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Flashcards in Lung Cancer Deck (39):
1

tumor growth and clinical presentation

for a single malignant cell with a doubling itme of 3-4 months to grow to a 1 cm nodule, it would take about 7-10 years

therefore, 75% of the life history of the cancer is in the undetectable stage

2

major pathologic cell types of lung cancer

small cell carcinoma, adenocarcinoma, squamous cell carcinoma, and large cell carcinoma

the latter three have overlapping clinical behaviors and are often grouped into non-small cell lung cancer (NSCLC) - 80% of all lung cancers

3

general characteristics of small cell lung cancer

strong relationship to cigarette smoking

only about 1% occur in nonsmokers

no known preinvasive phase or carcinoma in situ

the most aggressive of lung tumors, metastasize weidely, and are virtually incurable by surgical means

4

genes frequently mutated in small cell lung cancer

p53 and RB1 tumor suppressor genes

high levels of anti-apoptotic protein BCL2

low frequency of expression of the pro-apoptotic protien BAX

5

presentation of small cell lung cancer

central mass and lymphadenopathy

highly sensitive to chemotherapy and radiation initially - patient starts to deteriorate after 6-9 months

limited stage - lymph nodes and mass encopassable in one radiographic port

extensive stage - everything else

6

treatment for SCLC

LS (1/3) -> radiation/chemotherapy

ES (2/3) -> chemotherapy

7

T component of TNM staging

The ‘T’ component reflects the tumor size and invasiveness. T values range from 0 to 4; T0 indicates no evidence of primary tumor, while T4 indicates extensive extrapulmonary extension.

8

N component of TNM staging

The ‘N’ component indicates the absence or presence and extent of regional lymph node metastasis. N values range from 0 to 3; N0 indicates no regional lymph node metastasis, while N3 indicates metastasis to contralateral hilar and ipsilateral and contralateral supraclavicular/scalene lymph nodes.

9

M component of TNM staging

The ‘M’ component defines the absence or presence of tumor spread to distant lymph nodes or organ sites. M values range from 0 to 1; M0 disease indicates no distant metastasis, while M1 indicates the presence of distant metastasis.

10

strategies for screening lung cancer

chest x-rays

sputum analysis

CT scans

11

advantages of lung cancer CT screening

increases detection of early-stage lung cancer

improves lung-cancer specific and overall mortality in a high risk population

most realistic strategy or improving lung cancer mortality

12

disadvantages of lung cancer CT screening

high positive rate

benefits may not extrapolate to lower risk populations

long-term risk of repetitive radiation exposure

cost

13

Stage I and treatment

tumor of any size is found only in the lung

treatment - surgery

14

Stage II and treatment

tumor has spread to lymph nodes associated with the lung

surgery/chemotherapy

15

Stage IIIA and treatment

tumor has spread to the lymph nodes in the tracheal area, including chest awall and diaphragm

combination of surgery, radiation, and chemotherapy

16

Stage IIIB and treatment

tumor has spread to the lymph nodes on the opposite lung or in the neck

combination of chemotherapy and radiation

17

Stage IV and treatment

tumor has spread beyond the chest

chemotharapy and/or palliative (maintenance) care

18

criteria for surgery in stage I/II NSCLC

predicted FEV1 after pneumonectomy is 1.2L

patient is not hypercapnic

patient does not have cor pulmonale

19

adjuvant therapy

treatment to keep cancer from returning

patients with resectable disease are the only group likely to be cured of their cancer

20

pulmonary manifestations of lung cancer

cough from endobronchial erosion and irritation

dyspnea

chest pain

hemoptysis

postobstructive pneumonia or pneumonitis

large tumors may cavitate and present as lung abscesses

21

pulmonary manifestatiosn of centrall located lung tumors

stridor

wheezing

hemoptysis

dyspnea

chest pain in the central location

22

manifestations of intrathoracic disease

hoarseness from invasion of the recurrent laryngeal nerve and resultant vocal cord paralysis

dysphagia as a result of esophageal compression

superior vena cava syndrome

shoulder arm pain from superior sulcus due to local extension of a tumor in the apex of the lung that compresses the nerves

ipsilateral Horner syndrome

23

superior vena cava syndrome

characterized by plethoric apperance, distension of the venous drainage of the arm and neck, edema of the face, neck and arms

collateral venous drainage may also form

dilated veins over anterior chest

24

ipsilateral Horner syndrome

characterized by ptosis, meiosis, and anhydrosis due to paravertebral extension and sympathetic nerve involvement of the tumors

 

25

paraneoplastic syndromes as a result of lung cancer

cytokin-mediated responses to antigens from the intrathroacic lung tumor rather than the result of distant spread of cancer

manifestations of clubbing, hypertrophic osteoarthropathy, and neurologic and hormonaal abnormalities

26

mainfestations of extrathoracic disease in lung cancer

most common are anorexia, weight loss, and fatigue

bone pain accompanies mets tot he bone

CNS involvement is low with cancer that has not spread to the lymph

patients with signs of mediastinal or distant involvement, the risk of occult brain mets increases

the adrenal gland is the most frequent site of distant mets of lung cancer

27

treatment paradigms for advanced NSCLC

2-drug platinum-based chemotherapy improves survival and quality of life in patients iwht good PS

chemo is better than supportive care

2 drugs better than 1 drug

3 drugs not better than 2 drugs

treatment should be limited to 4-6 cycles of chemo

28

hallmarks of cancer

self-sufficiency in growth signals

insensitiveity to antigrowth signals

tissue invasion and metastasis

limitless replicative potential

sustained angiogenesis

evading apoptosis

29

targeted therapy in oncology

goal is to identify anti-tumor agents that target tumor-specific molecules and spare normal cells

30

ideal targeted therapy drug target

drives tumor growth

turns on key mechanisms of cancer progression

reversible by inhibition

dispensable in normal cells

target is measureable in tumor tissue used for diagnosis

31

Erlotinib

quinazolinamine-derived small-molecule inhibitor of the EGFR kinase

inhibits the intracellular phosphorylation of the tyrosine kinase associated with EGFR

the mechanism of clinical antitumor action of erlotinib is not fully characterized

32

EGFR

epidermal growth factor receptor, also called ErbB1

a transmembrane receptor tyrosine kinase of human epidermal growth factor receptor (HER)

dimerizes to become activated after ligand binding

activation contributes to cell division, migration, adhesion, and survival

33

Gefitinib

similar to erlotinib

EGFR tyrosine kinase inhibitor

34

EML4-ALK fusion mutation

associated with adenocarcinoma histology

fusion results in activation of tyrosine kinase that enhances cell proliferation and survival

about 25% of all lung cancers in never-smokers

35

crizotinib

small molecule tyrosine inhibitor

approved in 2011 for treating tumors that possess the EML4-ALK fusion protein

36

bevacizumab

a monoclonal antibody to vascular endothelial growth factor (VEGF)

neutralization can inhibit tumor vascularization and block tumor growth

useful for patients with non-squamous NSCLC

37

Pancoast's Tumor

superior sulcus tumor

usually squamous cell

usually initial symptoms are pain, sometimes upper extremity weakness

invasion of brachial plexus, 40%

38

Lambert-Eaton Syndrome

a syndrome that falls under paraneoplastic syndrome

similar to myasthenia gravis clinically

proximal muscle weakness and gait disturbance

strength increased with exercise

characterized by antibodies directed against voltage-gated calcium channel and interfere with normal calcium flux necessary for release of ACh

39

hypertrophic osteoarhopathy

thoracic malignancy is the most common cause

pain is often present

more common with adenocarcinoma

clubbing is often the first clue