Lung Cancer Flashcards
Carcinoid - Definition & Pathology
A borderline indolent/malignant lung tumor
Characterized by nests and ribbons of neuroendocrine cells
Small cell carcinoma - Pathology
Small, easily crushed, dark blue cells of neuroendocrine origin (“Kulchitsky cells”)
High mitotic rate and abundant necrosis
Often located in the central lung
Squamous cell carcinoma - Pathology
Large polygonal cells with dark nuclei and abundant cytoplasm invading into sub-epithelial tissue
May form keratin pearls
Often located in the central lung
Adenocarcinoma - Pathology
Cells forming ectopic gland-like structures
Often located in the periphery of the lung
What percentage of lung cancer cases are attributable to smoking?
85-90%
Risk factors for lung cancer
Previous history of tobacco-reated cancer (head and neck, esophageal, colon, bladder)
Smoking
Genetics
Lung disease (COPD, Sarcoidosis, PF, ILD)
Environmental exposures (Radon, asbestos, metals, polycyclic aromatic hydrocarbons)
Solitary pulmonary nodule - Definition
A solitary mass, <3cm in size, outlined by normal lung tissue and not associated with atelectasis or adenopathy
Definition of a benign pulmonary nodule
Stable in size over at least 2 years
SCLC Staging
Limited disease (25-30%) - tumor is limited to ipsilateral hemithorax
Extensive disease (70-75%) - tumor extends beyond the hemithorax
NSCLC - T stages
T0 - no evidence of primary tumor
Tis - Carcinoma in-situ
T1a - Tumor < 2cm
T1b - Tumor 2-3 cm
T2a - Tumor 3-5 cm or present in mainstem bronchus
T2b - Tumor 5-7 cm
T3 - Tumor > 7 cm or invading chest wall/diaphragm, pleura, pericardium
T4 - Tumor of any size with invasion of mediastinum, heart, trachea, esophagus, vertebral body
NSCLC - N staging
N0 - no nodal involvement
N1 - involvement of ipsilateral peribronchial or hilar nodes
N2 - involvement of ipsilateral mediastinal or subcarinal nodes
N3 - involvement of supraclavicular or contralateral mediastinal or hilar nodes
NSCLC - M staging
M0 no distant metastasis
M1a - separate tumor nodules in contralateral lobe or pleura
M1b - distant metastasis - to liver, brain, adrenals
Post-resection FEV1 lower limit
FEV1 > 800 mL (or > 40% predicted)
Types of Non-small cell lung cancer (NSCLC)
Squamous cell carcinoma (25%)
Adenocarcinoma (40%)
Large cell carcinoma (10%)
EGFR
Common mutation of adenocarcinoma; target for direct therapy with Gefitinib
Her2
Common mutation in adenocarcinoma; target for direct therapy with Herceptin
vEGF
Common mutation in adenocarcinma; target for direct therapy with Avastin
Ras mutations
2-30% of NSCLC adenocarcinoma
Associated with resistance to TKIs
National Lung Screening Trial (NLST)
Showed a 20% decrease in lung cancer mortality with low-dose CT screening vs. CXR screening over 5 years; overall, a 6.7% all-cause mortality reduction
Who should be recommended low dose CT screening?
Age 55-74
30+ pack year smoking history OR former smoker quit within last 15 years
Treatment of SCLC
Cisplatin and etoposide chemotherapy
Radiation improves survival in patients with limited disease and treats symptomatic metastases
SCLC is not treated surgically
SCLC Prognosis
2-year survival is 20% in limited disease and 5% in extensive disease
Remissions are short, with a duration of 7-9 months; once SCLC recurs, survival if 204 months
NSCLC - Treatment
Neoadjuvant chemotherapy
Surgical therapy
Adjuvant chemotherapy
