What are the other Names for this Condition? (Also known as/Synonyms)

• Lung Sarcomatoid Carcinoma
• Pulmonary Sarcomatoid Carcinoma
• Sarcomatoid Cancer (SARC) of the Lung

What is Sarcomatoid Carcinoma of the Lung? (Definition/Background Information)

• Sarcomatoid Carcinoma of the Lung is a type of lung cancer

Lung Cancer is categorized into two types:

• Non-Small Cell Lung Cancer (NSCLC)
• Small-Cell Lung Cancer (SCLC)

It is difficult to diagnose NSCLC, because the cancer cells are underdeveloped, when a pathologist examines them under a microscope. Sarcomatoid Carcinoma is a subtype of Non-Small Cell Lung Cancer.

• Abnormal cancer cells can form into new cancer cells, which can subsequently invade other tissues in the body. In addition, these abnormal cells do not ‘die-off’ as healthy cells do, resulting in the formation of a mass, or a tumor
• Sarcomatoid Carcinoma of the Lung causes spindle-like (connective tissue) appearance of epithelial cells of the lung, or involves a mesenchymal component, such as bone, skeletal muscle, or cartilage
• Sarcomatoid Carcinoma of the Lung has 5 subtypes:
  • Pleomorphic carcinoma
  • Spindle cell carcinoma
  • Giant cell carcinoma
  • Carcinosarcoma
  • Pulmonary blastoma
• It is more commonly seen in men, who are smokers. Sarcomatoid Carcinoma of the Lung is associated with a poor prognosis

Who gets Sarcomatoid Carcinoma of the Lung? (Age and Sex Distribution)

• Sarcomatoid Carcinoma of the Lung is relatively rare and comprises of 0.3-1.3% of all lung cancers
• The average age of individuals at diagnosis is 65 years. An exception to this is with the pulmonary blastoma subtype, which has an average age at diagnosis of 35 years
• 90% of the individuals diagnosed with Sarcomatoid Carcinoma of the Lung, are heavy tobacco smokers. Some studies have linked the exposure of asbestos too
• Men are 4-times as likely as women, to be diagnosed with this type of cancer, but for the pulmonary blastoma subtype that affects both sexes equally

What are the Risk Factors for Sarcomatoid Carcinoma of the Lung? (Predisposing Factors)

Multiple risk factors have been associated with Sarcomatoid Carcinoma of the Lung. These include:

• Smoking: Smoking cigarettes, cigars, or pipes, increase the risk due to damaging chemicals being inhaled into the lungs
• Prolonged exposure to asbestos, which was used (previously) in building construction and electrical insulation

When people inhale cigarette smoke, the harmful chemicals travel through the bronchi (breathing tubes), into the lungs. This result in lung tissue cells being exposed to cancer-causing substances (carcinogens), contained in the smoke. The cilia’s (small hair-like structure located in the cell lining) function is to clear contaminants out of the bronchi. Prolonged smoking damages the cilia, resulting in reduced clearance of the carcinogens. This can lead to an increased risk of developing Lung Sarcomatoid Carcinoma.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Sarcomatoid Carcinoma of the Lung? (Etiology)

• Like all other types of cancer, Sarcomatoid Carcinoma of the Lung is caused by genetic changes that turn healthy cells into cancer cells. These cancer cells have lost the ability to control their growth, leading to the formation of tumors
• While Sarcomatoid Carcinoma is seen mostly in smokers, the exact cause of the disease is unknown

What are the Signs and Symptoms of Sarcomatoid Carcinoma of the Lung?

Early symptoms of Sarcomatoid Carcinoma of the Lung are similar to those seen in common benign conditions and therefore, it is difficult to be diagnosed at an early stage. Signs and symptoms associated with Sarcomatoid Carcinoma of the Lung include:

• Coughing
• Hemoptysis: Blood in cough is the most common sign
• Fever due to recurring pneumonia
• Weight loss
• Labored breathing
• Fatigue
• Pain in the chest
• In case of metastasis, pain at metastatic sites, such as bone

How is Sarcomatoid Carcinoma of the Lung Diagnosed?

There are a variety of tests the physicians may use to detect, locate, and diagnose Sarcomatoid Carcinoma of the Lung and to examine, if it has potentially spread to other regions. A surgical procedure called a biopsy (usually performed by a radiologist or a cardiothoracic surgeon), is the only test a physician uses in order to make a definitive diagnosis of Sarcomatoid Carcinoma of the Lung.

