lung cancer Flashcards
aetiology of lung cancer
tobacco
asbestos
air pollution
pulmonary fibrosis
other radiation
susceptibility of lung cancer
more common in women
how does tobacco smoke cause lung cancer
destruction or metaplasia of the epithelium
causes destruction of the genes ( multi hit theory of carcinogenesis)
there is activation of pro -carcinogens and metabolism of pro-carcinogens .
pathways for lung carcinogenesis
terminal respiratory unit epithelial transformation
bronchial epithelial transformation
adenocarcinogenesis
could be from smoking with complex mutations
could be non tobacco carcinogenesis with a simple genomic driver alteration.
gene mutations that are associated with smoking
KRAS
BRAF
MET
genes mutations that are not associated with smoking
EGFR , HER2
mutations that lead to adenocarcinomas
GFR mutation
ALK rearrangement
ROS1 rearrangement
RET rearrangement
NTRK rearrangement
MET exon14 mutation
BRAF V600E mutation
KRAS G12C mutation
targets for adenocarcinoma therapy
there are drugs that can target the mutated genes
targets for squamous cell carcinoma
very few suitable targets and very few additive oncogenes
there is complete alteration of tumor suppressor genes
lung carcinoma based on cell types
squamous cell
adenocarcinoma ( cancer of the alveolar cells )
small cell carcinoma
large cell carcinoma
lung carcinoma based on histology
small cell carcinoma
non small cell carcinoma
tumors of the lung
benign mass
carcinoid tumour
tumour of bronchial glands
lymphoma
sarcoma
metastases to lungs
primary lung cancer
mostly asymptomatic
presentation in the later stages
symptomatic lung cancer is fatal
characteristics of squamous cell carcinoma
cavitating on the lung surface
local effects of lung cancer
collapse of the bronchial
lipoid pneumonia
infection and abscess
bronchiectasis
local effects of lung cancer on the pleural cavity
inflammation
malignant
there could also be chest wall invasion
lymph node metastases
Local effects of lung cancer to the nerves
effects on the phrenic nerve is diaphragmatic paralysis
effects of the tumor on the recurrent laryngeal nerve
hoarse and bovine cough ( coughing like a cow)
local effect of lung cancer on the brachial plexus
T1 damage
effect of lung cancer on cervical sympathetic
Horner`s syndrome
local effects of lung cancer on the mediastinum
pericardium
local effects of lung cancer on the lymph nodes
metastases of the cancer
SVC obstruction
accumulation of venous blood even on the upper body such as the face
Horner`s syndrome
there is the loss of the sympathetic nervous system and this leads to drooping and there is also no dilatation of the pupils when there is exposure to light in dark regions
distance metastases of lung cancer
metastases to the liver
adrenals, bone , skin , extrathoracic lymph nodes
secondary to local effects of lung cancer
neural and vascular
skeletal effects of lung cancer
clubbing
HPOA ( hypertrophic pulmonary osteoarthopathy )
effects of lung cancer on the endocrine system
PTH
ADH
ACTH
gynaecomastia
carcinoid syndrome
neurological
polyneuropathy
encephalopathy
cerebellar degeneration
myasthenia (Eaton-Lambert)
haematologic
granulocytosis
eosinophilia
DIC
renal
nephrotic syndrome
manifestation of hypertrophic pulmonary osteoarthropathy
pain and tenderness on the wrists and ankles
there is also distal periosteal inflammation
hormones affected by small cell carcinoma
ACTH (adreno -corticoprotic hormone )
ADH (anti-diuretic hormone) fluid retention
hormones affected by the squamous cell carcinoma
parathyroid hormone
investigations for lung cancer
chest x-rays
sputum cytology
bronchoscopy
trans-thoracic fine needle aspiration
trans-thoracic core biopsy
pleural effusion cytology and biopsy
advanced imaging techniques for lung cancer
CT scanning
MRI , PET scanning
therapy biomarkers for adenocarcinoma
adenocarcinoma
-EGRF, KRAS , BRAF, MET , HER 2 mutations
ALK , ROS1 ,RET , NTRK fusion genes
squamous cell biomarker therapy
little to no molecular targeted therapy
immunotherapy treatment
non small cell lung cancer
cancer immune response
some cancers are not immunogenic traht means there is no immune response
Immune checkpoint in non small cell lung cancer
The PD1/PD-L1 axis immune checkpoint in NSCLC
A therapeutic target
An important biomarker
Signs of lung cancer
Coughing up blood
Unexplained weight loss
Nail clubbing
Chest infections
Chest and bone pain
Nail clubbing
Wheezing sound (cows bovine voice)
Clinical signs of lung cancer
Chest signs
Clubbing
Hornet’s syndrome
Swelling of the lymph nodes
Hepatomegaly
Skin nodules metastasis
Tests to be conducted to test on the tissue of the lung tumour
Bronchoscopy
Liver biopsy
Lung biopsy
Bone biopsy
Surgical excision biopsy
Mediastinoscopy.
Types of lung cancer by histology
Small cell carcinoma
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
Upstaging of metastases in other regions of the body
PET -ct scan
Factors to consider before giving out the treatments
Performance status
Histologicql type and the stage of the disease
Aims of the treatment
What is meant by performance status
Level of activity will determine the kind of treatment that T the patient gets could lead to further deterioration
Communication with cancer patients
Pre and post cancer suggestions are given to the patient
Treatment of cancer
Surgical ,radiotherapy, chemotherapy
Surgical treatment of cancer
Lobectomy
Wedge resection which is only taking off the cancer although not recommended
Radiotherapy treatment
Radical treatment
Palliative treatment
Stereotactic
Chemotherapy targets
Tyrosine kinase inhibitor
Monoclonal antibodies erlotinib , gefitinib ,crizotinib
Palliative management of Lung cancer
Mostly symptom control
Chemotherapy is given to manage the symptoms a
