Sarcomatoid carcinoma of the lung

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2]

Sarcomatoid carcinomas are a type of cancer that looks like a mixture of carcinoma (cancer that begins in the skin or in tissues that line or cover internal organs in the body) and sarcoma (cancer of the bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue). Sarcomatoid carcinoma are rare, aggressive, malignant cancer and can occur in different organs such as the thyroid gland, bone, skin, breast, pancreas, liver, urinary tract, and lung. Sarcomatoid carcinoma of the lung is a group of poorly differentiated non-small cell lung carcinomas. Sarcomatoid cancer of the lung is a rare type of malignancy and it comprises of only 0.3% to 1.3% of cases of all lung cancers. The pathogenesis of sarcomatoid carcinoma of the lung is characterized by a rare epithelial origin, and morphologic features suggestive of a malignant mesenchymal tumor. The EGFR gene and K-ras mutations have been associated with the development of sarcomatoid carcinoma of the lung. The prevalence of sarcomatoid carcinoma of the lung is approximately 0.4 cases per 100,000 individuals worldwide. The most common risk factor in the development of sarcomatoid carcinoma of the lung is smoking, exposure to high levels of air pollution, asbestos, radiation therapy to the chest, radon gas, and occupational exposure to chemical carcinogens. If left untreated, the majority of patients with sarcomatoid carcinoma of the lung may develop distant metastasis. Prognosis is generally poor, even worse than other non-small cell carcinoma of the lung. The 5-year survival rate for patients with sarcomatoid carcinoma of the lung is 28.7%.

Sarcomatoid carcinoma is a rare type of malignant tumor. The name sarcomatoid carcinoma was first described by Virchow in 1865 as a “biphasic” lesion of adenocarcinomatous or squamous cell carcinoma with spindle cell or giant cell component.

Sarcomatoid carcinoma of the lung is a rare type of non-small cell lung cancer. On the basis of histopathological features, sarcomatoid carcinoma of the lung can be classified into 5 subtypes: pleomorphic carcinoma, spindle cell carcinoma, giant cell carcinoma, carcinosarcoma, and pulmonary blastoma.

Sarcomatoid carcinomas are rare, aggressive, malignant cancer and can occur in different organs such as the thyroid gland, bone, skin, breast, pancreas, liver, urinary tract, and lung. Sarcomatoid carcinoma of the lung is a group of poorly differentiated non-small cell lung carcinomas. Sarcomatoid carcinoma is defined as a biphasic tumor with morphological characteristics of both, carcinomatous and sarcomatous components. The exact pathogenesis of sarcomatoid carcinoma of the lung is not fully understood, but the EGFR and K-ras gene mutations have been associated with the development of sarcomatoid carcinoma of the lung.

The direct cause of sarcomatoid carcinoma of the lung is DNA mutations that often result in either activation of proto-oncogenes (e.g. K-RAS) or the inactivation of tumor suppressor genes (e.g. TP53) or both. The risk of these genetic mutations may be increased following exposure to environmental components.

Sarcomatoid carcinoma of the lung must be differentiated from other pulmonary disease causing cough, weight loss, hemoptysis, and dyspnea with the of tests such as chest X-ray, CT-scan of the chest, sputum culture and stain specific for microbes. Sarcomatoid carcinoma of the lung must be differentiated from different types of lung malignancies with the help of biopsy results and immunohistochemical staining of the biopsy specimen.

Sarcomatoid carcinoma of the lung is a rare lung malignancy with aggressive characteristics. The prevalence of sarcomatoid carcinoma of the lung is approximately 0.4 cases per 100,000 individuals worldwide. The average age of patients being diagnosed is between 65 to 75 years, male to female ratio 4:1. The 3-year and 5-year survival rates for patients with sarcomatoid cancer of lung are 35.8% and 28.7%.

The most potent risk factor in the development of sarcomatoid carcinoma of the lung is tobacco smoking. Other risk factors include second hand smoke, air pollution, radiation therapy to the chest, radon exposure, asbestos exposure and exposure to other chemical carcinogens.

