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biology of cancer > Lung cancer > Flashcards

Lung cancer Flashcards

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AP® Biology flashcards Biology 101 flashcards
1
Q

What are the two main groups of lung cancer?

A

Small cell lung cancer (SCLC)
Non-small cell lung cancer (NSLC)

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2
Q

small cell lung cancer

A
  • approx 15% of cases
  • associated with a worse prognosis
  • effects neuroendocrine cells
  • strongly associated with tobacco smoking
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3
Q

Non-small cell lung cancer

A
  • approx. 85% of cases
  • variable prognosis; dependent on subtype
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4
Q

what are the 3 main types of NSCLC?

A
  • adenocarcinoma; mucus cells
  • squamous cell carcinoma; squamous cells
  • large cell carcinoma; large, abnormal cells
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5
Q

what are the other types of lung cancers?

A
  • lymphomas
  • sarcomas
  • mesotheliomas
  • secondary lung cancer; metastasis
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6
Q

10 risk factors of lung cancer

A
  1. tobacco smoke
  2. air pollution
  3. occupation
  4. radon gas
  5. asbestos & other carcinogens
  6. radiation exposure
  7. dietary factors
  8. family history
  9. aging
  10. genetics
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7
Q

incidences of lung cancer in men and women

A

males and females: 13%

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8
Q

mortality rate of lung cancer

A

21.1%
- associated with low survival rates

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9
Q

SCLC characteristics

A
  • 90% chance due to smoking
  • aggressive (rapid metastasis to brain, liver, bone)
  • high mortality (1 year prognosis)
  • more responsive to traditional cancer therapies (chemotherapy)
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10
Q

NSCLC characteristics

A
  • in smokers and non-smokers
  • less aggressive
  • 5 year survival rate of 23%
  • more responsive to targeted therapies (relatively insensitive to chemo)
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11
Q

SCLC histology

A
  • typically, centrally located, arising in peribronchial locations
  • thought to develop from neuroendocrine cells
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12
Q

what is SCLC composted of?

A

sheets of small, round cells with dark nuclei, scant cytoplasm and fine, granular nuclear chromatin

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13
Q

NSCLC histology

A

histology correlates with site of origin
- adenocarcinoma usually originates in peripheral lung tissue
- squamous cell carcinoma usually near a central bronchus

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14
Q

what is NSCLC arise from?

A

epithelial cells of the lung or of the central bronchi to terminal alveoli

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15
Q

where does adenocarcinoma originate?

A

in the peripheral lung tissue
(also most common form of lung cancer)

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16
Q

where does squamous cell carcinomas form?

A

in the lining of the bronchial tubes

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17
Q

what are large cell carcinomas?

A

refers to NSCLC that are neither adenocarcinomas nor squamous cell carcinoma.

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18
Q

what are the genetics of lung cancer?

A
  • different types of lung cancer = different profiles in terms of their genetics
  • there are broader patterns observed within SCLC and NSCLC but also different between subsets (e.g. adenocarcinoma vs squamous cell)
  • further differentiation between molecular types, between individials and even different cells within the tumour
  • classic complexity observed in all cancers.
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19
Q

what is commonly mutated in SCLC?

A

TSGs

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20
Q

Key oncogenes in NSCLC

A

KRAS, EGFR, BRAF, NF1

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21
Q

key oncogenes in SCLC

A

KRAS, EGFR, BRAF, NF1 (but at lower %s)

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22
Q

SCLC: loss of tumour suppressor function

A
  • mutations in TP53 gene; 80-90% of primary tumours
  • point mutations and small deletions of PTEN gene; 10% of primary tumours
  • others include alterations in RB1; 55-65%
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23
Q

SCLC; gain in oncogenic mutations

A

amplification of c-MYC; 9% of primary tumours

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24
Q

how many cancers contain TP53 mutations

A

over 50%
- most commonly affected TSG
- due to missense mutations in the DNA binding domain

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25
Q

what is MYC?

A

family of genes which encode for TFs that regulate cell growth & metabolic genes
- amplification of c-MYC = poor prognosis

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26
Q

Molecular changes due to MYC genes

A

increase in:
- transcription
- mitochondrial biogenesis and function
- rRNA and protein biosynthesis
- glycolysis and anaplerosis

changes in microRNA

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27
Q

Cellular changes due to MYC genes

A

increase in:
- cellular proliferation
- metabolic transformation
- metastatic capacity
- glutaminolysis

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28
Q

NSCLC; loss of tumour suppressor function

A

mutations in TP53 gene; 50%
- lower in adenocarcinoma vs squamous cell

29
Q

NSCLC; gain in oncogenic mutations in adenocarcinoma

A
  • KRAS; 29%
  • EGFR; 14%
  • BRAF; 7%
  • ERBB2 (HER2); 4%
30
Q

multistep process of carcinogenesis

A

initiation
- normal cell; impacted by chemical, radiation or virus
- initiation cell
promotion
- preneoplastic cell
progression
- neoplastic cell
metastasis
- malignant tumor

31
Q

what are the tumour suppressors in lung carcinogenesis?

A
  • p53
  • RB1
  • PTEN
  • others
32
Q

what are the oncogenic drivers during lung carcinogenesis?

A
  • KRAS
  • EGFR
  • c-MYC
  • ERBB2
  • BRAF
33
Q

what causes an increase in inflammation?

A

increase in;
- ROS
- Electrophilic metabolites

34
Q

describe the process of carcinogenesis in lung cancer

A

normal lung epithelial cell is exposed to carcinogens, increase in inflammation, DNA repair fails, DNA adducts formation and epigenetic alterations happen creating a genetically altered epithelial cell.
Lack of apoptosis, cell cycle arrest or anti-inflammation causes continutation of gene mutations. Cell growth and proliferation leads to a tumour growth with then creates a lung metastasis.

