neoplasias iii. - semmelweis.husemmelweis.hu/patologia1/files/2015/11/ed-neoplasia-iii-za.pdf ·...
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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
0
10
20
30
40
50
60
ko
ck
áza
tfo
ko
zó
dá
s r
ela
tív
nö
ve
ke
dé
se
1 2 3 4 5 6
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
Rela
tive
ris
k in
cre
as
e1 = non-smokers
2 = pipe, cigar
3 = 1-10 cigarettes / day
4 = 11-20 cigarettes / day
5 = 21 – 34 cigarettes / day
6 = > 35 cigarettes / day
0
20
40
60
80
100
120
140
Évi tü
dő
ráko
s h
alá
lozási ará
ny / 1
00 0
00 lako
s
0
20
40
60
80
100
120
140
0 10 200 10 20 25
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
Rel
ati
ve
yea
rly
lu
ng
ca
nce
r m
ort
ali
ty
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…)