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Flashcards in Carcinogenesis & Cancer Deck (19):

The number one cause of death in men AND women in the world is ________.

Lung Cancer.


What are some risk factors for developing lung cancer?

-SMOKING (!!!)-- either actively or passively (secondhand smoke). This is the biggest cause of lung cancer (85-90%)
-Radon Gas
-Air pollution (suspected but not yet proven)

When these factors are combined (your risk goes up exponentially)

Also, age, history of a previous tabacco related cancer (which includes pretty much anything that tabacco smoke can touch in your body- head and neck, gastro, esophageal etc), being female, and having a 1st degree relative that had lung cancer was mentioned as increasing your risk of developing lung cancer.


What disease states are associated with an increased risk of lung cancer?

-pulmonary fibrosis/ILD

The biggest of these is COPD, especially if you also smoke. Your risk of lung cancer increases dramatically.


Heres another card to summarize the risk factors for lung cancer more succintly (sorry to repeat, he talked about this stuff for like 25 minutes).

-smoking history
-previous history of tabacco related cancer
-Age (old), gender (female is higher after controlling for smoking)
-Asbestos/Radon exposure
-Family History
-Airflow Obstruction (COPD)
-sputum cytologic dysplasia (spit in a cup, if cells are dysplastic you have a higher risk of developing lung cancer)


Lung cancer is divided into NSCLC which includes _____ and SCLC which includes ______

-adenocarcinoma, squamos cell carcinoma, and large cell carcinoma
-small cell carcinoma


How do we stage lung tumors?



there are a variety of growth factors in lung cancer we can target. Which ones did he talk about and how do they work?

-Epidermal growth factor (EGFR). treat with a monoclonal antibody. This helps to treat the disease not to cure the disease but we do see a dramatic response often.

-ALK- Targeted therapy was used to treat patients with ALK positive NSCLC and the results were really good.

others are VEGF, KRAS.

So lung cancers can be caused by one of a very large number of mutations. We are able to identify these mutations and then treat the patient specifically. This is precision medicine.


What is the basis of immunotherapy?

Tumors, through things like PDL1, are able to suppress the immune response to themselves. Immunotherapy is giving drugs like PDL1 inhibitors and doing other things which allow us to use the body's immune response to fight off the tumor.


What is a solitary pulmonary nodule?



What are the goals when evaluating a solitary pulmonary nodule?

-expedite resection of potentially curable lung cancer
-minimize resection of benign nodules (morbidity and mortality of nodule evaluation is 5-10%)


How do we determine the likelihood of malignancy of solitary pulmonary nodules?

bigger size=greater chance of malignancy. Other risk factors also play a role (age, previous cancers etc).


For SPNs what is the best surgery (what is done if the patient is healthy enough)?



When scan for SPNs sometimes we find _____. describe these.

Ground glass opacities or nodules. We need to watch these patient every 12-36 months because these can be slow growing cancers.


T or F. CXR provides as good of screening for lung cancer as spiral CT.

F. CT is better. There was more lung cancer found with CT. When we can find lung cancer early and treat it, we can really make a difference in the disease course. CT finds more early stage lung cancer than CXR.


PET scans help us to look for what? when should we use them?

mediastinal and extra thoracic metastases.

We should use them to evaluate all NSCLC patients being treated with curative intent. For a patient with a ground glass opacity of less than 2 cm or a peripheral stage T1A tumor a PET is not indicated (not necessary).


What is chemoprevention?

the use of specific agents to reverse, suppress or prevent carcinogenesis


what is iloprost?

an inhaled chemoprevention drug. It works on the COX 2 pathway because it is a PGI2 analogue. In former smokers, iloprost helped prevent lung cancer.


What are the stages of chemoprevention?

stage 1: smoking cessation (get people to stop smoking)
stage 2: identify the highest risk groups (people with COPD, family history, tobacco exposure etc)
stage 3: look for presence of pre-malignant lesions with specific alterations (consider characteristics of the first tumor to target treat and prevent a second tumor).


What chemoprevention drugs are available now?

none, they are only available as part of a clinical trial.