The U.S. Preventive Services Task Force (USPSTF) recommends annual screening for lung cancer by low-dose computed tomography. The screening test is recommended to the smokers who are between 55 to 80 years old and who have a history of smoking 30 pack-years or more and either continue to smoke or have quit within the past 15 years.

The majority of patients with sarcomatoid carcinoma of the lung remain are initially asymptomatic. Early clinical features include chronic cough, hemoptysis, dyspnea, weight loss, and fatigue. If left untreated, patients with sarcomatoid carcinoma of the lung may develop local invasion and distant metastasis. Majority of the patients with central sarcomatoid carcinoma of the lung may develop distant metastasis to esophagus, jejunum, rectum, and kidney. Sarcomatoid carcinoma of lung located in the periphery of lungs tends to be diagnosed later in the advanced stages with the large size and metastasis to the pleura and chest wall. Common complications of sarcomatoid carcinoma of the lung include respiratory failure, recurrent pneumonia, and distant metastasis. Prognosis is generally poor. The 3-year and 5-year survival rates for patients with sarcomatoid cancer of lung are 35.8 and 28.7%.

The diagnostic modality of choice for sarcomatoid carcinoma of the lung is CT scan of the chest. The definitive diagnosis of sarcomatoid carcinoma of the lung is made by biopsy of the tumor.

Sarcomatoid carcinoma of the lung is a rare group of non-small cell lung cancer. The patients with sarcomatoid carcinoma of the lung commonly are current smokers or have a history of smoking. Most commonly, sarcomatoid carcinoma of the lung presents as chronic cough, hemoptysis, dyspnea, fatigue, and weight loss. There are no paraneoplastic syndromes associated with sarcomatoid carcinoma of the lung.

Physical examination findings of sarcomatoid carcinoma of the lung will depend on the location of the tumor. Sarcomatoid carcinoma of the lung with central location may cause crackling sounds, focal wheezing, voice hoarseness, and tachypnea. Peripheral location can present with pleurisy findings, such as reduced chest expansion. Common physical examination of patients with sarcomatoid carcinoma of the lung include: crackling or bubbling noises and decreased/absent breath sounds.

There are no specific laboratory findings associated with sarcomatoid carcinoma of the lung.

There are no ECG findings associated with sarcomatoid carcinoma of the lung.

Conventional chest radiography is the initial imaging method of choice for the diagnostic evaluation of sarcomatoid carcinoma of the lung. The initial evaluation of suspected lung cancer will depend upon the results of the chest X-ray. Further evaluation of suspected lung cancer includes enhanced CT scan of the chest, upper abdomen, and neck. Imaging features for the evaluation of sarcomatoid carcinoma of the lung include location such as central or peripheral lesion, mass characteristics such as size, shape, and margins, the presence of cavitation, and type of lymphadenopathy such as hilar or mediastinal.

There are no echocardiography or ultrasound findings associated with sarcomatoid carcinoma of the lung.

CT scan of the chest is the imaging investigation of choice for sarcomatoid carcinoma of the lung. CT scan is useful in diagnosing the tumor and also to rule out any possible metastasis. CT scan finding of sarcomatoid carcinoma of the lung is similar to CT scan finding of lung cancer. On CT, characteristic findings of sarcomatoid carcinoma of the lung include ground-glass opacity, rounded or spiculated mass, local nodal involvement, and lobar collapse.

There are no MRI findings associated with sarcomatoid carcinoma of the lung.

Other imaging studies that can be used to assess metastasis of sarcomatoid carcinoma of the lung includes PET scan. For information on PET scan findings of lung cancer, click here sarcomatoid carcinoma of the lung.

The definitive diagnosis of sarcomatoid carcinoma of the lung is made by immunohistochemical staining and pathological subtyping of the specimen collected from biopsy, needle aspiration, sputum cytology or surgical resection of the tumor. Specimen for immunohistochemical analysis and pathological subtyping may be collected by transthoracic needle biopsy, bronchoscopy with biopsy, surgical resection, video-assisted thoracoscopic surgery (VATS), endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) and rarely sputum cytology.

The therapy for sarcomatoid carcinoma of the lung consists of surgery, radiation therapy, chemotherapy, and targeted therapy.

