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Chest Oct 2016Cysts are commonly seen on CT scans of the lungs, and diagnosis can be challenging. Clinical and radiographic features combined with a multidisciplinary approach may... (Review)
Review
Cysts are commonly seen on CT scans of the lungs, and diagnosis can be challenging. Clinical and radiographic features combined with a multidisciplinary approach may help differentiate among various disease entities, allowing correct diagnosis. It is important to distinguish cysts from cavities because they each have distinct etiologies and associated clinical disorders. Conditions such as emphysema, and cystic bronchiectasis may also mimic cystic disease. A simplified classification of cysts is proposed. Cysts can occur in greater profusion in the subpleural areas, when they typically represent paraseptal emphysema, bullae, or honeycombing. Cysts that are present in the lung parenchyma but away from subpleural areas may be present without any other abnormalities on high-resolution CT scans. These are further categorized into solitary or multifocal/diffuse cysts. Solitary cysts may be incidentally discovered and may be an age related phenomenon or may be a remnant of prior trauma or infection. Multifocal/diffuse cysts can occur with lymphoid interstitial pneumonia, Birt-Hogg-Dubé syndrome, tracheobronchial papillomatosis, or primary and metastatic cancers. Multifocal/diffuse cysts may be associated with nodules (lymphoid interstitial pneumonia, light-chain deposition disease, amyloidosis, and Langerhans cell histiocytosis) or with ground-glass opacities (Pneumocystis jirovecii pneumonia and desquamative interstitial pneumonia). Using the results of the high-resolution CT scans as a starting point, and incorporating the patient's clinical history, physical examination, and laboratory findings, is likely to narrow the differential diagnosis of cystic lesions considerably.
Topics: Algorithms; Amyloidosis; Biopsy; Birt-Hogg-Dube Syndrome; Bronchial Neoplasms; Bronchiectasis; Cysts; Diagnosis, Differential; Histiocytosis, Langerhans-Cell; Humans; Lung; Lung Diseases; Lung Diseases, Interstitial; Lung Neoplasms; Papilloma; Pneumonia, Pneumocystis; Pulmonary Emphysema; Tomography, X-Ray Computed; Tracheal Neoplasms
PubMed: 27180915
DOI: 10.1016/j.chest.2016.04.026 -
Discovery Medicine Mar 2019The understanding of genetic alterations that drive non-small cell lung cancer (NSCLC) is evolving. As many of these molecularly-defined subtypes are potentially... (Review)
Review
The understanding of genetic alterations that drive non-small cell lung cancer (NSCLC) is evolving. As many of these molecularly-defined subtypes are potentially actionable, new strategies in molecular diagnostics and targeted therapies in NSCLC to detect and treat them are being explored. At the International Association for Study of Lung Cancer 19th World Conference, several abstracts and oral presentations related to this topic. In this report, we discuss some of these updates.
Topics: Carcinoma, Non-Small-Cell Lung; Congresses as Topic; Humans; Lung Neoplasms
PubMed: 31095926
DOI: No ID Found -
Seminars in Cancer Biology Nov 2022Small cell lung cancer (SCLC) arises in peribronchial locations and infiltrates the bronchial submucosa, including about 15% of lung cancer cases. Despite decades of... (Review)
Review
Small cell lung cancer (SCLC) arises in peribronchial locations and infiltrates the bronchial submucosa, including about 15% of lung cancer cases. Despite decades of research, the prognosis for SCLC patients remains poor because this tumor is characterized by an exceptionally high proliferative rate, strong tendency for early widespread metastasis and acquired chemoresistance. Omics profiling revealed that SCLC harbor extensive chromosomal rearrangements and a very high mutation burden. This led to the development of immune-checkpoint inhibitors as single agents or in combination with chemotherapy, which however resulted in a prolonged benefit only for a small subset of patients. Thus, the present review discusses the rationale and limitations of immunotherapeutic approaches, presenting the current biological understanding of aberrant signaling pathways that might be exploited with new potential treatments. In particular, new agents targeting DNA damage repair, cell cycle checkpoint, and apoptosis pathways showed several promising results in different preclinical models. Epigenetic alterations, gene amplifications and mutations can act as biomarkers in this context. Future research and improved clinical outcome for SCLC patients will depend on the integration between these omics and pharmacological studies with clinical translational research, in order to identify specific predictive biomarkers that will be hopefully validated using clinical trials with biomarker-selected targeted treatments.
Topics: Humans; Small Cell Lung Carcinoma; Immunotherapy; Lung Neoplasms; Immunologic Factors; Cell Cycle Checkpoints
PubMed: 35568295
DOI: 10.1016/j.semcancer.2022.05.004 -
Nature Reviews. Cancer Aug 2014Non-small-cell lung cancers (NSCLCs), the most common lung cancers, are known to have diverse pathological features. During the past decade, in-depth analyses of lung... (Review)
Review
Non-small-cell lung cancers (NSCLCs), the most common lung cancers, are known to have diverse pathological features. During the past decade, in-depth analyses of lung cancer genomes and signalling pathways have further defined NSCLCs as a group of distinct diseases with genetic and cellular heterogeneity. Consequently, an impressive list of potential therapeutic targets was unveiled, drastically altering the clinical evaluation and treatment of patients. Many targeted therapies have been developed with compelling clinical proofs of concept; however, treatment responses are typically short-lived. Further studies of the tumour microenvironment have uncovered new possible avenues to control this deadly disease, including immunotherapy.
Topics: Animals; Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms
PubMed: 25056707
DOI: 10.1038/nrc3775 -
Journal of the National Comprehensive... Dec 2021The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Small Cell Lung Cancer (SCLC) provide recommended management for patients with SCLC, including...
