Histologic Typing of Lung Cancer with Clinical Implications

Our plain-English summary of Histologic Typing of Lung Cancer with Clinical Implications, by R. Yesner (1974).

The study

• Author: R. Yesner
• Published: Frontiers of Radiation Therapy and Oncology, Volume 9. (1974)
• Type of article: Book excerpt
• Our copy: from Johns-Manville's own medical library. The article is still under copyright, so we describe it here rather than post it.

In plain English

This 1974 article by a pathologist at the Veterans Administration Hospital in West Haven, Connecticut, was a narrative review. It covered how lung cancer is classified by cell type under the microscope and how cell type related to the disease's behavior, survival and treatment. It drew on the author's experience with about 10,000 lung cancers over 15 years, the author's earlier studies, and other researchers' published work. The author described several findings from the author's own material. The author's examination of tumors from Colorado uranium miners confirmed that two thirds were small cell carcinomas. Among surgically treated patients who survived 5 years, 60% had squamous carcinomas and none had small cell carcinomas, compared with 40% squamous among those who did not survive 5 years. The author concluded that histologic typing was of great importance in determining survival in lung cancer. The article contained no asbestos research of its own. It cited a report by Selikoff and colleagues that asbestos exposure plus cigarette smoking raised the risk of developing and dying of lung cancer about 90 times compared with men who did neither.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review drawing on the author's personal pathology experience, the author's earlier studies, and other published studies
• Who was studied: Lung cancer cases seen by the author (about 10,000 over 15 years) at the Veterans Administration Hospital, West Haven, Connecticut, plus material from VA and other study groups described in the review
• Exposure: The review's subject was lung cancer cell type, not asbestos. Its only asbestos mention cited Selikoff et al., who reported in asbestos workers that asbestos exposure combined with cigarette smoking increased the risk of developing and dying of lung cancer approximately 90 times compared with men who neither worked with asbestos nor smoked. This was another study's finding, not this article's.
• Main results:
  • The author's personal examination of lung tumors from Colorado uranium miners confirmed Saccomanno's finding that two thirds of the tumors were small cell carcinomas
  • Among resected lung cancer patients who survived 5 years (slides from 135 patients, coded and read by the author's group), 60% had squamous carcinomas
  • None of the 5-year survivors had small cell carcinomas
  • In a matched group of patients who did not survive 5 years, 40% had squamous carcinomas
  • In hundreds of autopsies reviewed from VA Lung Cancer Study Group protocols, only seven showed no residual tumor, with one more showing no residual primary tumor
  • The author's group found no small cell carcinomas among tumors associated with hypertrophic pulmonary osteoarthropathy
  • The author's analysis of VA protocols 2 (1960) and 12 (1970) showed a drop in the most common age of patients in all categories over 10 years
• The authors' conclusion: The author concluded that histologic typing is of great importance in determining survival in lung cancer, whether or not the tumor is resected for cure
• Limitations the authors state:
  • Poorly differentiated squamous carcinomas lacking objective features were described as a highly unreliable diagnostic category on biopsy
  • The undifferentiated large cell group was described as a 'waste-basket' collection with variable characteristics and a low degree of agreement among pathologists

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Carcinoma, Asbestos Exposure.

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