Sarcomatoid carcinoma of the lung surgery involves the surgical excision of the tumor from the lung by surgical procedures such as segmentectomy, lobectomy, or pneumonectomy.

Effective measures for the primary prevention of lung cancer include smoking cessation and avoidance of second-hand smoking. Lifestyle changes, such as a healthy diet rich with fruits and vegetables and regular exercise, might decrease the risk of developing cancer in general.

Secondary prevention for lung cancer consists of smoking cessation and screening. Secondary chemoprevention focuses on blocking the development of lung cancer in individuals in whom a precancerous lesion has been detected.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2]

Sarcomatoid carcinoma is a rare type of malignant tumor. The name sarcomatoid carcinoma was first described by Virchow in 1865 as a “biphasic” lesion of adenocarcinomatous or squamous cell carcinoma with spindle cell or giant cell component.

Sarcomatoid carcinoma is a rare type of malignant tumor. The name sarcomatoid carcinoma was first described by Virchow in 1865 as a “biphasic” lesion of adenocarcinomatous or squamous cell carcinoma with spindle cell or giant cell component.

• Sarcomatoid carcinoma was first described by Virchow in 1865 as a “biphasic” lesion of adenocarcinomatous or squamous cell carcinoma with spindle cell or giant cell component.^[1]
• In 1981, World Health Organization (WHO) classification on lung cancers, mentioned pleomorphic carcinomas showing a prevalence of spindle or giant cells as morphologic variants of squamous cell carcinomas and large-cell carcinomas, respectively, and defined carcinosarcomas as biphasic tumors consisting of an intimate admixture of carcinoma and sarcoma.^[2]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2]

Sarcomatoid carcinoma of the lung is a rare type of non-small cell lung cancer. On the basis of histopathological features, sarcomatoid carcinoma of the lung can be classified into 5 subtypes: pleomorphic carcinoma, spindle cell carcinoma, giant cell carcinoma, carcinosarcoma, and pulmonary blastoma.

Sarcomatoid carcinoma of the lung can be classified according to WHO classification into 5 subtypes:^[1][2]

• Pleomorphic carcinoma
• Spindle cell carcinoma
• Giant cell carcinoma
• Carcinosarcoma
• Pulmonary blastoma

Sarcomatoid carcinoma of the lung can also be classified according to their location including:^[2]

• Central
• Peripheral

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2]

Sarcomatoid carcinomas are rare, aggressive, malignant cancer and can occur in different organs such as the thyroid gland, bone, skin, breast, pancreas, liver, urinary tract, and lung. Sarcomatoid carcinoma of the lung is a group of poorly differentiated non-small cell lung carcinomas. Sarcomatoid carcinoma is defined as a biphasic tumor with morphological characteristics of both, carcinomatous and sarcomatous components. The exact pathogenesis of sarcomatoid carcinoma of the lung is not fully understood, but the EGFR and K-ras gene mutations have been associated with the development of sarcomatoid carcinoma of the lung.

• The pathogenesis of sarcomatoid carcinoma of the lung is characterized by a rare epithelial origin and morphologic features suggestive of a malignant mesenchymal tumor.^[1][2][3]
• Four major hypotheses may explain sarcomatoid neoplasms:^[4][5]
  • The embryonic rest hypothesis: This theory suggests that sarcomatoid tumors are the result of misplaced “mini-organs” that has epithelial and stromal component.
  • The collision hypothesis: This theory implies separate but concomitant malignant proliferation of epithelium and mesenchyme.
  • The stromal induction/metaplasia hypothesis: This theory suggests that sarcomatous elements are an atypical response to the growth of a carcinoma.
  • Totipotential hypothesis: This hypothesis proposes an origin from a single totipotential stem cell that differentiates into epithelial and mesenchymal components.

• The development of sarcomatoid carcinoma is the result of multiple genetic mutations include:^[6]
• EGFR
• K-ras

There are no conditions associated with sarcomatoid carcinoma of the lung.