However, if a physician is unable to perform a lung biopsy due to the risk of damaging vital organs, additional tests will be recommended, and these may include:

• Physical examination: During a physical exam, a physician will check the individual’s overall health status, listen to their breathing, and check for possible fluid buildup in the lungs (auscultation)
• Chest x-ray: Two-dimensional pictures using tiny amounts of radiation are taken, in order to detect any tumors or other medical issues associated with the lungs, such as pneumonia. Tumors inside the lung, including Sarcomatoid Carcinoma of the Lung, which is usually on the periphery, can be detected using a chest x-ray; although sometimes, these tumors are too small to visualize
• Computerized tomography (CT) scan: Also known as CAT scan, this radiological procedure creates detailed three-dimensional images of structures inside the body. CT scans are not a tool of preference to detect Lung Sarcomatoid Carcinoma; although, CT scans may be helpful in detecting recurrences, or if the cancer has metastasized to the surrounding lymph nodes of the lungs
• Positron emission tomography (PET): A PET scan is a nuclear medicine imaging technique that uses three-dimensional images to show how tissue and organs are functioning. A small amount of radioactive material may be injected into a vein, inhaled or swallowed. A PET scan is also helpful in detecting recurrences, or if any metastasis (to the surrounding lymph nodes of the lungs) has occurred
• Magnetic resonance imaging (MRI): An MRI scan uses magnetic fields that create high quality pictures of certain body parts, such as tissues, muscles, nerves, and bones. These high-quality images may indicate to a physician, if any Lung Sarcomatoid Carcinoma is present
• Sputum cytology: Sputum cytology is test that involves the collection of mucus (sputum), coughed-up by a patient. After the mucus is collected, a pathologist examines in an anatomic pathology laboratory, if any cell abnormalities are present indicative of Sarcomatoid Carcinoma of the Lung
• Bone scan: A bone scan is a nuclear imaging test that involves injecting a radioactive tracer into an individual’s vein. Bone scans are primarily used to detect, if the cancerous cells in Sarcomatoid Carcinoma of Lung, has metastasized to the bones and formed secondary tumors
• Bone marrow biopsy: Bone marrow is a soft tissue found within bones. Occasionally, with Lung Sarcomatoid Carcinoma, a bone marrow biopsy is used to detect blood abnormalities, or if a physician thinks that metastasis to the bone marrow may have occurred

A biopsy refers to a medical procedure that involves the removal of cells or tissues, which are then examined by a pathologist. Different biopsy procedures include:

• Bronchoscopy: During bronchoscopy, physicians’ use a special medical instrument called a bronchoscope, which is inserted through the nose and into the lungs to collect small tissue samples. These samples are then examined by a pathologist, after the tissues are processed, in an anatomic pathology laboratory
• Thoracentesis: During thoracentesis, physicians use a special medical device called a cannula, to remove fluid between the lungs and the chest wall. A pathologist then examines the extracted cells from the fluid, in an anatomic pathology laboratory to determine any signs of Sarcomatoid Carcinoma of Lung
• Thoracoscopy: During thoracoscopy, a surgical scalpel is used to make very tiny incisions into the chest wall. A medical instrument called a thoracoscope is then inserted into the chest, in order to examine and remove tissue from the chest wall, which are then examined further
• Thoracotomy: Thoracotomy is a surgical invasive procedure with special medical instruments to open-up the chest. This allows a physician to remove tissue from the chest wall or the surrounding lymph nodes of the lungs. A pathologist will then examine these samples under a microscope after processing the tissue in a laboratory
• Mediastinoscopy: During mediastinoscopy, a surgical scalpel is used to make very tiny incisions above the breastbone. Then, a medical instrument called a mediastinoscope, is inserted into the chest wall to examine and remove samples. These tissue samples are processed and then examined under a microscope for any abnormalities
• Fine needle aspiration biopsy (FNAB): During fine needle aspiration biopsy, a device called a cannula is used to extract tissue or fluid from the lungs, or surrounding lymph nodes. These are then examined in an anatomic pathology laboratory, in order to determine any signs of Lung Sarcomatoid Carcinoma
• Autofluorescence bronchoscopy: It is a bronchoscopic procedure in which a bronchoscope is inserted through the nose and into the lungs and measure light from abnormal precancerous tissue. Samples are collected for further examination by a pathologist

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Sarcomatoid Carcinoma of the Lung?

Complications of Sarcomatoid Carcinoma of the Lung include:

• Dyspnea (shortness of breath): Individuals with Sarcomatoid Carcinoma of the Lung may have an increased risk of exhibiting signs of dyspnea, if the cancerous tumor expands to block important large or small airways of the chest or lung
• Hemoptysis (coughing-up blood): Individuals may cough-up blood, due to excessive amounts of blood in the airways
• Pain: Advanced stages of Lung Sarcomatoid Carcinoma that has metastasized to the pleural cavity (lining surrounding the lungs), invaded the chest wall, or other areas of the body, may cause excessive pain and agony
• Pleural effusion (fluid in the chest): Excessive fluid accumulation, resulting from cancerous cells of Sarcomatoid Carcinoma spreading inside the lungs, or outside of the lungs
• Lung Sarcomatoid Carcinoma that spreads to other parts of the body: There is an increased risk of the cancer metastasizing (or spreading) to other parts of the body, such as the adrenal gland, liver, bones, and to the other lung

How is Sarcomatoid Carcinoma of the Lung Treated?

