Cancer precursor lesions project

Do you have expertise in particular malignancies? If so, we invite you to review our new Cancer precursor spreadsheet of all distinct human cancers (1,231 as of 3 Apr 24) and their identifiable precursors (192 as of 3 Apr 24) to advise

• What malignant diagnoses should be added or removed from this spreadsheet?
• What precursor lesions should be added or changed for any of the diagnoses listed?
• Are some diagnoses duplicative because they are essentially the same within or at different sites?

Please email proposed updates to Nat@PathologyOutlines.com. An overview of the project with additional information is available here. Our goal is to identify precursor lesions for all malignancies to better understand and treat cancer and reduce its 600,000 annual U.S. deaths. Studying known precursors and their patterns of molecular expression may suggest molecular patterns for tumors with unknown precursors (Pernick 2018).

Neuroendocrine tumors

Our first essay discusses malignancies and their precursor lesions based on our new Cancer Precursor Project. This essay examines data compiled by our project on neuroendocrine tumors and summarizes current knowledge about precursor lesions in the stomach (enterochromaffin-like cell hyperplasia) and lung (DIPNECH). You can read the full essay here.

Premalignant precursors for glioblastoma

We propose that the premalignant precursors may be relatively stable based on the attractor concept and have distinctive molecular patterns that may or may not be identifiable histologically (Pernick 2018).

Glioblastoma, IDH wild type is the most common primary brain tumor in adults (“primary” in this context means not representing metastatic disease). It accounts for 14% of all primary central nervous system (CNS) tumors and 49% of all malignant CNS tumors in adults (Ostrom 2021). 

Although we believe that most malignancies have a premalignant precursor lesion, to our knowledge, none has been identified for primary glioblastoma or any primary CNS tumor.

What might a glioblastoma premalignant precursor look like? We suggest it may have “milder” features of glioblastoma but in a nonmalignant context.

More information and the full essay can be found here.

Characteristics of premalignant precursors, part 1

Although premalignant precursors have been identified for 15.6% of distinct malignancies, the percentage varies widely by pathology subspecialty, from 1.8% to neuropathology (brain / eye) to 41.3% for thoracic (lung, heart, mediastinum). 

We believe that studying these precursor lesions will help identify existing, but currently unknown cancer precursors, such as in the CNS (central nervous system or brain) and soft tissue.

This essay gives examples of precursors for carcinomas of the pancreas and lung and lists common precursors at other epithelial sites.

More information and the full essay can be found here.

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Nat Pernick, M.D. | nat@pathologyoutlines.com