• Sarcomatoid carcinomas can arise centrally or peripherally.^[7][8]
• Most commonly present as poorly circumscribed solitary peripheral masses.
• Sarcomatoid carcinoma is commonly found in upper lobe of the lungs.
• Tumors are large, ranging from 1 to 13 cm, with a median of 4.9 cm, and often invade the chest wall.
• Tumor consistency is described as soft and fleshy or firm, hard, or rubbery.
• Cut surfaces vary from white-grey to yellow, frequently show hemorrhagic and necrotic foci, and occasionally demonstrate cavitation.

• On microscopic histopathologically sarcomatoid carcinoma is classified into 5 subtypes:^[9]
  • Pleomorphic carcinoma
    • Poorly differentiated, sarcomatoid carcinoma composed of malignant spindle and giant cells.
    • Spindle cell may vary from epithelioid to strikingly spindled and are arranged in haphazard fascicles or storiform pattern.
    • Giant cells are discohesive, uninucleated or multinucleated, have moderate to abundant, dense, eosinophilic cytoplasm which may show emperipolesis by polymorphonuclear leukocytes or lymphocytes.
    • Giant cells are anaplastic, with many bizarre forms.
    • Tumor cells are embedded in a fibrous or myxoid stroma.
  • Spindle cell carcinoma
    • Sarcomatoid carcinoma composed only of spindle-shaped tumor cells.
  • Giant cell carcinoma
    • Sarcomatoid carcinoma composed only of anaplastic, giant cell tumor.
  • Carcinosarcoma
    • A mixture of carcinoma and true sarcomas such as osteosarcoma, chondrosarcoma or rhabdomyosarcoma.
    • The carcinoma component may be squamous cell carcinoma, adenocarcinoma, adenocarcinoma mixed with squamous cell carcinoma, and large cell carcinoma, whereas the sarcoma component may be rhabdomyosarcoma, osteosarcoma mixed with chondrosarcoma, and osteosarcoma.
  • Pulmonary blastoma
    • A biphasic tumor composed of a primitive epithelial component with well-differentiated, fetal adenocarcinoma and a primitive mesenchymal stroma that may contain rhabdomyosarcoma, osteosarcoma, or chondrosarcoma.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2]

The direct cause of sarcomatoid carcinoma of the lung is DNA mutations that often result in either activation of proto-oncogenes (e.g. K-RAS) or the inactivation of tumor suppressor genes (e.g. TP53) or both. The risk of these genetic mutations may be increased following exposure to environmental components.

• The direct cause of lung cancers is DNA mutations that often result in either activation of proto-oncogenes (e.g. K-RAS) or the inactivation of tumor suppressor genes (e.g. TP53) or both.^[1]
• The risk of these genetic mutations may be increased following exposure to environmental components, which are regarded as risk factors that predispose to the development of lung cancer.

• To view a comprehensive list of risk factors that increase the risk of lung cancer, click here.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2]

Sarcomatoid carcinoma of the lung must be differentiated from other pulmonary disease causing cough, weight loss, hemoptysis, and dyspnea with the of tests such as chest X-ray, CT-scan of the chest, sputum culture and stain specific for microbes. Sarcomatoid carcinoma of the lung must be differentiated from different types of lung malignancies with the help of biopsy results and immunohistochemical staining of the biopsy specimen.

Sarcomatoid carcinoma of the lung must be differentiated from some serious infectious diseases of the lung and other types of lung cancer.

• Sarcomatoid carcinoma of the lung must be differentiated from the following infectious diseases of the lung that can cause cough, hemoptysis, dyspnea, and weight loss among adults with the help of chest X-ray, CT-scan of the chest, sputum culture and stain specific for microbes.^[1][2][3]
  • Tuberculosis
  • Fungal pneumonia
  • Lung abscess
• Sarcomatoid carcinoma of the lung must be differentiated from different types of lung malignancies with the help of biopsy results and immunohistochemical staining.

For more information on differentiating lung cancer from other diseases, click here.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2]

Sarcomatoid carcinoma of the lung is a rare non-small cell lung cancer with aggressive characteristics. The prevalence of sarcomatoid carcinoma of the lung is approximately 0.4 cases per 100,000 individuals worldwide. The average age of patients being diagnosed is between 65 to 75 years, male to female ratio 4:1. The 3-year and 5-year survival rates for patients with sarcomatoid cancer of lung are 35.8 and 28.7%.