35
Q

what are the symptoms of lung cancer?

A
  • persistent cough
  • fatigue
  • shortness of breath (dyspnea)
  • coughing up blood (hemoptysis)
  • weight loss
  • pain when breathing
  • wheezy
  • repeated chest infection
36
Q

process of a simplified diagnostic pathway

A
  • GP assessment
  • scans
  • biopsy
  • MDT assessment and staging
37
Q

radiology: chest x-ray

A
  • sometimes challenging to interpret
  • will give an indication but needs CT and biopsy to help confirm lung cancer
  • location of abnormality can help narrow down the type
  • small cell and squamous cell tend to be central
  • adenocarcinoma and large cell tend to be peripheral
  • can help with staging
38
Q

CT scans and PET-CT scans

A
  • higher resolution
  • can provide more detail and help define size, location and spread more effectively
  • tend to be employed after initial chest x-ray to provide more informaiton
  • helps with staging and diagnosis
39
Q

staging of SCLC

A

limited staging:
- cancer found in one side of the chest, involving just one part of the lung and nearby lymph nodes
- chemo + radio to cure

extensive staging:
- cancer has spread to other regions of the chest or other body parts
- chemo to control (not cure)

40
Q

staging of NSCLC

A

more extensive staging that covers tumor size, lymph nodes affected and how much it has metastasised.

41
Q

percutaneous needle biopsy

A

tissue or fluid

42
Q

bronchoscopy biopsy

A

trachea and large airways

43
Q

endobronchial ultrasound (EBUS)

A

lymph nodes

44
Q

thoracoscopy

A

deeper and smaller spots in the lung

45
Q

mediastinoscopy

A

mediastinal lymph nodes

46
Q

metastasis

A
  • approx 50% of lung cancer is metastatic at diagnosis
  • SCLC; 70% are metastatic at diagnosis
  • associated with poor survival outcomes at stage 4 for NSCLC and extensive for SCLC
47
Q

what are common metastatic sites?

A
  • brain
  • bones
  • liver
  • peripheral lymph nodes
  • adrenal glands
48
Q

traditional therapeutic approach for SCLC

A
  • surgery for non-metastatic; lobectomy, pneumonectomy, wedge resection
  • chemotherapy (etoposide/cisplastin)
  • radiotherapy
49
Q

traditional therapeutic approach for NSCLC

A
  • chemotherapy (when unknown driver mutation)
  • radiotherapy (or chemoradiotherapy)
  • surgery
  • targeted treatments; EGFR antagonists, BRAF inhibitors, ALK inhibitors, anti-angiogenics (in combination)
50
Q

surgery

A
  • potential cure for early stage lung cancer
    BUT
  • tumour cells may remain
51
Q

radiotherapy

A
  • can be used as an intent to cure treatment for early NSCLC
    BUT
  • toxicity and poor outcomes for advanced disease
52
Q

platinum based chemotherapy

A
  • available as first line therapy, numerous combinations
    BUT
  • toxic and prone to tumour resistance
53
Q

targeted therapy

A
  • relatively effective against tumors with defined mutations
    BUT
  • not available for most lung cancer patients, tumours develop resistance
54
Q

immunotherapy

A
  • specific tumor killing with potentially less toxicity. lots of potential strategies
    BUT
  • development of autoimmune reactions, expensive
55
Q

targeted therapies

A
  • design to interact with their targets
  • act on specific molecular targets associated with cancer
  • cytostatic
  • many are oral agents
56
Q

chemotherapy

A
  • indetified because they kill cells
  • act on all rapidly dividing cells
  • cytotoxic
  • mainly intravenous, some oral agents
57
Q

Treatments for SCLC

A
  • combinations of chemo ; limited approach
  • loss of TSG not as amenable for therapeutic targeting
  • difficulty restoring function despite research
  • c-MYC targeted therapeutics in preclinical development, issues with targeting TFs slowly being improved
  • immunotherapy potential
58
Q

what are topoisomerase inhibitors?

A
  • enzymes involved in DNA winding, prevent DNA replication
  • Topo type 1; cut one strand
  • Topo type 2; cut both strands
59
Q

what are platinum-based agents?

A
  • cross-linking of DNA, inhibits repair and DNA synthesis
60
Q

what can be combined chemotherapy?

A

etoposide/ irinotecan (topo) +cisplastin/ carboplatin (platinum)

61
Q

NSCLC therapy

A
  • surgery first choice if limited
  • can be assisted by neoadjuvant approach radio/chemotherapy
  • targeted therapies effective is molecular subtype is known
  • depends on cancer stage.
62
Q

EGFR tyrosine kinase inhibitors (TKIs)

A
  • Iressa (geftinib)
  • Tarceva (erlotinib)
62
Q

what is ALK?

A

anaplastic lymphoma kinase is gene that can become an oncogene in cancer

63
Q

what is EML4?

A

echinoderm microtubule-associated-protein like 4

64
Q

EML4-ALK

A

ALK is the oncogene activated by EML4 in lung cancer.

65
Q

use of crizotinib for treatment

A
  • crizotinib competes binding within the ATP-binding pocket of ALK to stop the ALK from being abnormally activated due to fusion with EML4.
66
Q

immunotherapy

A

wide range of potential and existing therapies;
- cytokines
- cancer vaccines
- checkpoint inhibitors
- monoclonal antibodies
- adoptive cell therapy (CAR-T cell therapy)

67
Q

immunotherapy trials

A
  • PD1 inhibitors; Pembrolizumab & Nivolumab
  • PD-L1 inhibitors; Atezolizumab

biology of cancer (13 decks)

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