Adenosquamous Cell Lung Cancer Recurrent
Recurrent adenosquamous cell lung cancer is a rare and aggressive form of lung cancer that comes back after treatment. Understanding this disease and the treatment options available can help patients and their families navigate their journey toward better health outcomes.
Table of contents
- What is Adenosquamous Cell Lung Cancer
- What Does Recurrence Mean
- Diagnosis and Detection
- Risk Factors for Recurrence
- Treatment Options for Recurrent Disease
- Prognosis and Outlook
Adenosquamous Cell Lung Carcinoma Recurrent, Recurrent Adenosquamous Cell Carcinoma of the Lung, Recurrent Adenosquamous Carcinoma of the Lung
- Lungs
- Bronchi
- Lymph nodes
What is Adenosquamous Cell Lung Cancer
Adenosquamous carcinoma of the lung is a relatively rare subtype of non-small cell lung cancer, which is a major category of lung cancer. This disease is defined as a cancer containing both components of lung adenocarcinoma (cancer that begins in cells that make mucus and other substances) and lung squamous cell carcinoma (cancer that forms in thin, flat cells lining the lungs). According to current medical definitions, each of these two components must make up at least 10% of the tumor[1][2].
This type of lung cancer is uncommon, accounting for 2% to 4% of all lung cancers[4]. The average age at diagnosis is about 70 years, and it affects more men than women. Most patients are current or former smokers[4].
Although adenosquamous carcinoma has biological characteristics of both adenocarcinoma and squamous cell carcinoma, it is not simply a mixture of these two types. The disease has its own unique molecular and genetic features that remain poorly understood[1][4].
What Does Recurrence Mean
Recurrent adenosquamous cell lung cancer means that the cancer has come back after it has been treated[7]. This is the reemergence of the cancer after a period of remission, which is a time when the disease could not be detected or was controlled[7].
It is important to understand that recurrent cancer is different from a new, separate lung cancer. When cancer returns, doctors need to determine whether it is the same cancer that has come back or if it is a completely new cancer that has developed. This distinction is important because it affects treatment decisions[4].
Adenosquamous carcinoma is reported to be relatively aggressive compared to typical adenocarcinoma and squamous cell carcinoma tumors. Studies indicate that at diagnosis, these cancers have higher rates of spreading to lymph nodes and can spread rapidly to other parts of the body[4].
Diagnosis and Detection
Diagnosing adenosquamous carcinoma of the lung can be extremely difficult before surgery. The disease is often misdiagnosed or undiagnosed before the actual surgical removal of the tumor. In fact, nearly all cases (98%) were either misdiagnosed or not properly diagnosed before surgery in one study[4].
The mixed nature of this cancer, with both adenocarcinoma and squamous cell components, creates challenges during diagnosis. Different types of biopsy samples may yield different results. A small biopsy (a procedure where a small piece of tissue is removed for examination) might only capture one component of the tumor, missing the other[1][4].
A definitive diagnosis typically requires larger samples, such as several core biopsies or complete surgical removal of the tumor. Only by examining the entire tumor specimen can doctors fully evaluate all components of the cancer[4].
When recurrence is suspected, doctors use various tests to detect whether the cancer has returned. These may include imaging tests such as CT scans (detailed X-ray pictures), PET scans (tests that show how tissues and organs are functioning), and other diagnostic procedures[3].
Risk Factors for Recurrence
After treatment for adenosquamous carcinoma, certain factors may increase the risk of the cancer coming back. Research has identified several important risk factors associated with postoperative recurrence[3].
The stage of the original tumor plays a significant role. Both T stage (which describes the size of the primary tumor) and N stage (which indicates whether the cancer has spread to lymph nodes) are significant risk factors for recurrence[3].
Lymphovascular invasion, which means the cancer has grown into blood vessels or lymph vessels, is an independent predictor of recurrence. The expression of certain proteins in the tumor, specifically CEA and p53, has also been linked to higher recurrence rates[3].
Studies have shown that with a median follow-up of 35 months after surgery, 95 out of 176 patients experienced disease recurrence. The cumulative rate of recurrence was 25.8% at one year, 55.8% at three years, and 63.1% at five years[3].
Treatment Options for Recurrent Disease
Treatment decisions for recurrent adenosquamous cell lung cancer are based on several factors, including where the cancer has come back, what treatments have already been given, any side effects from previous treatment, whether the cancer has certain genetic changes, and the patient’s overall health[9].
Chemotherapy
Chemotherapy uses drugs to kill cancer cells. It may be used to treat recurrent disease if the patient is well enough to receive it. If there are no genetic changes that can be identified in the tumors, chemotherapy is typically offered[9].
For adenosquamous carcinoma, platinum-based chemotherapy (treatment using drugs that contain platinum) is recommended. Common drug combinations include cisplatin or carboplatin with gemcitabine. Other combinations that may be used include cisplatin or carboplatin with docetaxel, carboplatin with paclitaxel, or other drug pairings[1][9].
Single chemotherapy drugs may be offered if the patient is in poor health or if certain drugs cannot be used anymore because of side effects. These single drugs may include gemcitabine, paclitaxel, or docetaxel[9].
Targeted Therapy
Targeted therapy uses drugs designed to attack specific features of cancer cells. This treatment is usually offered for recurrent disease, and the type of targeted therapy depends on the genetic changes found in the cancer[9].
EGFR-targeted therapy may be effective for patients whose tumors have mutations in the EGFR gene (a gene that helps control cell growth). Studies show that about 30% of adenosquamous carcinomas have EGFR mutations[13]. Drugs such as erlotinib and gefitinib can be effective therapeutic strategies for advanced disease with EGFR mutations[1][9].
Erlotinib may be used after two or three different types of chemotherapy have been tried. Gefitinib or afatinib may be used if targeted therapy has not been used before. Osimertinib may be offered for patients whose cancer has developed a specific mutation called T790M after being treated with other EGFR-targeting drugs[9].
For patients with ALK rearrangement (a genetic change found in about 5% of adenosquamous carcinomas), crizotinib may be recommended, although studies of this treatment in adenosquamous carcinoma are very limited[1][13].
Immunotherapy
Immunotherapy uses the body’s own immune system to fight cancer. Immune checkpoint blockade therapy may be a potential treatment choice for patients with adenosquamous carcinoma[1]. Studies have found that PD-L1 expression (a protein that can help cancer cells hide from the immune system) is present in some adenosquamous carcinomas, with one study showing it in 11% of adenocarcinoma components and 28% of squamous components[13].
Adjuvant Radiotherapy
Adjuvant radiotherapy is radiation treatment given after surgery to reduce the risk of cancer coming back. Research has shown that adjuvant radiotherapy significantly improved disease-free survival (the length of time after treatment without any signs of cancer) and was associated with longer overall survival among patients with either pathological T3-4 or N+ disease (more advanced tumors or those that had spread to lymph nodes)[3].
Prognosis and Outlook
Adenosquamous carcinoma of the lung generally carries a poorer prognosis compared to pure adenocarcinoma or pure squamous cell carcinoma. The overall survival of patients with these tumors is relatively short compared to other non-small cell lung cancer subtypes[4].
In a 2022 population-based study, five-year survival rates after surgery for early-stage cancers were 65% for adenosquamous carcinoma compared to 69% for squamous cell carcinoma and 77% for adenocarcinoma[4].
The prognosis for recurrent disease depends on multiple factors, including where the cancer has returned, how much time has passed since the initial treatment, what treatments are available, and the patient’s overall health condition. Each patient’s situation is unique, and treatment plans should be individualized based on these factors.
