小細(xì)胞肺癌診斷治療進(jìn)展r課件

1、Small Cell Lung Cancer (SCLC):Diagnosis, Treatment and Natural HistoryGary L.Weinstein M.D.Small Cell Lung Cancer (SCLC):SCLCLung cancer epidemiologySCLCPathologyTumor markersGeneticsClinical courseStagingTreatmentSCLCLung cancer epidemiology小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)

2、胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件SCLC, fa

3、ctoids15 25 % of all lung cancersAlmost exclusively in smokersDistinguished from NSCLC by:Rapid doubling timeHigh growth fractionEarly development of wide-spread metsSCLC, factoids15 25 % of allSCLC, factoids (contd)Considered highly responsive to “chems and beams”BUTusually relapses within 2 years

4、despite treatmentOverall, only 3 8 % of all patients survive more than 5 yearsMost common malignancy associated with Neurologic paraneoplastic syndromesSCLC, factoids (contd)ConsideSCLC, pathologyMost recent (1999) WHO classificationClassical small cell carcinomaLarge cell neuroendocrine cancerCombi

5、ned small cell carcinoma with some NSCLCCells are approx. 2 Xs the size of normal lymphocytesSCLC, pathologyMost recent (19SCLC, pathology SCLC, pathology SCLC, pathology SCLC, pathology SCLC, clinical presentationTypically arise centrallyMost common presentation is a large hilar mass with bulky med

6、iastinal LANCommon symptoms cough, SOB, wt lossApprox. 70 % with overt mets at presentationCommonly spread to liver, adrenals, bone and brainCan present with paraneoplastic syndomeSCLC, clinical presentationTypSCLC, tumor markers3 main groups: Neural, Epithelial, NeuroendocrineEpithelial: virtually

7、all SCLCs are immunoreactive for Keratin and Epithelial Membrane Antigen1 or more markers of Neural/Neuroendocrine differentiation found in approx. 75 % of SCLCsSCLC, tumor markers3 main grouSCLC, tumor markersLeads to expression of dopa decarboxylase, calcitonin, neuron-specific enolase, chromogran

8、in A, CD-56 (a neural cell adhesion molecule) gastrin releasing peptide and insulin-like growth hormoneOccasionally patients produce antibodies that cross-react with both the SCLC cells and the CNS cerebellar degeneration syndromesSCLC cells can produce a number of polypeptide hormones including ACT

9、H and Vasopressin SCLC, tumor markersLeads to exNeurologic Paraneoplastic Syndromes Neurologic Paraneoplastic SyndLung cancer, Paraneoplastic Syndromes Lung cancer, Paraneoplastic SySCLC, geneticsDevelopment of lung cancers occur through stimulation of proliferation and mutagenesis, occurring over Y

10、EARS and resulting from exposure to tobacco and other carcinogensSCLC, geneticsDevelopment of lSCLC, geneticsThe most common genetics of SCLC are:P53 mutation is present in 75 -90 %Loss of heterozygosity of c-somes 9p and 10q in the majorityDeletion of 3p inactivation of as many as 3 tumor suppressor genesLoss of the retinoblastoma gene function is nearly ubiquitousActivation of telomerase in approx. 90 % (allows cells to divide forever)SCLC, geneticsThe most common 小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺癌診斷治療進(jìn)展r課件小細(xì)胞肺