Old Chen came to the outpatient clinic, self-reported that nearly half a month of walking time will be asthmatic, suspect that it is not their own old slow branch, come to check the body, do not check do not know, a check frightened, old Chen left lung upper lobe a huge lump, there is the size of a child's fist, from the morphological point of view, malignant tumor possibility is very large. A lung puncture biopsy was arranged, and pathology suggested squamous cell carcinoma. After PET-CT evaluation, there are no lymph nodes and other organ metastases, and the Thoracic Surgeon believes that surgery may be considered, or 2-3 neoadjuvant treatments before surgery.
On the same day to the outpatient clinic of the old Yang, there is no discomfort, smoked for 40 years, is to want a routine physical examination, chest CT found that the left lower lung 1.5cm solid nodule, irregular shape, consider malignant. This result made Lao Yang completely unexpected, so he quickly did PET-CT, when he waited for the bed to prepare for surgery, PET-CT showed that Lao Yang's parietal lobe of the brain had a 1cm lesion, and the thoracic vertebrae 3 vertebrae saw a high metabolic lesion, considering metastases. After lung aspiration biopsy pathology, Lao Yang's pathological type is small cell lung cancer.
The tumor of the fist-sized lung did not metastasize, but the 1.5 cm lung nodule did metastasize, a result that many people may not understand. In fact, the main reason is that the pathological types of tumor cells are different. One is squamous cell carcinoma, the other is small cell lung cancer, squamous cell carcinoma and small cell lung cancer have completely different properties.
If you turn these two kinds of cancer cells into two "bad children", squamous cell carcinoma this "bad child" is more homely, keeping to yourself in place, constantly absorbing nutrients, and gradually eating yourself into a big fat man. The "bad kids" of small cell lung cancer are very lively, like to visit the door and wander around.
Squamous cell carcinoma and small cell lung cancer have two common features, both of which are closely related to smoking, so they are more common in elderly men. Secondly, lung squamous cell carcinoma and small cell lung cancer are mostly central, the lesion will be close to the hilar and mediastinum, many patients have a small lesion, but it is closely related to blood vessels, resulting in inability to operate.
Strictly speaking, small cell lung cancer is more inclined to a systemic disease, due to the high degree of cellular malignancy and easy metastasis, many patients have distant metastasis at a very young age at the primary lesion. Small lesions and large metastases make such patients lose the opportunity for surgery and radical radiotherapy, and can only choose chemotherapy or chemotherapy combined with immunotherapy, the overall prognosis is relatively poor, and the median survival time is short. Arguably, small cell lung cancer is the one with the worst prognosis of all lung cancer types.
We may also find that many patients with squamous cell carcinoma of the lung also have distant metastases in the end, such as bone metastases and brain metastases. The same pathology type, why are some patients prone to metastasis, while some have been growing locally?
The first is related to the degree of differentiation of tumor cells, the lower the differentiation, the higher the degree of malignancy, the easier it is to metastasize. Low-differentiated malignancies have a relatively poor prognosis than high- and medium-differentiated tumors.
From the perspective of molecular biology, the metastasis of tumors is actually related to genes. At present, studies have shown that at least 10 kinds of oncogenes can induce and promote the metastatic potential of cancer cells, such as MYC, RAS, MOS, RAF, FES, FMS, SER, FOS, P53 mutation, ERBB2, etc. In addition, the important mtsl gene, also known as the tumor metastasis gene, its mutation or inactivation can lead to a decrease in the ability of cells to adhere, prompting tumor occurrence and metastasis. The nm23 gene and MKK4 gene are transfer inhibition genes, and high expression means that the probability of metastasis is low.
Therefore, patients with the same pathological type of lung cancer, high expression of tumor metastatic genes and low expression or mutation of metastatic suppression genes are prone to distant metastasis.
(Medical cards have been added here, please check out to today's headlines client)