Neoplasias III.

Attila Zalatnai

Mortality ranks of the most frequent malignant tumors in

Hungary

32 000 – 33 000 cancer deaths/ year

Men Women

1. Lung cancer lung cancer

2. colorectal carcinoma colorectal carcinoma

3. cc of lip and oral cavity breast cancer

4. prostatic cancer pancreatic cancer

5. cancer of stomach lymphomas and leukemias

6. pancreatic cancer cancer of stomach

Lung cancer (bronchial carcinoma; pulmonary cancer)

Incidence: 7000 – 8000 / year

Etiology:

smoking!!asbesos exposition

radon (urane miners)

Macroscopic appearance :

central

peripheral (incl.: Pancoast-tumor – Horner-triad)

diffuse

Component Harmful effect

Tar

Polyclic aromatic hydrocarbons (PAH)

Benz(a)pyrene

Dimethyl-benzanthracene

Benzo(b,j)fluorantrene

5-methylchrysene

3-methylcholantrene

NNK (nicotine-derived nitrosamine keton)

Nitrosamines (DEN, DMN)

Aromatic amines

Metals (chromium, cadmium, nickel

subsulfid, arsenic)

Polonium-210

Lactones

Fenols, fenol derivates

Formaldehid, acetaldehide

Benzene

Acrolein

Carbon monoxide

carcinogenic

carcinogenic

strong carcinogenic (paper!!)

strong carcinogenic

moderate carcinogenic

carcinogenic

promoter

lung-specific carcinogen (+ pancreas)

carcinogens

urinary carcinogens

carcinogens

radioactive compound (-emission)

strong carcinogens

promoters

mucosal irritants

Leukemogenic, myelodepressive

microvillus immobilizer

carboxyhemoglobin-production

Some very harmful compounds of the cigarette smoke

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A tüdőrák relatív kockázata nemdohányzók és dohányzók körében

1 = nemdohányzók2 = pipázók, szivarozók3 = 1-10 cigaretta / nap4 = 11-20 cigaretta / nap5 = 21-34 cigaretta / nap6 = 35-nél több cigaretta / nap

Relative risk of lung cancer in smokers

and non-smokers

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2 = pipe, cigar

3 = 1-10 cigarettes / day

4 = 11-20 cigarettes / day

5 = 21 – 34 cigarettes / day

6 = > 35 cigarettes / day

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Eltelt évek a dohányzás abbahagyását követően

Tüdőrák-gyakoriság a dohányzásról való leszokást követően

Nemdohányók tüdőrák-gyakorisági arányaNon-smokers

Lung cancer incidence after stopping smoking

Years after quitting

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Histological types

Small cell anaplastic carcinoma (microcellular)

Non-small cell carcinomas

- squamous cell cancer

- adenocarcinoma

- large cell carcinoma

ChrA

Sites of metastases

hilar and mediastinal lymph nodes

pleural carcinosis (sangionolent fluid!)

pericardal carcinosis

Virchow-node

liver

adrenals

bones

brain (small cell!)

Virchow’s node

Activating mutation of EGFR:

associated with good

response rate with anti-EGFR

treatments

Activating mutation of K-RAS:

associated with resistance to

anti-EGFR therapy

poor prognostic factor

MUTUALLY EXCLUSIVE!

Complications

hemoptoe / pulmorrhaghia

obstructive pneumonia

paraneoplastic syndromes

(ectopic hormone production: ACTH, ADH,

PTHrP…)