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Assessing and Treating Tobacco Use in Lung Cancer Care

Summary of Key Points Addressing tobacco dependence in patients with cancer increases the quality of care by reducing their risk for treatment complications, improving their prognosis, and reducing the risk of disease recurrence and second primary cancers. Smoking cessation after a diagnosis of lung cancer has been shown to have a beneficial effect on performance status. Many patients with cancer who smoke want to quit but…

Tobacco Control and Primary Prevention

Summary of Key Points Smoking is the predominant risk factor for development of lung cancer. As tobacco is introduced to societies, common patterns emerge. Typically, it is first used in men, then later in women. A 20- to 25-year lag between smoking rates and lung cancer rates reflects this. The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) provides a comprehensive global tobacco-control strategy.…

Classic Epidemiology of Lung Cancer

Summary of Key Points Lung cancer incidence and mortality has declined among men in many countries, following a decline in the prevalence and level of smoking. Among women, lung cancer incidence and mortality is still increasing in many countries and has become the main cause of cancer death. Despite important advances in lung cancer screening, primary prevention through tobacco control remains the main approach in the…

Hematologic cancer therapy

Key points Many forms of cancer chemotherapy are designed to inhibit tumor cell proliferation by interfering with DNA synthesis. Cancer chemotherapeutic agents can be classified as cell-cycle active agents and non–cell-cycle active agents; cell-cycle agents target actively proliferating cells, whereas non–cell-cycle agents target tumor cells, regardless of their proliferative status. Combination chemotherapy is designed both to simultaneously target cycling and noncycling tumor cells and to minimize…

Blood transfusion and stem cell transplantation

Key points Donor blood is collected and separated into red blood cell (RBC), platelet, granulocyte, and plasma fractions for transfusion into patients with severe anemia, thrombocytopenia, neutropenia, and bleeding, respectively. The ABH blood group antigens (A, B, and O) consist of a family of terminal oligosaccharide residues expressed by a variety of cell types, including RBCs. Acute hemolytic transfusion reactions are caused by incompatibility between the…

Benign conditions of lymphoid organs

Key points Lymph nodes are composed of four major compartments: the cortical B cell–rich follicles, the paracortical T cell–rich interfollicular zone, the medullary region, and the sinusoidal compartment. Lymphoid hyperplasia may be classified according to the compartment and major cell type that is affected: B-cell follicular hyperplasia, T-cell paracortical hyperplasia, or histiocytic sinusoidal hyperplasia. Lymphadenopathy refers to any lymph node enlargement, whether caused by lymphoma, metastatic…

Platelets

Key points Megakaryocytes in the bone marrow are stimulated by the liver-derived cytokine thrombopoietin to produce platelets by cytoplasmic budding. Platelets are small anucleate cytoplasmic fragments that circulate in the blood with a half-life of 8 to 10 days.. The normal platelet count ranges from 150,000 to 400,000/μL of blood; one third of all platelets in the vascular pool reside in the spleen (marginal pool). Bleeding…

Blood coagulation

Key points Liver-derived coagulation factors circulate in an inactive state and are activated in a cascading fashion, leading to thrombin-mediated fibrin formation. Thrombosis is triggered in most cases by vessel wall damage and exposure of blood to tissue factor, collagen, and von Willebrand factor (VWF). Tissue factor leads to factor VIIa–mediated activation of the coagulation cascade. Exposure of blood to subendothelial collagen and VWF leads to…

Lymphoma and related disorders

Key points Lymphomas are malignant clonal neoplasms of lymphocytes. Lymphomas are classified by cell of origin (B, T, or natural killer cell), degree of maturation (immature [blastic], or mature), cell size (small or large), mitotic rate (low or high), histologic pattern (nodular, diffuse, or sinusoidal), immunophenotype (e.g., CD10+ Bcl-6+ germinal center B cell, CD5+ B cell, cyclin D1+ mantle B cell), and cytogenetics (e.g., t(8;14), t(14;18),…

Leukemia and related disorders

Introduction The term leukemia refers to a family of malignant neoplasms of the bone marrow characterized by clonal proliferation of hematopoietic cells and often accompanied by circulating immature cells in the peripheral blood. Leukemia is often accompanied by suppression of normal hematopoiesis, leading to pancytopenia. Neutropenia (<500 neutrophils per microliter of blood) and thrombocytopenia (<20,000 platelets per microliter of blood) increase the risk of life-threatening sepsis…

Genetic basis of hematologic neoplasia

Key points The cell cycle is controlled at two steps, the G1 and G2 restriction points, by cyclin-dependent protein kinases (CDKs). CDKs are subject to control by cyclin proteins, cyclin-CDK inhibitors such as cell damage-sensing protein (p53) and retinoblastoma (RB) protein, and cyclin-CDK activators such as c-Myc protein. Growth factors stimulate hematopoietic cell growth and differentiation by binding to growth factor receptors, which activate the JAK-STAT…

Immune system and related disorders

Key points Immune system organs include the bone marrow, thymus, lymph nodes, spleen, tonsils, as well as gut-, skin-, and bronchial-associated lymphoid tissues. The major types of immune system cells are lymphocytes, plasma cells, and antigen-presenting cells (APCs). The four major lymphocyte types are T cells, B cells, natural killer (NK), and natural killer T cells (NKT cells). APCs include dendritic cells and macrophages. Lymphocytes and…

Myeloid cells

Key points Under the influence of specific cytokines, common myeloid progenitors in the marrow undergo differentiation into granulocytes (neutrophils, eosinophils, mast cells, basophils, and monocytes. Neutrophils are phagocytic microbicidal cells that contain cytoplasmic granules rich in proteolytic enzymes. In response to localized infection, neutrophils collect to form netlike extracellular traps of chromatin and antimicrobial toxins. Upon activation, neutrophils produce toxic reactive oxygen species. Neutrophils released into…

Aplastic anemia and related disorders

Key points Aplastic anemia is broadly defined as pancytopenia (low hemoglobin, leukocyte count, and platelet count) with a hypocellular bone marrow. Some inherited forms of aplastic anemia present in early childhood and may be associated with increased risk for development of malignancy. Idiopathic aplastic anemia is an autoimmune condition most often seen in adults that may respond to immunosuppressive drugs. Pure red blood cell (RBC) aplasia,…

Hemolytic anemia

Key points Hemolytic anemia can be caused by intrinsic red blood cell (RBC) defects (hemoglobin defects, enzyme defects, or membrane defects) or extrinsic causes (autoimmune, vascular defects, toxins, or heat). Intravascular hemolysis results from direct destruction of circulating s by extreme heat, toxins, infectious agents, complement, or shear forces. Extravascular hemolysis results from phagocytosis of intact (but abnormal) RBCs by macrophages of the spleen and liver.…

Red blood cell metabolism and enzyme defects

Key points Red blood cell (RBC) energy is supplied entirely by anerobic glycolysis. Three auxiliary metabolic pathways branch from the glycolytic pathway: the hexose monophosphate (HMP) shunt, the 2,3-bisphosphoglycerate (2,3-BPG) pathway, and the methemoglobin reductase pathway. The HMP shunt produces glutathione, a reducing agent that protects RBCs from oxidative damage. Bisphosphoglycerate produced by the 2,3-BPG pathway leads to decreased hemoglobin oxygen affinity and more rapid release…