Chemical carcinogenesis in the tracheobronchial epithelium.

Some of the recent work in pulmonary carcinogenesis is briefly reviewed. Morphologic studies of neoplastic and preneoplastic lesions of the human bronchi are compared with similar studies of carcinogenesis and epithelial regeneration in the hamster trachea. These studies suggest that bronchogenic carcinomas are typically complex mixtures of three basic phenotypes, the epidermoid and the mucous and dense-core granulated (endocrine) phenotypes. Pure forms of these phenotypes are rare, as different cells and even individual cells in single tumors express more than one phenotype. The clinical significance of such phenotypic variability is not yet known. Bronchial cell types which retain the capacity to divide include the mucous cell, the basal cell and perhaps the dense-core granulated cell. Studies of epithelial regeneration and preneoplastic lesions suggest that the mucous cell may be pivotal both in the response to injury and in carcinogenesis. Cigarette smoking is believed to be the major etiologic factor in bronchogenic carcinoma. Cigarette smoke contains initiators of carcinogenesis, but it contains a plethora of probable promoters and cocarcinogens as well. It is hypothesized that cigarette smoke may both initiate bronchial cells and promote carcinogenesis in cells which have previously been initiated by smoke or other factors. It is further hypothesized that that mucous cell is the major target for initiation and subsequent tumorigenesis. The ultimate phenotype(s) displayed by the tumor is suggested to result from the effect of microenvironmental factors upon the initiated cell and its progeny.