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STAGING OF LUNG CANCERBY DR ANEFU, N .E
CTU/PULMONOLOGY PRESENTATION04/11/2010
AHMADU BELLO UNIVERSITY TEACHING HOSPITAL,ZARIA,NIGERIA
OUTLINEINTRODUCTIONDIAGNOSIS STAGINGMANAGEMENTCONCLUSION
Introduction The staging of any tumor is an attempt to measure / estimate
the extent of disease The information help to determine the patient's prognosis The staging of solid epithelial tumors is based on the AJCC-
TNM staging system
The "T" status provides information about the primary tumor itself, such as its size and relationship to surrounding structures
the "N" status provides information about regional lymph nodes the "M" status provides information about the presence or
absence of metastatic disease.
INCIDENCE OF LUNG CANCER173,700 Americans Diagnosed/yr-2004,NEJM,Art,RevM >F4oyrs+
164,440 mortality
14% 5yr survival
May be curable in early stagesGood px enhances long survival & ameliorate symtoms
BREIF ANATOMY OF THE LUNGS
The thorax
DIAGNOSISSTAGING WORK-UPHistoryPhysical examinations Basic laboratory
evaluations:
Investigations RADIOLOGY-
CXR PA viewFeatures of the mass
Features of complications e.g pleural effusion, collapsed lobe, Atelectasis, cavitation, consolidation, mediastinal shadow, hilar shadow, diffuse shadow
Investigations cont…CT-Scan
TumourSite, size, relation to structuresMetastatic deposits- liver, bones Lymph nodes• ULTRASONOGRAPHY- Liver, Adrenals• MRI-chest wall or med. Invasion• Screening of the diagphragm-phrenic Nr
paralysis• PET- Used alone or combined with CT- scan
Investigations cont…Sputum –cytology, shows malig. 60% in exp
handsOthers- M/C/S, AFBx3
BRONCHOSCOPY-Biopsy•Assess operability, vocal cords•Trachea,Carina, Bronchus
Inv cont..Mediasinoscopy- Biopsy, assessments as in
bronchoscopyBa swallowBrain ImagingBone scanFBC, ESR, LFT,
AJCC-TNM STAGINGTNM Classification (Applicable only in Non – sclc)T - 1 Tumour Tx – proven by cytology, but Imaging or
endoscopically negative. Cannot be determined as in px staging.
T0 – No Evidence of primary T. Tis – Ca - in - situ T1 - T 3cm. Surrounded by lung tissue or visceral
pleura and without proximal lobar bronchus extension at Bronchoscogy.
T2 -T3cm. -T of any size invading the viscera
pleural -Atelectasis or obstructive
pneumonitis, extending to the hilum; involving less than whole lung.
-Any extension to lobar bronchus must be confined transluminally and 2cm distal to the carina.
T3 –Any size of T invading:Chest wall including sup.sulcusDiaphragmMediastinal pleuraPericardium without thoracic visceral( heart,grt
vssl, trachea or oesoph)involvementProx. Ext.within 2cm of carina at bronchoscopyAtelectasis or obstructive pneumonitis of entire
lung
T4 – Any size of T with invasion of:MediastinumThoracic visceral( grt vssl, trachea, oesoph )
involvement,CarinaMalignant pleural or pericardial effusionSatellite T nodules in Ipsilateral prim. T-lobe.
N-NODAL INVOLVEMENT. No – No regional LN metastasis
demonstrated N1 – Positive peri-bronchial LN Ipsilateral hilar LNs.N2 – Ipsilateral med LNs or sub-carinal LNs.
N3 – Contralateral med. LN, Hilar LN,ipsi or contra lateral,scalene LNs, supraclavicular LNs-ipsi/contra.
M – Distant Metastasis M0 – No (known) Distant Metastasis M1 – Distant metastasis present/specify
sites.
Grp Staging of carcinoma of the lungs Stage Tumour Nodal
involvementDistant metastasis
operability
Occult carcinoma
TX No Mo
Stage O Tis No MoStage 1 T1 No Mo OperableStage 11 T1 N1 Mo Operable
T2 N1 Mo OperableStage 111a T3 No Mo Inoperable
T3 N1 Mo InoperableT1-3 N2 Mo Inoperable
Stage 111b Any T N3 Mo InoperableT4 Any N Mo Inoperable
Stage 1v Any T Any N M1 Inoperable
TREATMENT Rx - Depends on Types 1. SCLC – Medical Mx – 5- 10%2. NSCLC – Combination therapy – surgical resection - Radiotherapy - Chemotherapy i Surgical resection – offers the best cure & Rx of choice mainly - Palliative. - 20% considered suitable for exploration & 2% actually resectable.a) Lobectomyb) Radical Pneumonectomy Sq. cell Ca – Best prognosis
Treatment cont… ii Radiotherapy – mainly used in relief of symptoms such as
SVC obstruction. Bleeding & Haemoptysis
- Bone pain Isolated Brain Metastasis.
Dose: 4,000 – 5,000 CCG in fractionated doses iii Chemotherapy (Cytotoxics) VAC - Vincristine/Vinblastine - Adriamycin (Doxorubdicin) - Cyclophosphanide b. - Cisplastin - Etoposide - Cyclophosphanide vi. Others – Laser therapy (As in Radiotherapy).
CONCLUSIONStaging of lung cancer is a veritable principle
in the management; in deciding modalities of treatment and prognosis
Presentation at stages 1-11 and appropriate treatments; offer longer survival and better symptom ameliorations
More community awareness is required to encourage early presentations.
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