Lung cancer for both small and non-small cells is the leading cause of cancer death among both men and women and makes up almost 25% of all cancer deaths (American Cancer Society, 2020). There are two main types of lung cancer, including non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) (American Cancer Society, 2020). They are distinguished and can be treated differently (Centers for Disease Control and Prevention, 2020). These different tumor subclasses arise from distinct cells of origin localized within a defined regional compartment, and these cells of origin also help to understand lung cancer biology and treatment (Sutherland and Berns, 2010). Understanding normal epithelial cells’ function would help to understand different types of lung cancer. There are five different epithelial cells in lung tissue, including ciliated cells, goblet cells, basal cells, club cells, and neuroendocrine cells (Whitsett, 2018). For example, the goblet cell function is to secrete mucin and secrete diverse inflammatory mediators. Club cells protect the bronchiolar epithelium and serve as the primary progenitors of ciliated cells (Whitsett, 2018). When there is the uncontrolled division of epithelial cells in the respiratory tract or cells mutation by either environmental or genetic factors, cancer cells pile up and become tumor mass (National Cancer Institute, 2020). As tumor mass increases, it induces the blood flow and is called angiogenesis (Malapelle and Rossi, 2019). When cancer becomes malignant, it means the cells are uncontrolled cell division breaks through the basement membrane and becomes secondary growth metastasis (McCance and Huether, 2019). When cancer metastasizes quickly, it goes to the sites of secondary tumors such as mediastinum and hilar, lymph nodes, lung pleura, heart, liver, brain, and bone (McCance and Huether, 2019).
As mentioned above, depending on the epithelial cell of origin, it determines what types of lung cancer (Cheng and Nikitin, 2011). For SCLC, the cause is from small immature neuroendocrine cells (Cheng and Nikitin, 2011). The expression of neuroendocrine markers is synaptophysin and calcitonin gene-related peptide (Cheng and Nikitin, 2011). On the other hand, NSCLC has four categories. These include the adenocarcinomas form glandular structures that generate mucins, the squamous cell with square-shaped cells producing keratin, a carcinoid tumor from mature neuroendocrine cells, and a large cell carcinomas with large glandular and squamous differentiation (McCance and Huether, 2019).
The main difference between SCLC and NSCLC is the cells’ actual size (McCance and Huether, 2019). The type of lung cancer can determine the histological cell types with these different characteristics (Moffitt Cancer Center, 2018). The SCLC cells are not fully developed, divided, and spreads quickly (McCance and Huether, 2019). SCLC has a small section and no distance from one size to another (McCance and Huether, 2019). This cancer occurs more in females with a history of smoking and accounts for approximately 15% of bronchogenic carcinomas (National Cancer Institute, 2020). Patients with SCLC will have tumors confined to the hemithorax of origin, the mediastinum, or the supraclavicular lymph nodes (National Cancer Institute, 2020)
For NSCLC, these types of cancers are with big major cells (McCance and Huether, 2019). The first NSCLC is adenocarcinomas form glandular structures generate mucins about 40% women effective for both smoker and non-smoker (National Cancer Institute, 2020). The second NSCLC is a squamous cell with square-shaped cells that produce keratin. They are large cells and stick together and happens in males with a history of smoking, about 30% of lung cancer (National Cancer Institute, 2020). The third NSCLC is carcinoid tumors from mature neuroendocrine cells and about 10% in males with a history of smoking. The last category of NSCLC is large cell carcinomas with large glandular and squamous differentiation and is about 5%, both male and female, with direct smoking (National Cancer Institute, 2020).
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McCance, K.L., & Huether, S.E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MI: Elsevier.
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Malapelle, U., & Rossi, A. (2019). Emerging angiogenesis inhibitors for non-small cell lung cancer. Expert Opinion on Emerging Drugs Journal, 24 (2) 71-81. doi:10.1080/14728214.2019.1619696
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Whitsett, J. (2018). Airway epithelial differentiation and mucociliary clearance. Annals of the American Thoracic Society, 15, 1-6. Retrieved from: https://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201802-128AW
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