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
