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Invasive adenocarcinoma of the lung includes a heterogenous mixture of subtypes and variants. The 2011 consensus describes five subtypes of invasive adenocarcinomas based on the cell pattern that is most predominant. These subtypes are described below: Histopathology of lepidic predominant adenocarcinoma. Acinar pattern. [16] Solid pattern. [17]
Minimally invasive adenocarcinoma of the lung (MIA) is defined as a small (≤3 cm), solitary tumour with predominant alveolar epithelial appearance (lepidic growth), as in situ adenocarcinoma of the lung, with a zone of focal invasion of the stroma with a size inferior to 5 mm. [1] For MIA—as with adenocarcinoma in situ—, the prognosis is near 100% survival.
If completely removed by surgery, the prognosis is excellent with up to 100% 5-year survival. [ 1 ] Although the entity of AIS was formally defined in 2011, [ 2 ] it represents a noninvasive form of pulmonary adenocarcinoma which has been recognized for some time.
A subtype of adenocarcinoma, the bronchioloalveolar carcinoma, is more common in female never-smokers, and may have a better long-term survival. [13] This cancer usually is seen peripherally in the lungs, as opposed to small cell lung cancer and squamous cell lung cancer, which both tend to be more centrally located. [14] [15]
Prognosis is better for people with lung cancer diagnosed at an earlier stage; those diagnosed at the earliest TNM stage, IA1 (small tumor, no spread), have a two-year survival of 97% and five-year survival of 92%. [58] Those diagnosed at the most-advanced stage, IVB, have a two-year survival of 10% and a five-year survival of 0%. [58]
In the United States there has been an increase in the 5-year relative survival rate between people diagnosed with cancer in 1975-1977 (48.9%) and people diagnosed with cancer in 2007-2013 (69.2%); these figures coincide with a 20% decrease in cancer mortality from 1950 to 2014. [8]
Acinar adenocarcinoma of the lung is a highly lethal disease. Overall, the five-year survival rates approximate 16% to 22%. Generally, survival is better in all stages for patients with the acinar (or papillary) pattern than it is in patients with the solid pattern, but considerably worse than those with the bronchioloalveolar pattern.
A few of the less common types are pleomorphic, carcinoid tumor, salivary gland carcinoma, and unclassified carcinoma. [5] All types can occur in unusual histologic variants and as mixed cell-type combinations. [6] Non-squamous-cell carcinoma almost occupies the half of NSCLC.