Basic Science of Lung Cancer

Question 1

Outline the steps in the formation of a metastasis

Answer 1

• Primary tumour
• Proliferation/angiogenesis
• Detachment/Invasion
• Intravasation (into circulation)
• Transport
• Adherence to vessel wall
• Extravasation
• Proliferation/angiogeneis
• Metastasis

Question 2

Describe three gene sequencing techniques

Answer 2

• Microarray
• Illumina
• Thermofisher

Question 3

What’s the difference between exons and introns

Answer 3

Exons are protein coding

Introns are non-protein coding

Question 4

Name a point mutation found in Lung cancers and how is it involved in the cancer formation

Answer 4

• EGFR
• Highly expressed on cancer cells
  
  • RAF-MEK-ERK pathway to lead to cell growth

Question 5

What therapy exists to target EGFR and name an example

Answer 5

EGFR tyrosine kinase inhibitors

Osimertinib

Question 6

What fusion protein mutation is found in NSCLC and how is this involved in NSCLC

Answer 6

EML4-ALK gene

Activation of PI3K-AKT-mTOR and JAK/STAT (cell survival)

Activation of Ras/Raf/MEK/ERK (cell proliferation)

Question 7

Name a therapy used to treat EML4-ALK fusion gene mutation in NSCLC

Answer 7

Crizotinib

~4% have this mutation and is effective

Question 8

Describe how cancer cells take advantage of immune checkpoints

Answer 8

• PDL1/2 acts as host identifier
• Tumour cells can develop these receptors through:
  
  • Innate
    
    • Normally have PDL1 anyway
  • Adaptive-induced
    
    • tumour cell presents antigen to T cel
    • T cell secretes IFN-γ
    • STAT pathway increases PDL1 expression on tumour cell surface

Question 9

What can be used to combat immune checkpoint evation

Answer 9

PDL-1 inhibitors

Question 10

Name some diagnostic tools for cancer

Answer 10

• Blood-based biomarkers
  
  • DNA
  • RNA
  • Proteins - Oncoimmune (lung cancer antigens)
  • Tumour DNA
• Trap Cancer Cells
  
  • Cell Search - FCAM expression, cells recovered and counted - not known how many cancer cells express FCAM
  • Screencell -