Akciğer Malign Tümörleri
Özet
Akciğer tümörleri dünyada en sık ölüme sebep olan ve büyük çoğunluğu malign karakter gösteren heterojen bir gruptur. Dünya Sağlık Örgütü’nün 2015 yılı sınıflamasına göre bu tümörler; adenokarsinom, skuamöz hücreli karsinom, nöroendokrin tümörler, büyük hücreli karsinom, adenoskuamöz karsinom, sarkomatoid karsinom ve tükürük bezi tümörleri gibi kategorilere ayrılmaktadır. Tütün mamullerinin kullanımı, akciğer kanserinin bilinen en büyük risk faktörünü oluşturmaktadır. Kanserler klinik ve patolojik davranışlarına göre temel olarak küçük hücreli ve küçük hücreli dışı olarak iki ana gruba ayrılır. En sık görülen histolojik tip olan adenokarsinomlar, glandüler diferansiyasyon ve müsin salınımı ile tanımlanır ve preinvazif formlardan agresif invazif varyantlara kadar alt tiplere sahiptir. Moleküler profilleme ve EGFR, ALK, ROS1 gibi mutasyonların tespiti, hedefe yönelik tedavide kritik öneme sahiptir. İkinci sıradaki skuamöz hücreli karsinom ise keratinizasyon ile belirgindir ve santral yerleşim gösterir. Nöroendokrin tümörler grubunda ise tipik/atipik karsinoidler ile yüksek dereceli küçük hücreli ve büyük hücreli karsinomlar yer alır. Bu tümörlerin ayırıcı tanısında, prognoz tayininde ve tedavi protokollerinin belirlenmesinde histopatolojik inceleme, immünohistokimyasal belirteçler (TTF-1, napsin A gibi) ve genetik profilleme en önemli yapı taşlarını oluşturmaktadır.
Lung tumors represent a heterogeneous group of malignancies that constitute the leading cause of cancer-related mortality worldwide. According to the 2015 World Health Organization classification, these tumors are categorized into major groups including adenocarcinoma, squamous cell carcinoma, neuroendocrine tumors, large cell carcinoma, adenosquamous carcinoma, sarcomatoid carcinoma, and salivary gland-type tumors. Tobacco consumption remains the most significant risk factor for development. Historically and clinically, lung cancers are broadly divided into small cell and non-small cell lung cancers due to their distinct clinical courses. Adenocarcinoma, the most prevalent histological subtype, is characterized by glandular differentiation or mucin production and is classified into preinvasive, minimal invasive, and highly aggressive invasive variants. Molecular profiling for driver oncogenic mutations, such as EGFR, ALK, and ROS1, is essential for guiding targeted therapies. Squamous cell carcinoma, strongly associated with smoking, features keratinization and typically presents as central masses. Neuroendocrine tumors encompass low-grade typical/atypical carcinoids and high-grade small cell and large cell neuroendocrine carcinomas. Accurate differential diagnosis, prognostic stratification, and therapeutic management rely heavily on comprehensive histopathological evaluation, immunohistochemical markers like TTF-1 and napsin A, and advanced genetic profiling techniques.
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