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Adenocarcinoma in situ

Myths and Misconceptions About Bronchioloalveolar Carcinoma (BAC)

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GRACE Cancer Video Library - Lung

GCVL_LU-AA02_Myths and Misconceptions About Bronchioloalveolar Carcinoma (BAC)

Unfortunately, there is as much misinformation as good information about the unusual subtype of lung cancer known as bronchioloalveolar carcinoma (BAC) or adenocarcinoma in situ. Dr. Jack West reviews the top 5 myths.

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Bronchioloalveolar Carcinoma (BAC): What is It?

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GRACE Cancer Video Library - Lung

GCVL_LU-AA01_Bronchioloalveolar Carcinoma (BAC): What is It?

Bronchioloalveolar carcinoma (BAC), also known as adenocarcinoma in situ, is an unusual subtype of lung cancer with its own appearance under a microscope and on imaging. Dr. Jack West introduces some of the basics of the unique features of BAC.

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Please feel free to offer comments and raise questions in our Discussion Forums.

 


How Long A Period of Follow-Up is Long Enough to Be Confident a Ground Glass Opacity Won’t Grow?

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GGO over timeAn interesting article from Japan was published out in the Journal of Thoracic Oncology that asks how long a duration of follow-up imaging of a ground-glass opacity (GGO) is really needed to be confident it’s going to remain stable and not grow.   It’s very common to see small lung nodules that are ambiguous in their significance, for which follow-up scans are typically recommended rather than diving into a biopsy, and non-solid, hazy GGOs are another form of lung lesion that might possibly represent a lung cancer but are also the way a little inflammation or small infection would appear.   Even when they turn out to be something technically called cancer based on its appearance under the microscope, it’s often a non-invasive adenocarcinoma (sometimes termed bronchioloalveolar carcinoma, or BAC, but shifting in terminology to adenocarcinoma in situ, or AIS) or minimally invasive adenocarcinoma (MIA), in which the invasive component is less than 5 mm in diameter.  Even when they grow, it can be at an extremely slow pace.

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How does the diagnosis of BAC shape systemic therapy considerations today?

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It’s not uncommon for a question here to be about the a pathologist’s terminology on a report that equivocates about whether a lesion is bronchioloalveolar carcinoma (BAC) or another form of adenocarcinoma, perhaps “well-differentiated adenocarcinoma”, especially if it has a radiographic appearance of a hazy infiltrate or many small ground glass opacities. Meanwhile, there’s a new classification of lung cancer subtypes that obliterates the term BAC, instead favoring a definition of adenocarcinoma in situ, classifying small non-invasive lesions previously called BAC as a pre-malignant condition. How have the changes over the past few years changed how we should approach BAC?

I would have to say that the new reassignment of BAC as adenocarcinoma in situ hasn’t taken the lung cancer world by storm and that I still think of the clinical entity as BAC. For the preceding decade, the definition the pathologist’s used technically excluded a lesion with even 1% or 5% of the lesion being invasive as being called BAC, even if it acted for all the world like BAC. Clinicians learned not to be too hung up on a pathologist’s technical definitions and tended to define BAC more functionally/operationally. General oncologists and expert lung cancer specialists alike managed BAC based on the overall picture of how it behaved if it looked like a BAC pattern.

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Redefining Lung Cancer: Seeing the Patterns from Individual Colors

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This month’s Journal of Thoracic Oncology includes a landmark article, written by a multidisciplinary group of lung cancer experts that features several of the leading lung cancer pathologists in the world, that is attempting to do no less than present a new categorization of the pathology of lung cancer, focusing primarily on adenocarcinomas, but also touching on other lung cancer subgroups. Among the concepts included is a proposal that the term bronchioloalveolar carcinoma (BAC) be discontinued and recategorized based on whether patients have any invasive component to their lung cancer or not, and whether is is mucinous or non-mucinous. As significant as it is to redefine an entire disease of BAC, the concepts it introduces have implications that actually lead to a fundamentally different way of thinking about lung cancer, or at least NSCLC.

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