CPRS 83: Lung Cancer Flashcards by Karl Wong

___________ will lead to oxidative stress, then mutations, then cancer

Reactive Oxygen Species

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Name a Single Nucleotide Polymorphic (SNP) gene that will cause cancer

P450

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There are 4 types of Primary Lung Carcinoma:
Non-small cell Lung Cancers:
\_\_\_\_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_\_\_\_\_
and
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Non-small cell Lung Cancers:
Adenocarcinoma, Squamous cell carcinoma, Large cell carcinoma
and
Small cell lung carcinoma

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Which is the commonest type of cancer amongst smokers and non-smokers

Adenocarcinoma

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What is the feature of adenocarcinoma

Tumour forming glands and tubules

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Which cell types are involved in adenocarcinoma

Cells lining terminal bronchioles and alveoli

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What is the difference between Dysplasia and Adenocarcinoma

No invasion to underlying tissues VS

Yes invasion to underlying tissues

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Under adenocarcinoma, what’s ‘Lepidic predominant’?

Cells grow along the original alveolar wall with little invasion to the stroma

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Under adenocarcinoma, what’s ‘Solid Adenocarcinoma’?

A solid mass without glands

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Under adenocarcinoma, what’s ‘Acinar Predominant’?

Tumour cells arranged in gland-like structures

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Under adenocarcinoma, what’s ‘Papillary predominant’?

Branching and finger-like stromal cores

Tumour cells lining the cores

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Under adenocarcinoma, what’s ‘Mucinous Adenocarcinoma’?

Tumour cells spreading along alveolar wall

Large amounts of mucin

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What is the distinctive symptom for Mucinous Adenocarcinoma

Severe cough with sputum

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What are the process for formation of squamous cell carcinoma

Normal 
Metaplasia
Dysplasia
Carcinoma in situ
Squamous cell carcinoma

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What are some distinctive features for squamous cell carcinoma

Keratin formation

Intercellular bridges

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What are distinctive features for large cell carcinoma

Large, poorly differentiated tumour cells

What cells are small cell lung carcinoma derived from

Neuro-endocrine cells

What are the distinctive features of small cell lung carcinoma

Sheets of small tumour cells

Hyperchromatic nuclei and indistinct nucleoli

What are the 4 ways for cancer to spread

Local spread (Irregular edges and infiltrate adjacent lung)
Direct spread to adjacent organs (e.g. Oesophagus, Pleura, Pericardium)
Lymphatic spread
Hematogenous spread

What are the differences between Small Cell Lung Carcinoma (SCLC) and Non Small Cell Lung Carcinoma (NSCLC)

Aggressive VS Less Aggressive
Early blood spread VS Local spread at first
Poor Outcome VS Better Outcome
Good Response to Chemotherapy and Radiotherapy VS Surgery is the only treatment of choice

For the NSCLC, what’s the TNM staging system?

T: Tumour- Tumour size and extent of local tumour spread
N: Lymph nodes- Site of lymph node involved
M: Metastasis-Distant organs

Ipsilateral means on the _______ side

Contralateral means on the _________ side

Ipsilateral means on the same side

Contralateral means on the opposite side

What are the nodal stages?
N1:
N2:
N3:
N3:

N1: Ipsilateral Hilar
N2: Ipsilateral Mediastinal
N3: Ipsilateral Neck
N3: Contralateral Hilar/ Contralateral Mediastinal
*For whatever contralateral, already indicates N3

What is the difference between limited stage and extensive stage of small cell lung cancer

Limited stage: Tumour confined to an area, can be covered by 1 radiotherapy
Extensive stage: Cannot be covered by 1 radiotherapy

What is the first thing to do after finding a malignant tumour in lung or pleura

Ensure the tumour is not due to metastasis

How to diagnose the tumours

Bronchoscope

What is meant by paraneopalstic syndromes

Signs or symptoms not directly due to physical presence of tumour, rather due to circulating tumour derived factors acting on distant sites

What are the causes of paraneoplastic syndromes

1. immune responses generated against tumour cells that wrongly attack nromal cells 2. Cytokines and hormones affecting organ systems distant from the tumour

When there is a mutation in oncogene, what cancer treatment method should be undergone?

Targeted therapy

When there is no mutation, what cancer treatment method should be undergone?

Chemotherapy or Radiotherapy

What is the most common mutation in non-small cell lung cancer?

epidermal growth factor receptor (EGFR)

What does EGFR mutation lead to?

Continual activation: Cell proliferation | Dimerization occurrence even without EGF binding to EGFR

What is the way to activate and inhibit EGFR respectively?

Activate: EGFR binding to ATP more than TKI Inhibit: EGFR binding to TKI more than ATP, which will lead to reduced proliferation and reduced cancer

What is the nature of EGFR mutation

Allow ATP binding more than TKI binding, so EGFR is not inhibited

All mutations in EGFR involves exons __________

18-21

ALK gene will partner with which two genes and leads to translocation, then cell proliferation and survival?

EML4 | KIF5B

In immune checkpoint blockade: | Tumour tolerance will be induced when ________ binds to __________, which inactivates _______.

Tumour tolerance will be induced when PD-L1 binds to PD-1, which inactivates T-cells.

To prevent T-cell inactivation, one can inhibit _______ or ________.

To prevent T-cell inactivation, one can inhibit PD-L1 or PD-1.