11. Lung Cancer Flashcards
Epidemiology (in US) •Estimated New Cases in 2017: \_\_\_\_ •% of All New Cancer Cases: \_\_\_\_ •Estimated Deaths in 2017: \_\_\_\_ •% of All Cancer Deaths: \_\_\_\_ •5 year survival rate: \_\_\_\_
Males: ____ most common cancer and ____ cause of cancer-related death
Females: ____ most common cancer and ____ cause of cancer-related death
222,500 13.2% 155,870 25.9% 18.1%
second
leading
second
leading
Epidemiology (in US)
Most lung cancers diagnosed after already ____
Very ____ survival in patients with metastatic disease
metastasized
poor
Epidemiology (in US)
____ numbers of new cases and deaths resulting from ____ efforts
Still typically a disease of ____ individuals
reduced
smoking cessation
older
Risk factors
- Smoking
- Dependent upon ____
- Environment
- Second-hand ____, radon, ____, asbestos
- Familial risk and/or genetic susceptibility
- Polymorphisms or inherited mutations in ____
dose and duration
smoke
polluition
DNA repair genes
Clinical manifestations and diagnosis Variable signs and symptoms: • \_\_\_\_ • Persistent \_\_\_\_ • \_\_\_\_ • Unexplained \_\_\_\_ • \_\_\_\_
- Appears as ____ opacity on routine chest radiograph
- Biopsy performed via ____ or CT-guided needle biopsy
Cancer as seen using positron emission tomography-computed tomography (PET/CT scan)
asymptomatic cough dyspnea weight loss hemoptysis
ground-glass
bronchoscope
Primary epithelial lung cancers
Non-small cell lung carcinoma (NSCLC)
• ____ > 40%
• ____ 20%
• ____ 2-3%
Neuroendocrine tumors
• ____ 15%
adenocarcinoma
squamous cell carcinoma
large cell carcinoma
small cell carcinoma
Non-small cell carcinoma (NSCLC)
- Must define ____ prior to treatment
- ____ guides decision-making for targeted therapies
histologic subtype
molecular testing
NSCLC - Adenocarcinoma
- Most ____ NSCLC
- Cancers that form ____ structures and/or produce ____
- Most common subtype of NSCLC in ____
- Smoking link not as strong as in ____
- These cancers usually originate in ____
common glandular mucin women and non-smokers squamous cell carcinoma and small cell carcinoma periphery of lung
NSCLC - Adenocarcinoma
- Frequently associated with mutations in:
- KRAS – only seen in ____, no specific ____ therapy yet; presence predictive of ____ prognosis
- Epidermal growth factor receptor (EGFR) – more common in ____; can be ____ therapeutically
- BRAF – can be ____ therapeutically
- These three proteins are linked via ____
- Molecular profile different between ____
smokers
targeted
poor
never-smokers
targeted
targeted
common signaling pathway
smokers and never-smokers
Mutations in either KRAS or BRAF will result in ____ signaling even in presence of ____ drugs
constitutive downstream
anti-EGFR
Anti-EGFR Therapy and KRAS mutations
Mab > ____ > ____ > nucleus > cell cell progression continues:
– cell proliferation, survival and invasion and metastasis
EGFR
KRAS
BRAF Mutations and Anti-EGFR Therapy
Mab > ____ > ____ > nucleus > cell cycle progression continues inclduing proliferation, survival, invasion and metastasis
EGFR
BRAS
NSCLC – Squamous cell carcinoma
- Primarily associated with ____
- Most cancers usually originate ____ within lung
- Same histopathology and progression as ____
- ____
- Evolves from ____
- No characteristic ____ changes
cigarette smoking
centrally
oral squamous cell carcinoma
multi-step theory of carcinogenesis
dysplastic (pre-cancerous) epithelium
molecular
NSCLC – Large cell carcinoma
- Large ____ differentiated tumor cells without ____ differentiation
- Cancers may originate ____ within lung
- Often times grows ____ and to ____ size with ____ metastasis
- Has ____ prognosis
poorly glandular or squamous centrally or peripherally rapidly large early poor
Small cell carcinoma (aka oat cell carcinoma)
• Lung cancer ____ strongly associated with ____
- High-grade neuroendocrine carcinoma
- Tumor cells are ____, round and ____
- Can be confused for ____
• Often originates ____ then spreads to parenchyma
• Frequently associated with amplification of ____
or inactivation of ____
• Tumor cells may aberrantly express various hormones including ____ leading to ____
most smoking small blue lymphoma centrally c-MYC protooncogene RB tumor suppressor ACTH cushing syndrome
Progress in lung cancer treatment
1970s: surgery and radiation
1980s: chemo
1990s: chem combinations
2000s: targeted therapy and targeted therapy + chemo
Present: ____ therapy and ____
next-gen targeted
immunotherapy
Metastatic cancer to lungs • Most \_\_\_\_ anatomic site for metastases • Most common cancers most commonly metastasize • \_\_\_\_ > \_\_\_\_ > \_\_\_\_ • Spread via \_\_\_\_ or \_\_\_\_ circulation • Extremely \_\_\_\_ prognosis
Each arrow highlights a discrete metastatic deposit; other tumor nodules are also seen in these image
common carcinomas sarcomas melanomas lymphatics venous poor
Mesothelioma • Malignant tumor of \_\_\_\_ • Tissue lining \_\_\_\_ • Primarily caused by \_\_\_\_ exposure • May take \_\_\_\_ after exposure before cancer develops - Very \_\_\_\_ prognosis
Workers must be covered head-to-toe and wear inhalation mask whenever they work in areas that contain asbestos
Notice must be clearly and publicly displayed warning of any work that will lead to asbestos removal
mesothelium pleural cavity asbestos years poor
