CPRS 83: Lung Cancer Flashcards
___________ will lead to oxidative stress, then mutations, then cancer
Reactive Oxygen Species
Name a Single Nucleotide Polymorphic (SNP) gene that will cause cancer
P450
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
Which is the commonest type of cancer amongst smokers and non-smokers
Adenocarcinoma
What is the feature of adenocarcinoma
Tumour forming glands and tubules
Which cell types are involved in adenocarcinoma
Cells lining terminal bronchioles and alveoli
What is the difference between Dysplasia and Adenocarcinoma
No invasion to underlying tissues VS
Yes invasion to underlying tissues
Under adenocarcinoma, what’s ‘Lepidic predominant’?
Cells grow along the original alveolar wall with little invasion to the stroma
Under adenocarcinoma, what’s ‘Solid Adenocarcinoma’?
A solid mass without glands
Under adenocarcinoma, what’s ‘Acinar Predominant’?
Tumour cells arranged in gland-like structures
Under adenocarcinoma, what’s ‘Papillary predominant’?
Branching and finger-like stromal cores
Tumour cells lining the cores
Under adenocarcinoma, what’s ‘Mucinous Adenocarcinoma’?
Tumour cells spreading along alveolar wall
Large amounts of mucin
What is the distinctive symptom for Mucinous Adenocarcinoma
Severe cough with sputum
What are the process for formation of squamous cell carcinoma
Normal Metaplasia Dysplasia Carcinoma in situ Squamous cell carcinoma
What are some distinctive features for squamous cell carcinoma
Keratin formation
Intercellular bridges
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
- immune responses generated against tumour cells that wrongly attack nromal cells
- 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.
