Lung cancer SD Flashcards
(32 cards)
what are the symptoms of lung cancer?
Chest discomfort or pain.
*Trouble breathing.
*Wheezing.
*Blood in sputum
*Hoarseness.
*Trouble swallowing.
*Loss of appetite
*Weight loss for no known reason.
*Feeling very tired.
*A cough that doesn’t go away or gets worse over time.
*Swelling in the face and/or veins in the neck.
how do you diagnose lung cancer?
*GP Visit > Blood tests > Imaging > Biopsy > Pathology > Diagnosis >
Treatment
what can a x-ray identify?
can identify an abnormal mass
what are CT scans?
CT scans are 3 dimensional X-ray images stitched together by Computer
algorithms
*Can traverse THROUGH stacked images – not static like an X-RAY
*Higher resolution and clarity in detecting tumours
what is a PET scan?
PET uses an IV radioactive tracer (18f-fluorodeoxyglucose (FDG) which is
detected by the PET scanner
*A combined CT scan runs at the same time to outline the tissues/structures
*Combined PET-CT is very high resolution to detect tumours, plus accurately
locates smaller tumours
how do you obtain a biopsy?
*A CT scan or ultrasound is used to locate the mass in the lung.
*A small incision may be made in the skin where the biopsy needle is inserted
*A biopsy is removed with the needle and sent for pathology analysis
what is a bronchoscopy?
A bronchoscope is inserted through the nose or mouth into the trachea and lungs.
Biopsies can be taken from the lung for analysis
what is SCLC?
–SCLC is highly malignant and spreads very rapidly. Metastases are typically found when a diagnosis is made. Located in central airway
–Tumours are smaller in size compared to NSCLC
what are the subtypes of NSCLC?
- Squamous cell carcinoma, cancer in the epithelial cells lining the
lungs. Typically found in central portion of the lung and in airways. - Adenocarcinoma, a tumour originated from the bronchial/alveolar
epithelium. Adenocarcinoma is the most common type of lung cancer
in women who have never smoked. - Large cell cancers, originates in larger cells of the lungs, peripherally
located e.g. large clear cells
how do you identify adenocarcinoma?
TTF-1, Napsin A - expressed
in more than 85% of the adenocarcinomas.
Confirms adenocarcinoma
how do you identify squamous cell carcinoma?
p63, CK5 / CK6, SOX2 and Desmoglein-3
how do you identify small cell lung cancers?
LMWK, CAM5.2, chromogranin, synaptophysin,
CD5/6, CK5 and NKX2-1 / TTF-1
what elaborates paraneoplastic syndromes?
hormones/ hormone- like factors
what are the dominant oncogenes that are frequently involved in cancer?
–c-MYC
–KRAS(G12C)
–EGFR
–RET
–NTRK
what tumour suppressor genes are commonly lost in lung cancer?
–p53
–RB1
–p16
–Multiple Loci on chromosome 3
what genes are associated with small cell lung carcinoma?
*C-KIT (40–70%)
*MYCN and MYCL (20–30%)
*p53 (90%)
*3p (100%)
*RB (90%)
*BCL2 (75–90%)
what genes areassociated with non-small cell lung carcinoma?
EGFR (25%)
KRAS (10–15%)
p53 (50%)
p16 INK4a (70%)
what are the genes associated with non-small cell lung carcinoma?
EGFR (25%)
KRAS (10–15%)
p53 (50%)
p16 INK4a (70%)
what are some drug therapies for NSCLC?
chemo
Targeted Therapy
–EGFR signalling
–ALK signalling
–RAS Signalling
–Angiogenesis signalling
*Immunotherapy
–PD-L1 inhibitors
what inhibits EGFR?
tyrosine kinase inhibitors
what are the main TKIs?
*Erlotinib (Tarceva)
*1st gen and 1st line
*Gefitinib (Iressa)
*1st gen and 1st line
*Osimertinib (Tagrisso)
*3rd gen and when gen 1 fails
what is a monoclonal antibody against EGFR?
*Cetuximab (Erbitux)
how does erlotinib work?
*Tyrosine Kinase Inhibitor (TKI)
*Prevents EGFR phosphorylation
*Inhibits MAPK / AKT
*Inhibits proliferation
*Tumour regression
*Resistance can occur within 10-14
months
what is the mutation that occurs in erlotinib in the ATP binding pocket?
T790M mutation occurs in the ATP
binding Pocket