Sarcomatoid carcinoma of the lung is a rare type of non-small cell lung cancer with aggressive characteristics. There is no sufficient information on the incidence rate of sarcomatoid carcinoma of the lung. Sarcomatoid carcinoma comprises of 0.3% to 1.3% of total lung malignancies.

• The prevalence of sarcomatoid carcinoma of the lung is approximately 0.4 cases per 100,000 individuals worldwide.^[1]
• Sarcomatoid carcinoma comprises of 0.3% to 1.3% of total lung malignancies.^[2]
• The overall prevalence of sarcomatoid carcinoma of the lung is 0.1% to 0.4% of all non-small cell lung malignancies.^[3]

• The 3-year and 5-year survival rates for patients with sarcomatoid cancer of lung are 35.8 and 28.7%.^[4].

• Sarcomatoid carcinoma of the lung is more commonly diagnosed among patients aged 65 to 75 years old.^[5]
• Sarcomatoid carcinoma of the lung is more commonly observed among elderly patients and adults.
• Biphasic blastoma subtype is an exception with average age of 35 years old patients being more commonly diagnosed.

• There is no racial predilection to sarcomatoid carcinoma of the lung.

• Males are more commonly affected with sarcomatoid carcinoma of the lung than females. The male to female ratio is 4:1.^[6][4][5]
• Biphasic blastoma subtype is an exception, that affects men and women equally.

• Geographical location has no effect on the epidemiology of sarcomatoid carcinoma of the lung.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2]

The most potent risk factor in the development of sarcomatoid carcinoma of the lung is tobacco smoking. Other risk factors include secondhand smoke, air pollution, family history of lung cancer, radiation therapy to the chest, radon exposure, asbestos exposure and exposure to other chemical carcinogens.

Common risk factors in the development of sarcomatoid carcinoma of the lung are the following:^[1][2][3][4]

• History of cigarettes, cigars, or pipe smoking
• Secondhand or passive smoking
• Family history of lung cancer
• Genetic predisposition
• High levels of air pollution
• Radiation therapy to the chest
• Heavy alcohol consumption
• Radon gas
• Occupational exposure to silica, asbestos, uranium, arsenic, chromium, or nuclear radiation
• Previous history of lung diseases

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2]

The U.S. Preventive Services Task Force (USPSTF) recommends annual screening for lung cancer by low-dose computed tomography. The screening test is recommended to the smokers who are between 55 to 80 years old and who have a history of smoking 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).

According to the U.S. Preventive Services Task Force (USPSTF), screening for lung cancer by low-dose computed tomography is recommended every year among smokers who are between 55 to 80 years old and who have history of smoke 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).^[1][2]

Guidelines

• According to the clinical practice guideline by the U.S. Preventive Services Task Force (USPSTF), screening for lung cancer by low-dose computed tomography (LDCT) is recommended every year among smokers and former smokers who are between 55 to 80 years old and who have smoked 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).^[3]

• According to the clinical practice guideline issued by the American College of Chest Physicians (CHEST) in 2013, screening for lung cancer by low-dose CT (LDCT) is recommended every year among smokers and former smokers who are age 55 to 74 and who have smoked for 30 pack-years or more and either continue to smoke or have quit within the past 15 years.^[4]

Strategies

• Low-dose helical computed tomography
  • Pros:
    • There is evidence that screening persons aged 55 to 74 years who have cigarette smoking histories of 30 or more pack-years and who, if they are former smokers, have quit within the last 15 years reduce lung cancer mortality by 20% and all-cause mortality by 6.7%.^[5]
  • Cons:
    • The majority of all positive low-dose helical computed tomography screening exams do not result in a lung cancer diagnosis. False-positive exams may result in unnecessary invasive diagnostic procedures.

• Chest x-ray and/or sputum cytology
  • Pros:
    • Screening with chest x-ray and/or sputum cytology does not reduce mortality from lung cancer in the general population or in ever-smokers.^[6]
  • Cons:
    • False positive exams
    • The majority of all positive chest x-ray screening exams do not result in a lung cancer diagnosis.
    • False-positive exams result in unnecessary invasive diagnostic procedures.

