11-3: 12/15: Lung Cancer

Front 1

Cigarette smokers who have never quit have ______ risk of lung cancer as non-smokers.

Back 1

Smokers have 20x risk

Front 2

____% of lung cancer cases in females occur in never smokers versus ____% for males.

Back 2

9-13% of lung ca cases in females were never smokers

2-6% of lung ca in males were never smokers

Front 3

Risk factors for lung cancer.

Back 3

Environmental/passive tobacco smoke

Radiation exposure: radon gas (uranium miners, home radon)

Air pollution (weak factor)

Cooking oil fumes and indoor coal/biomass burning

Fam Hx

Occupational Hx (asbestos)

Front 4

Role of 15q in lung cancer susceptibility

Back 4

Locus contains genes coding for nicotinic receptor subunits; polymoprhisms here confer 30% inc'd risk of lung ca

May relate to influence on smoking bhvr/addiction susceptibility

Front 5

What are the two main forms of lung cancer? Which is more common?

Back 5

85% non-small cell
15% small cell lung ca

Front 6

This lung cancer subtype has the strongest association with smoking.

Back 6

Small Cell Carcinoma

Front 7

Small Cell Carcinoma:
Arise from
Sites in lung
Prognosis

Back 7

Pulmonary neuroendocrine cells

Central/hilar, perihilar mass (centrally in lung)

Poor prongosis

Front 8

What is a paraneoplastic syndrome?

Associated with which lung cancer?

Back 8

Paraneoplastic syndrome: when tumor releases hormone

Assocd w/Small Cell--arises from neuroendocrine cells

Front 9

Non-small cell lung cancer:
Subtypes
Which is predominant?
Sites in lung for each subtype
Association with smoking

Back 9

Adenoca > Squamous cell; likely due to changes in cigarette manufacture and smoking behavior

Squamous cell:
Arise in central location; cavitary
Strong assocn w/smoking

Adenoca:
Arise peripherally
Most common in never-smokers

Front 10

Lepidic adenocarcinoma:
Appearance
Sites in lung

Back 10

Malignant cells line up along alveoli, using it as scaffolding for growth
Multi-focal presence in lung

Front 11

This lung cancer subtype may have an appearance similar to pneumonia.

How would you non-invasively differentiate?

Back 11

Lepidic adenoca; may not appear as solid mass, and may have appearance ~pneumonia

If after administration of antibx, pneumonia does not clear, begin thinking about cancer.

Front 12

This lung cancer subtype is a well-differentiates neuroendocrine tumor.

Back 12

Carcinoid

Front 13

Carcinoid tumors:
Site in lungs
Presentation
Prognosis

Back 13

Well-dx/dy neuroendocrine tumor

arise in central airways; present with wheezing (they're in central airways, like bronchi!), cough, obstructive pneumonia

Better prognosis than small cell/NSCLC

Front 14

This lung cancer arises from preinvasive foci of dysplasia.

Back 14

Squamous Cell Carcinoma

These areas of dysplasia seen in central airways of smokers.

Front 15

What does the field cancerization effect state?

Back 15

Multiple sites of dysplasia present in bronchial epithelium of a smokers, which may go onto form squamous cell carcinoma.

Front 16

Precursor lesions of adenocarcinoma.

Back 16

Atypical adenomatous hyperplasia (AAH)

Adenocarcinoma in situ

Front 17

The Egfr signaling pathway leads to ________ in ________.

Back 17

Egfr in nonsmokers-->invasive adenoca

Front 18

The Ras signaling pathway leads to _________ in ______.

Back 18

Ras in smokers-->invasive adenoca

Front 19

How are DNA adducts formed? How do they contribute to lung cancer?

Back 19

Cigarette smoke metabolites react with DNA and form DNA adducts.

Misrepair leads to gene mutations.

Accumuln of gene mutations-->impairs tumor suppressor gene function and activation of oncogenes

Front 20

Proteomic changes caused by smoking affect __________.

Back 20

Inflammatory gene expression and apoptosis that may contribute to neoplasms.

Front 21

This mutation pathway is important in mucinous adenocarcinoma.

Back 21

KRAS--smokers

Front 22

This mutation pathway is important in nonmucinous adenocarcinoma.

Back 22

EGFR--non-smokers

Front 23

____ mutations are very rare in squamous cell carcinomas and are indicative of ________.

Back 23

Mucinous adenocarcinoma

Note: if adenoca has KRAS mutation, it can't have EGFR mutation.

Front 24

____ mutations are often overexpressed or mutated in lung cancers.

Back 24

EGFR

Front 25

EGFR inhibitors work best on these patients.

Back 25

Asians/females/non-smokers

Front 26

Mutation profiles in lung cancer seem to be distinct between ___________ and _________ (2).

Back 26

Smokers and non-smokers
Squamous and adenoca's

Front 27

This lung cancer presents with cough, hemoptysis, dypsnea, and post-obstructive pneumonia.

Back 27

Sq cell (central airways)

Front 28

Lungs cancers with mediastinal spread often present with _________.

Back 28

Hoarsness (recurrent laryngeal involvement)
Diaphgram paralysis (phrenic nerve)

Front 29

Lung cancers with distant spread often present with _______.

Back 29

HA, loc'd weakness, seizure (brain), bone pain, abdominal pain (liver mets)

Front 30

What is SVC syndrome?

Presentation?

Back 30

SVC obstructed by surrounding tumor; occludes venous return from head.

Results in facial swelling, ha's.

Front 31

This lung cancer presents with arm pain or weakness.

Why?

Back 31

Pancoast tumor (superior sulcus)

Due to brachial nerve involbement

Front 32

Paraneoplastic syndromes:
Mostly occur with which lung cancer?
Which hormones?
Exceptions?

Back 32

Mostly in setting of small cell: Cushing's (cortisol), SIADH (ADH)

Except:
HyperCa2+: Squamous cell
Clubbing: any NSCLC

Front 33

This cancer typically presents on CT scan as a solitary pulmonary nodule.

Back 33

Adenocarcinoma

Commonly due to benign etiologies though.

Front 34

How do you determine with a single pulmonary nodule needs biopsy?

Back 34

Lack of growth of lzn over 2 years-->benign

Can also look at calcification patterns; asymmetric calcification is worrisome (spiculated appearance).

Front 35

Bronchoscopy is best for ________ tumors.

Back 35

Central

Front 36

TNM staging: what does T, N, and M stand for?

Back 36

T: site, size, invasion of primary tumor

N: assess spread to nodes

M: assess spread to distant mets

Front 37

Small Cell:
Treatment (confined vs spread)

Back 37

Limited to chest: chemo, XRT
Mets: just chemo

Front 38

Which NSCLC patients are candidates for curative surgery?

Back 38

Stages I and II; some exceptions for stages IIIA/B (regionally advanced)

Surgery is only curative therapy!!

Chemo is life-extending by months for advanced dz (mets)
XRT used for local control in combo w/chemotx

Front 39

Effect of smoking cessation on development of lung cancer.

Back 39

Smoking cessation decreases long-term lung ca related mortality, but risk of lung ca remains elevated in ex-smokers.

Front 40

What is the trend of lung cancer development in the world?

Back 40

Lung cancer burden is being placed in developing world, esp. China.