Lecture 48: Lung Cancer II - Detailed Overview on Staging and Treatments

-CBC, Chemistry profile

-LFT's

-CT chest/abd

-PET

-Mediastinoscopy

-VATS

-EUS/EBUS

-Needle biopsy

-Thoracentesis

-Mediastinal nodes should be biopsied

options for lung cancer staging

Thoracotomy

if you perform staging for lung cancer, and disover it is the early stage of disease, what should you do?

T

primary tumor

Tx

primary tumor cannot be assessed or tumor proven by the presence of malignant cells in sputu of bronchial washings but not visualized by imaging or bronchoscopy

Tis

tumor measuring 3 cm or less and has no invasive component at histopathology

Regional lymph node involvement

in TNM system, what is N looking at?

Distant Metastasis

in TNM system, what is M looking at?

3

if the tumor is _______ cm or less, it is early enough in disease process for surgery

Surgery

Treatment for lung cancer stage I- IIIb

Radiation or Chemotherapy

treatment for lung cancer, stage IIIb - IV

40

FEV1 > ____% post operative you are a surgical candidate

40

DLCO > ____% post operative you are a surgical candidate

Small Cell Lung Cancer

Typically surgery is the best treatment for cancer, except for _____________________

• Extensive disease treated with chemotherapy

• Consider Palliative Care Initiation

• Survival still only about 10 months

Radiation AND Chemotherapy

treatment for SCLC only in the chest

Brain

SCLC spreads very quickly, especially to the ___________

Palliative Care

What has been show to improve longevity in advanced lung cancer?

Bronchioalveolar Cell Carcinoma (Mucninous Adenocarcinoma)

42 yr old female presents with a cough and is felt to have worsening pneumonia

-never smoked

-treated empirically for bonchitis

-pt presents with pleuritic chest pain weeks later

• Bronchial Alveolar Lavage and transbronchial biopsy reveal atypical mucin laden cells

Bronchioalveolar Cell Carcinoma (Mucninous Adenocarcinoma)

histology shows a mucinous cell

Stage IV

What Stage?

• Disease is in both lungs on chest CT

• Staging PET scan shows disease confined to the lungs

• Epidermal growth factor receptor shows a mutation in exon 19

• She is discharged home on O2 and oncology follow up

EGFR Inhibitors

-Cetuximab

-Erlotiinib

-Gefitinib

Adenocarcinoma

-______________in situ affects older, smoking women & men

• Mimics pneumonia

• Goes weeks to months undiagnosed

• Is insidious and indolent

• Family history of lung cancer

• Surgery for cure

Metastatic Tumor

If there is a new tumor found that has the same gene mutation as the previous tumor, it is ___________________

New Primary Tumor

If there is a new tumor found that has a different gene mutation as the previous tumor, it is ___________________

Effects staging and therefore treatment

why is it important to decide if another tumor is a metastatic tumor or a new primary tumor>

Surgically Remove it!!!!!!!!

what should you do if you keep watching a ground glass opacitiy every year, and one year it appears solid?

Small Cell Lung Cancer

• Shares risk factors with non-small cell, only lung cancer where smoking is the only cause

• Rapid growth and early metastasis

• Staging "limited" or "extensive"

• Tends to be sensitive to chemotherapy

• Surgery rarely used for treatment

• High recurrence rates

"Limited" stage

refers to disease confined primarily to the thoracic cavity while "extensive" refers to disease that has spread to distant sites such as the other lung, brain, bone, liver,

adrenals, skin, etc.

Small Cell Lung Cancer

the only cancer where you HAVE to have smoked to get it

• Ectopic ACTH

• SIADH

• Inflammatory polyneuropathy

• Cerebellar degeneration

• Eaton-Lambert (Myasthenia Gravis)

Common Paraneoplastic Syndromes in SCLC

Lobectomy

Sleeve Resection

Pneumonectomy

Wedge Resection

usually for diagnosis, not treatment

Non-Small Cell Lung Cancer

EML4-ALK translocation

Stereotactic Radiation

Asbestos

#1 risk factor for mesothelioma

Mesothelioma

• Rare tumor of the pleural and peritoneal lining cells

• Highly litigious malignancy given the work place exposure

• Insidious dyspnea (on background of lung scarring), pain

• Pleural effusion

• "Rind" forms, restricting lung function

• Local spread (SVC syndrome, Pericardial Tamponade, Cord Compression)

• Poor response to chemotherapy or radiation

• Platinum

• Taxanes

• Gemcitabine

• Navelbine

• Etoposide

• Alimta

conventional chemotherapy