As with most cancers, early detection is linked with better survival results. The treatment method used is dependent on the location of the tumor, its type, and the stage of cancer. For Sarcomatoid Carcinoma of the Lung, there are 3 basic treatment methods: Radiation therapy, chemotherapy, and surgery

• Chemotherapy: Chemotherapy drugs are typically taken as pills, or injected directly into a vein. These drugs travel through the body to kill any cancer cells. But, they can also kill healthy cells, located within the gastrointestinal tract and in hair follicles. The side effects include vomiting, nausea, and hair loss
• Radiation therapy: Radiation therapy involves using x-rays to kill cancerous cells. High-powered radiation beams are directed to particular body regions to target cancer. In the process, healthy cells can also be damaged. Radiation therapy can be administered in the following ways:
  • Either by a machine, placed outside the body (called external beam radiation)
  • Or it may be administered internally, by a device positioned directly at, or close to the malignant tumor, inside the lungs (called brachytherapy)

Radiation therapy and chemotherapy can be used as a combination therapy. Combinational therapy increases the effects of both types of treatment. However, the side effects are cumulative. Studies have shown that combination therapy of radiation and chemotherapy is not particularly useful, in Sarcomatoid Tumors of the Lung.

Surgery: Depending on the stage of Lung Sarcomatoid Carcinoma, surgery might be a viable option. However, the location of the tumor in the periphery makes it commonly associated with metastasis. The surgical options include:

• Wedge resection: Wedge resection is a partial removal of the wedge-shape portion of the lung that contains cancerous cells (along with any surrounding healthy tissue)
• Segmentectomy: Segmentectomy is also the partial removal of the cancerous lung and any surrounding healthy tissue
• Lobectomy (pulmonary lobectomy): Lobectomy is the most common type of surgical procedure performed for Sarcomatoid Carcinoma of the Lung, to partially remove a portion of a lung
• Sleeve lobectomy: Sleeve lobectomy is also a surgical procedure to partially remove a portion of the lung and a part of the airway (bronchus)
• Pneumonectomy: It is the surgical removal of the entire lung

Some Lung Sarcomatoid Carcinomas are positive for epidermal growth factor receptor (EGFR) overexpression on the cell surface and targeted therapy erlotinib (Tarceva) is used to disrupt this receptor. The drug is administered to patients orally (in pill-form), and it is usually taken in combination with chemotherapy.

How can Sarcomatoid Carcinoma of the Lung be Prevented?

Most cancers may not be completely prevented. However, reducing their risk factors may contribute towards their prevention.

• As smoking is a risk factor for Sarcomatoid Carcinoma of the Lung, restraining from smoking can reduce one’s risk for cancer of this type
• Avoid exposure to asbestos

What is the Prognosis of Sarcomatoid Carcinoma of the Lung? (Outcomes/Resolutions)

The prognosis of Sarcomatoid Carcinoma of the Lung is poorer than that associated with other lung cancers. Tumor stage is the best indicator of the tumor outcome.

Sarcomatoid Carcinoma is staged as follows:

• Stage I: Sarcomatoid Carcinoma is only in the lung
• Stage II: Sarcomatoid Carcinoma is in the lung and has metastasized to adjacent lymph nodes
• Stage IIIA: Sarcomatoid Carcinoma is in the lung and the lymph nodes, on the same side of the chest, as the cancer
• Stage IIIB: Sarcomatoid Carcinoma is in the lung and the lymph nodes, on the opposite side of the chest as the cancer, or is above the collar bone
• Stage IV: Sarcomatoid Carcinoma has spread to other side of the lung and other parts of the body

Other indicators include:

• Size and location of the tumor: The tumors on the periphery of the lung are often larger than those on the center of the lung, and are more likely to invade the chest wall
• Whether it has spread (metastasized) to the lymph nodes
• Genetic mutation in K-Ras (oncogene/cancer-causing gene) or p53 (tumor suppressor gene) - it has been associated with a poorer prognosis

Furthermore, as with other forms of cancer, early detection is correlated with higher survival rates. For patients diagnosed with Sarcomatoid Carcinoma of the Lung, it is important to have follow-up appointments with a physician, to evaluate the effects of the current treatment method, and to monitor for any returning tumors.

Additional and Relevant Useful Information for Sarcomatoid Carcinoma of the Lung:

Lung Cancer is categorized into two types, Non-Small Cell Lung Cancer (NSCLC) and Small-Cell Lung Cancer (SCLC). It is difficult to diagnose NSCLC, because the cancer cells are underdeveloped when a pathologist looks under a microscope. Types of Non-Small Cell Lung Cancer include:

• Adenocarcinoma of the lung
• Squamous cell carcinoma
• Large cell carcinoma of the lungs

Small-Cell Lung Cancer is a fast-growing type of Lung Cancer that metastasizes faster than Non-Small Cell types. This type comprises about 15% of all Lung Cancer cases. Types of SCLC include:

• Small cell carcinoma
• Combined small cell lung carcinoma (c-SCLC)