• The table below summarizes the screening eligibility for non-small cell lung cancer screening by different organizations.

Screening Guidelines for Non Small Cell Lung Cancer Adapted from Center of Disease Control and Prevention (CDC). 2016 [7]
Organization	Groups eligible for screening	Year
American Academy of Family Practice	Evidence is insufficient to recommend for or against screening	2013
American Association of Thoracic Surgery	1. Age 55 to 79 years with 30 pack year smoking history 2. Long term lung cancer survivors who have completed 4 years of surveillance without recurrence and who can tolerate lung cancer treatment following screening to detect second primary lung cancer until the age of 79 3. Age 50 to 79 years with a 20 pack year smoking history and additional comorbidity that produces a cumulative risk of developing lung cancer ≥ 5% in 5 years	2012
American Cancer Society	Age 55 to 74 years with ≥30 pack year smoking history, who either currently smoke or have quit within the past 15 years, and who are in relatively good health	2015
American College of Chest Physicans	Age 55 to 74 years with ≥30 pack year smoking history,who either currently smoke or have quit within the past 15 years	2013
American Society of Clinical Oncology	Age 55 to 74 years with ≥30 pack year smoking history,who either currently smoke or have quit within the past 15 years	2012
American Lung Association	Age 55 to 74 years with ≥ 30 pack year smoking history and no history of lung cancer	2012
Medicaid Services	Age 55 to 77 years with ≥ 30 pack year smoking history and smoking cessation < 15 years	2015
National Comprehensive Cancer Network	Age 55 to 74 years with ≥30 packyear smoking history and smoking cessation < 15 years OR Age ≥ 50 years and ≥20 pack year smoking history and additional risk factor (other than secondhand smoke exposure	2015
U.S Preventive Services Task Force	Age 55 to 80 years with ≥30 pack year smoking history and smoking cessation < 15 years	2013

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2]

The majority of patients with sarcomatoid carcinoma of the lung remain are initially asymptomatic. Early clinical features include chronic cough, hemoptysis, dyspnea, weight loss, and fatigue. If left untreated, patients with sarcomatoid carcinoma of the lung may develop local invasion and distant metastasis. Majority of the patients with central sarcomatoid carcinoma of the lung may develop distant metastasis to esophagus, jejunum, rectum, and kidney. Sarcomatoid carcinoma of lung located in the periphery of lungs tends to be diagnosed later in the advanced stages with the large size and metastasis to the pleura and chest wall. Common complications include respiratory failure, recurrent pneumonia, and distant metastasis. Prognosis is generally poor. The 3-year and 5-year survival rates are 35.8 and 28.7%.

The majority of patients with non-small cell lung cancer are initially asymptomatic.^[1]

• The majority of patients with sarcomatoid carcinoma of the lung remain are initially asymptomatic.
• Early clinical features include chronic cough, hemoptysis, dyspnea, weight loss and fatigue.^[2][3]
• If left untreated, patients with sarcomatoid carcinoma of the lung may develop local invasion and distant metastasis.
• The majority of patients with central sarcomatoid carcinoma of the lung may develop distant metastasis to esophagus, jejunum, rectum, and kidney.
• Sarcomatoid carcinoma of lung located in the periphery of lungs tends to be diagnosed later in the advanced stages with the large size and metastasis to the pleura and chest wall.

Common complications of sarcomatoid carcinoma of the lung, include:^[1]

• Acute respiratory failure
• Respiratory acidosis
• Malignant pleural effusion
• Metastases
• Recurrent pneumonia

Prognosis of sarcomatoid carcinoma of the lung depends on the origin of the tumor, histological type, and stage.^[1]

• Prognosis of sarcomatoid carcinoma of the lung is generally poor.
• The 3-year and 5-year survival rates for patients with sarcomatoid cancer of lung are 35.8 and 28.7%.^[4]
• Non-small cell lung cancer survival rate ranges from 1% to 52% (stage I to stage IV).

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