Lung CA Flashcards
What is the progression of Squamous cell carcinoma?
Irritation, squamous metaplasia, dysplasia, Carcinoma in situ, invasive SCC
Clara cells
adenocarcinoma precursors. Non ciliated
From which cells does Adenocarcinoma arise?
from the ones that line alveoli.
what is the progression of AdCa?
irritant or mutation, type 2 and clara hyperplasia, dysplasi (AAH), AIS (lepidic), invasive
How high is the correlation b/w smoking and CA?
for Squamous and small cell it is very high. For adenocarcinoma ~80%
What preinvasive lesions are there for NETs (Small cell)?
bronchial neuroendocrine cell prolif.
Squamous cell: where? histo?
central, involves major bronchi. Keratin pearls
Adenocarcinoma: who? where? histo?
women. peripheral. glandular (acinar). AIS is lepidic.
Small cell: associations? histo?
high grade malignancy, widespread mets, paraneoplastic syndromes. Small cells w/ little cytoplasm and finely granular chromatin. high mitotic rate, neurosecretory granules
With which cancers do we look at molecular mutations? What are the top three mutations? Which can be treated and with what?
Adenocarcinoma. EGFR, KRAS, EML4/ALK. Tyrosine kinase inhibitors treat EGFR.
What do you need in order to treat AdCA with TKI?
EGFR mutation with wild type KRAS
ALK translocations. Tx?
translocates with EML4. Tx with crizotinib. Use FISH to diagnose. No involvement of EGFR/Ras
-mab, -nib
biologics, monoclonal ab’s. TKIs
Who most commonly has EGFR mutations? Implications?
women, non-smokers, asians. Can be treated with TKI’s
what percent of americans smoke?
20%
How does CA risk decrease with cessation?
Decreases for 10-15 yrs then holds steady at about 2x normal
National Lung Screening Trial: who was included? what did it show?
older than 55, >30 pack years. Ct scans improve mortality but have high FP rate. CXR don’t improve mortality. Wait for more studies before we use it for screening
Tx fo SCLC
Limited stage (seen in one radiograph)- rad/chemo. Extensive stage-chemo
Staging
Stage 1-no nodal. Stage 2-invasive tumor or small tumor with same side nodes. Stage3-Advanced tumor with opposite side nodes. Stage 4-any tumor, any node, metastasis
Pancoast’s Tumor
Superior sulcus. Usually SCC. Involves brachial plexus so you get elbox pain
Horner’s syndrome
Involves sympathetic chain. Ptosis, miosis, anhidrosis
Superior Vena Cava Syndrome
facial edema, collateral veins over chest
Paraneoplastic syndromes more common in what CA? What are some?
more common in Small cell. SIADH, Cushings, Calcium problems,Lamber-eaton, Hypertrophic Osteoarthopathy
Lambert-Eaton syndrome
similar to myasthenia gravis but strength increases with exercise. Ab’s interfere with Ca channels
Hypertrophic osteoarthopathy
Painful, common in adenocarcinoma. Clubbing
Who gets adjuvant therapy?
Stage 2 and 3, esp if node is involved
Bevacizumab targets what?
VEGF
Erlotinib
EGFR TKI. Trial shows only six week benefit but can be much larger if you have the mutation.
What are the three most common mutations
KRAS, EGFR, ALK-EML4, CML
