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What Type of Lung Cancer is BAC (Bronchioloalveolar Carcinoma)?

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Updated May 16, 2014

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BAC (Bronchioloalveolar cancer) has sometimes been called the “mystery” lung cancer. Accounting for 2% to 14% of all lung cancers, less is known about this type of cancer than other non-small cell lung cancers. The World Health Organization has classified BAC as a type of adenocarcinoma, a form of lung cancer that is more common in non-smokers.

What is BAC (Bronchioloalveolar Carcinoma)?

BAC develops in cells near in the small air sacs (alveoli) in the outer regions of the lungs. It spreads either along the tissue that separates the alveoli, or through the airways. Unlike other forms of lung cancer that often spread to the lining of the lungs (the pleura), and other regions of the body, BAC spreads primarily within the lungs. It can appear as a single spot in the periphery of the lungs, or as scattered spots throughout the lungs. There are 2 main types of BAC: non-mucinous BAC is more common, and found more often in smokers, and mucinous BAC, which is less common and often found in non-smokers.

How Does BAC (Bronchioloalveolar Carcinoma) Differ From Other Lung Cancers?

BAC is more likely to affect non-smokers, women, and Asians (especially eastern Asians) than other forms of lung cancer. Its incidence appears to be increasing, especially among younger non-smoking women.

Symptoms

Symptoms of BAC are similar to symptoms seen with other lung cancers, and include a persistent cough, coughing up blood (hemoptysis), and chest pain. But it has also been called the “masquerader.” It is not uncommon for BAC to be mistaken for pneumonia or other lung diseases before it is diagnosed.

Diagnosis

BAC diagnosis is also similar to the diagnosis of other lung cancers, with a few exceptions. A diagnosis of BAC requires a sample of tissue, and fine-needle aspiration biopsy can provide the diagnosis roughly half the time. Unlike other lung cancers, where PET scans are helpful in addition to CT scans in determining where cancer is present, PET scans are less reliable. Staging is similar to other forms of non-small cell lung cancer.

Treatment

Surgery is the treatment of choice for BAC, and when a single tumor can be removed, there is often a good chance that it will be cured. It appears to be less sensitive to traditional chemotherapy, and there is controversy over whether or not adjuvant chemotherapy (chemotherapy given along with surgery) should be used with surgery. BAC does appear to be more sensitive to the newer targeted therapies, treatments designed to attack cancer specifically and spare healthy tissue. Lung transplants are being looked at as an additional treatment. And if the cancer does not recur in the transplanted lungs, it offers another chance for long-term survival.

Prognosis

The survival rate is significantly better for BAC than for other forms of non-small cell lung cancer, especially when it is caught early and only one tumor is present. In one study, those who were diagnosed with BAC and had tumors less than 3 centimeters in diameter, had a 5-year survival rate of 100% with surgery. The 5-year survival rate for stage 3 and 4 disease is roughly 60%.

Sources:

Arenberg, D., American College of Chest Physicians. Bronchioalveolar lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2008. 132(3 Suppl):306S-13S.

Ebright, M. et al. Clinical pattern and pathologic stage but not histologic features predict outcome for bronchioloalveolar carcinoma. The Annals of Thoracic Surgery. 2002. 74(15):1640-6.

Garfield, D. et al. Bronchioalveolar carcinoma: the case for two diseases. Clinical Lung Cancer. 2008. 9(2):24-9.

Liu, Y. et al. Prognosis and Recurrent Patterns in Bronchioloalveolar Carcinoma. Chest. 2000. 118:940-947.

MacDonald, L. and H. Yazdi. Fine-needle aspiration biopsy of bronchioloalveolar carcinoma. Cancer. 2001. 93(1):29-34.

Raz, D. et al. Bronchioalveolar carcinoma: a review. Clinical Lung Cancer. 2006. 7(5):313-22.

Read, W. et al. The epidemiology of bronchioloalveolar carcinoma over the past two decades: analysis of the SEER database. Lung Cancer. 2004. 45(2):137-42.

Sakurai, H. et al. Bronchioloalveolar carcinoma of the lung 3 centimeters or less in diameter: a prognostic assessment. The Annals of Thoracic Surgery. 2004. 78(5):1728-33.

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