patients. It can be seen that both staging and classification are very important, but in general, staging has a greater impact on prognosis, and early stage means it is easier to be completely removed. After all, radical surgery is still the most effective treatment for lung cancer.