What is the most common primary tumor?
Hamartoma (benign)
-approximately 95% of tumors
Top 3 most prevalent cancers in men by number of cases
- Prostate
- Lung & Bronchus
- Colon & Rectum
Top 3 most prevalent cancers in women by number of cases
- Breast
- Lung & Bronchus
- Colon & Rectum
Top 3 killer cancers
- Lung & Bronchus
- Prostate/Breast
- Colon & Rectum
Percent of lung carcinomas that occur in smokers?
90%
Increased chance of developing lung cancer if you smoke?
- Average smokers have 10x risk
- Heavy smokers have 60x greater risk
Other facts about smoking and cancer
- women more susceptible than men
- second hand smoke increases risk by 2 compared to non-smoking
- cessation of smoking decreases risk but may not return person to baseline
- associated with alterations in p53
Which organ has no evidence of being at higher risk of cancer due to smoking?
Breast
Types of Lung cancer by percentage
- Small cell carcinoma (20%)
- —-Non-small cell carcinoma (80%)
- Squamous cell carcinoma (25-30%)
- Adenocarcinoma (30-40%)
- Unclassifiable/Large cell (10-15%)
Is Squamous cell carcinoma more common in men or women?
Men
Is Squamous cell carcinoma associated with smoking?
yes
Which elevated hormone is Squamous cell carcinoma associated with?
inappropriate PTH secretion (elevated Ca++)
What is the progression of Squamous cell carcinoma?
- Squamous metaplasia –> dysplasia –> carcinoma in situ
- arises centrally
Describe the immunohistochemistry of Squamous cell carcinoma
- intercellular bridges or keratinization
- diffuse p63/p40
- local nodes involved in 70 - 90%
- spreads outside the thorax, later than other histological types
- highest frequency of p53 mutations
What is the 5 year survival?
5 - 7.5%
Clinical presentation of Adenocarcinoma
Female non-smokers
What is the progression of Adenocarcinoma?
Atypical Adenomatous Hyperplasia –> Adenocarcinoma in situ –> Minimally invasive adenocarcinoma
-more often peripheral
Another name for Adenocarcinoma in situ?
Bronchioalveolar Carcinoma
What are subtypes of Adenocarcinoma?
- Acinar
- Papillary
- Solid
- Mucinous
What are mutations of Adenocarcinoma?
- —-EGFR
- 30 - 40% asians
- targeted therapy: erlotinib (EGFR inh.)
- —-ALK gene fusions
- targeted therapy: Crizotinib (ALK inhibitors)
- —-KRAS
- most common in caucasians
- presence leads to worst outcome
- confers resistance to EGFR inhibitors and no targeted therapy
Large cell/undifferentiated carcinoma
- un-differentiated
- poor prognosis
- metastasize to liver, adrenal, brain
- 2 - 3 % 5 year survival
Where does small cell carcinoma arise from?
- tissue
- location
- rapidly growing, high grade neuroendocrine tumor
- central
Is small cell carcinoma associated with smoking?
yes
Characteristics of small cell carcinoma
- widely metastatic
- Paraneoplastic syndromes
- –ACTH, ADH
- Rarely resectable
