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Pathophysiology of lung cancer, References, Diagnosis and Treatment -…

- - - - helix-loop-helix transcription factors
        
        activate neuroendocrine genes
        
        essential for the development of pulmonary neuroendocrine cells (PNECs)
      - ASCL is necessary for development of classic SCLC
      - sensitive to BCL2 inhibitors
    - - helix-loop-helix transcription factors
        
        Double negative tumors
        
        neuroendocrine-low subtype
      - NEUROD1 is not required for SCLC initiation
      - sensitive to aurora kinase inhibitors
    - - tuft cell may serve as a cell of origin for SCLC
        
        non-NE SCLC
        
        also known as brush cells
        
        least common, almost always double negative
      - sensitive to PARP inhibitors
    - - notable for an inflamed gene signature with a high expression of multiple immune genes
        
        presence of CD8-positive cytotoxic T cells
      - most sensitive to immune checkpoint blockade
- - - - Weight loss
        
        Hemoptysis
      - compression of the laryngeal nerve
- - - - affects outer part of lung
        
        usually found early
  - - - Second most common subtype of NSCLC
- - - - Chest CT
        
        More detailed imaging to lung tissues
      - Chest Xray
        
        First test done to look for spots on the lungs
      - Bronchoscopy
        
        Biopsy of lung tissue to exam cancer cell type
      - PET Scan
        
        Used to diagnosed where cancer is spreading in the body, using sugar to illuminate hot spots
      - Limited Stage
      - Extensive Stage
- - - - Radiation exposure
- - - - Treatment only prolongs life and relieves symptoms. Cure is not the goal.
  - - - Sunburn skin changes
      - Fatigue
    - - Newer, more precise
  - - - Treatment can be for weeks or months
    - - First line of treatment
  - - - "Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system."
        
        The inhibitors allow the cancer cells to be seen by the immune system
    - - Atezolizumab (Tecentriq) and durvalumab (Imfinzi)
        
        "target PD-L1, a checkpoint protein found on some tumor cells and immune cells."
    - - Tarlatamab (Imdelltra)
        
        "one part of the drug attaches to immune cells called T cells, while another part attaches to the DLL3 protein on SCLC cells"
        
        Used for cancer that is no longer responding to previous treatments