29_30_Lung Cancer Flashcards
What are the main causes of lung cancer?
- Smoking,
- air pollution,
- radon,
- asbestos,
- nickel,
- other carcinogenic substances.
What are the histological manifestations of lung cancer?
- Epithelial tumors,
- soft tissue sarcoma,
- mesothelial tumors,
- metastases.
What are the two main histological types of lung cancer?
Small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC).
What is the most common histological type of lung cancer?
Adenocarcinoma.
In what population is adenocarcinoma more common?
non-smokers, women, and young patients
What is the most important treatment for small cell lung cancer?
Chemotherapy.
Is surgery a part of the treatment protocol for small cell lung cancer?
No.
What is the first choice of treatment for non-small cell lung cancer in early stages?
Surgery.
What is the treatment for non-small cell lung cancer in stage IIIB and IV?
Chemotherapy and radiotherapy.
What is the targeted therapy used for non-small cell lung cancer?
Immune therapy.
What is the first step in molecular pathology for tumor examination?
Taking a sample (e.g. by using bronchoscopy) and sending it for histological examination.
What is the purpose of immunohistochemistry in molecular pathology?
To determine the origin of the tumor (primary or metastatic) and the histological type (SCLC or NSCLC).
Which genes are examined for mutations in adenocarcinoma?
ALK, BRAF, KRAS, EGFR genes.
ALK : anaplastic lymphoma kinase
What is the method used for examining mutations in adenocarcinoma?
NGS (next generation sequencing).
What is the targeted therapy used for squamous cell carcinoma?
EGFR inhibitors, anti-VEGF, KRAS inhibitors, BRAF inhibitors.
What are the local symptoms of lung cancer?
- Cough with sputum,
- coughing up blood,
- dyspnea if the tumor causes pleural fluid or obstructs a bigger bronchus,
- chest pain if the tumor invades the pleura,
- Horner’s syndrome if the tumor is in the apex of the lung,
- SVC syndrome if the tumor compresses the SVC.
What is Horner’s syndrome?
Seenin 50% of patients with pancoast tumors (tumors in apex)
What is SVC syndrome?
Obstruction of blood flow in SVC causes edema of face and neck, dilated neck veins, dyspnea, flushed appearance
+ can have compression of laryngeal nerve : hoarse voice
What are the general symptoms of cancer?
Loss of appetite, weight loss, and fatigue.
What are the symptoms caused by metastases in lung cancer?
- Bone metastases can cause pain and pathological fracture,
- brain metastases can cause confusion, epileptiform seizures, paresis, and other neurological symptoms,
- liver metastases can cause an enlarged liver.
What are the paraneoplastic symptoms of lung cancer?
- SIADH (syndrome of inappropriate ADH secretion),
- PTHrP production leading to hypercalcemia,
- ACTH production leading to Cushing’s syndrome.
PTHrp: parathyroid hormone related protein
Why is screening important for lung cancer?
Lung cancer often has few or no symptoms at all, and complete remission is only possible if it is diagnosed in early stages and surgery is executed. Screening would increase the chance of early diagnosis, thus improving the survival rate. Low dose CT would be the best tool for screening.
What imaging methods are used for staging of lung cancer?
PET-CT, chest + abdomen + head CT, and bone scintigraphy.
What is bronchoscopy used for in the diagnosis of lung cancer?
To collect samples for histology and molecular pathology.
What are the methods used to collect samples for histology in lung cancer diagnosis?
- Bronchoscopy,
- CT-guided biopsy,
- pleural biopsy,
- pleuroscopy,
- VATS (video assisted thoracic surgery),
- mediastinoscopy.
What is immunohistochemistry used for in lung cancer diagnosis?
To determine the origin of the tumor (primary or metastatic) and the histological type (SCLC or NSCLC).
What is the staging system for lung cancer based on the 8th TNM?
T: size of the primary tumor, N: spread of cancer to nearby lymph nodes, M: distant metastases.
What does T stand for in the TNM staging system for lung cancer?
T stands for the size of the primary tumor.
What are the different categories of T in the TNM staging system for lung cancer?
T1a, T1b, T1c, T2a, T2b, T3, T4.
What is the size of the tumor for T1a in the TNM staging system for lung cancer?
Tumor size is less than 1cm.
What is the size of the tumor for T1b in the TNM staging system for lung cancer?
Tumor size is greater than 1cm, but less than 2cm.
What is the size of the tumor for T1c in the TNM staging system for lung cancer?
Tumor size is greater than 2cm, but less than 3cm.
What is the size of the tumor for T2a in the TNM staging system for lung cancer?
Primary tumor is between 3cm and 4cm.
What is the size of the tumor for T2b in the TNM staging system for lung cancer?
Primary tumor is between 4cm and 5cm.
What is the size of the tumor for T3 in the TNM staging system for lung cancer?
Tumor is between 5cm and 7cm.
What is the size of the tumor for T4 in the TNM staging system for lung cancer?
Tumor is greater than 7cm or has invaded nearby structures.
What is N1 in cancer spread to nearby lymph nodes?
Ipsilateral hilar.
What is N2 in cancer spread to nearby lymph nodes?
Ipsilateral mediastinal and/or subcarinal.
What is N3 in cancer spread to nearby lymph nodes?
- Contralateral mediastinal/hilar,
- supraclavicular bilateral,
- scalenus lymph node bilateral.
What is M1 in distant metastases of cancer?
Spreads to chest.
What is M1a in distant metastases of cancer?
Malignant pleural/pericardial effusion or contralateral, separate tumor nodule.
What is M1b in distant metastases of cancer?
Single extrathoracic metastasis (e.g. liver, regional LN).
What is M1c in distant metastases of cancer?
Multiple extrathoracic metastases in several organs (e.g. brain, bone, liver, adrenals).