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Small Cell Lung Cancer (SCLC) provide recommended management for patients with SCLC, including diagnosis, primary treatment, surveillance for relapse, and subsequent treatment. This selection for the journal focuses on metastatic (known as extensive-stage) SCLC, which is more common than limited-stage SCLC. Systemic therapy alone can palliate symptoms and prolong survival in most patients with extensive-stage disease. Smoking cessation counseling and intervention should be strongly promoted in patients with SCLC and other high-grade neuroendocrine carcinomas. The "Summary of the Guidelines Updates" section in the SCLC algorithm outlines the most recent revisions for the 2022 update, which are described in greater detail in this revised Discussion text.
Topics: Humans; Lung Neoplasms; Medical Oncology; Neoplasm Recurrence, Local; Small Cell Lung Carcinoma
PubMed: 34902832
DOI: 10.6004/jnccn.2021.0058 -
Cells Jul 2021The gene expression program induced by NRF2 transcription factor plays a critical role in cell defense responses against a broad variety of cellular stresses, most... (Review)
Review
The gene expression program induced by NRF2 transcription factor plays a critical role in cell defense responses against a broad variety of cellular stresses, most importantly oxidative stress. NRF2 stability is fine-tuned regulated by KEAP1, which drives its degradation in the absence of oxidative stress. In the context of cancer, NRF2 cytoprotective functions were initially linked to anti-oncogenic properties. However, in the last few decades, growing evidence indicates that NRF2 acts as a tumor driver, inducing metastasis and resistance to chemotherapy. Constitutive activation of NRF2 has been found to be frequent in several tumors, including some lung cancer sub-types and it has been associated to the maintenance of a malignant cell phenotype. This apparently contradictory effect of the NRF2/KEAP1 signaling pathway in cancer (cell protection against cancer versus pro-tumoral properties) has generated a great controversy about its functions in this disease. In this review, we will describe the molecular mechanism regulating this signaling pathway in physiological conditions and summarize the most important findings related to the role of NRF2/KEAP1 in lung cancer. The focus will be placed on NRF2 activation mechanisms, the implication of those in lung cancer progression and current therapeutic strategies directed at blocking NRF2 action.
Topics: Animals; Antineoplastic Agents; Carcinoma, Non-Small-Cell Lung; Gene Expression Regulation, Neoplastic; Humans; Kelch-Like ECH-Associated Protein 1; Lung Neoplasms; Molecular Targeted Therapy; NF-E2-Related Factor 2; Signal Transduction; Small Cell Lung Carcinoma
PubMed: 34440648
DOI: 10.3390/cells10081879 -
Annals of Oncology : Official Journal... Apr 2023
Topics: Humans; Carcinoma, Non-Small-Cell Lung; Lung Neoplasms; Follow-Up Studies
PubMed: 36669645
DOI: 10.1016/j.annonc.2022.12.013 -
Annals of Oncology : Official Journal... Jul 2021
Topics: Carcinoma, Non-Small-Cell Lung; Follow-Up Studies; Humans; Lung Neoplasms; Small Cell Lung Carcinoma
PubMed: 33864941
DOI: 10.1016/j.annonc.2021.03.207 -
Annals of Oncology : Official Journal... Jul 2019The National Lung Screening Trial showed that lung cancer (LC) screening by three annual rounds of low-dose computed tomography (LDCT) reduces LC mortality. We evaluated... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The National Lung Screening Trial showed that lung cancer (LC) screening by three annual rounds of low-dose computed tomography (LDCT) reduces LC mortality. We evaluated the benefit of prolonged LDCT screening beyond 5 years, and its impact on overall and LC specific mortality at 10 years.
DESIGN
The Multicentric Italian Lung Detection (MILD) trial prospectively randomized 4099 participants, to a screening arm (n = 2376), with further randomization to annual (n = 1190) or biennial (n = 1186) LDCT for a median period of 6 years, or control arm (n = 1723) without intervention. Between 2005 and 2018, 39 293 person-years of follow-up were accumulated. The primary outcomes were 10-year overall and LC specific mortality. Landmark analysis was used to test the long-term effect of LC screening, beyond 5 years by exclusion of LCs and deaths that occurred in the first 5 years.
RESULTS
The LDCT arm showed a 39% reduced risk of LC mortality at 10 years [hazard ratio (HR) 0.61; 95% confidence interval (CI) 0.39-0.95], compared with control arm, and a 20% reduction of overall mortality (HR 0.80; 95% CI 0.62-1.03). LDCT benefit improved beyond the 5th year of screening, with a 58% reduced risk of LC mortality (HR 0.42; 95% CI 0.22-0.79), and 32% reduction of overall mortality (HR 0.68; 95% CI 0.49-0.94).
CONCLUSIONS
The MILD trial provides additional evidence that prolonged screening beyond 5 years can enhance the benefit of early detection and achieve a greater overall and LC mortality reduction compared with NLST trial.
CLINICALTRIALS.GOV IDENTIFIER
NCT02837809.
Topics: Aged; Carcinoma, Non-Small-Cell Lung; Early Detection of Cancer; Female; Follow-Up Studies; Humans; Italy; Lung Neoplasms; Male; Middle Aged; Prognosis; Prospective Studies; Small Cell Lung Carcinoma; Survival Rate
PubMed: 30937431
DOI: 10.1093/annonc/mdz117 -
Annals of Oncology : Official Journal... Dec 2021
Topics: Carcinoma, Non-Small-Cell Lung; Early Detection of Cancer; Humans; Lung Neoplasms; Practice Guidelines as Topic
PubMed: 34481037
DOI: 10.1016/j.annonc.2021.08.1994