19 - Lung Cancer Flashcards
Leading cause of cancer DEATH in Australia
Lung cancer
Risk factors
- Smoking
- Environmental carcinogens (asbestos)
- Radiation
- Chronic inflammation (e.g. TB)
- Family history
Sampling techniques for diagnosis of lung cancer
- Transbronchial FNA
- Core biopsy
- Pleural fluid aspiration
Ancillary studies on neoplastic cytology/biopsy specimens
- IHC
- NGS
- PCR
- FISH
- Flow Cytometry
Major categories of lung cancer
- Small cell carcinoma
- Adenocarcinoma
- Squamous cell carcinoma
- Large cell carcinoma
- Adenosquamous carcinoma
- Sarcomatoid carcinoma
Small cell carcinoma
- Highly aggressive malignant epithelial tumour with neuroendocrine differentiation
- Strongly associated with smoking
- Widespread metastases
- Central > peripheral
Small cell carcinoma characteristics
Small cells with scant cytoplasm, finely granular chromatin & absent nucleoli
Adenocarcinoma
- Invasive malignant epithelial tumour with glandular differentiation or mucin production
- Most common cancer in non smokers (most cases smokers)
- Peripheral > central
- Adrenal, bone, brain metastases
Adenocarcinoma in situ
- No stromal, vascular or pleural invasion
- 100% 5-year disease free survival if completely resected
- Precursor to invasive malignancy
- CT chest: ground glass nodule
Oncogenic drivers of lung adenocarcinoma
- EGFR
- KRAS
- ALK
- ROS
NSCLC IHC
- TTF-1 (primary lung adenoma)
- p40 and CK5/6 (squamous markers)
- Periodic acid-Schiff + diastase (PASD) for mucin
EGFR-mutated lung adenocarcinoma
- Mutations in exon 19 and 21 most common
- Real-time PCR, NGS
- Predicts response to EGFR tyrosine kinase inhibitors
Cancer hallmarks seen in EGFR mutation in lung adenocarcinoma
1, 3, 5, 6
(Sustaining proliferative signalling, resisting cell death, inducing angiogenesis, activating invasion and metastasis)
ALK-rearranged lung adenocarcinoma
- Almost always mutually exclusive with other driver mutations
- Younger pts, light or never smokers
- Adenocarcinoma with solid-signet ring or mucinous cribriform pattern
Hallmarks of cancer in ALK-rearranged lung adenocarcinoma
1, 3, 6
(Sustaining proliferative signalling, resisting cell death, activating invasion and metastasis)
