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Lung Cancer: Staging And Prognosis

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Lung Cancer is the leading malignant cause of death in both men and women ... After discovering a patient has Lung Cancer, it is very important to stage the ... – PowerPoint PPT presentation

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Title: Lung Cancer: Staging And Prognosis


1
Lung CancerStaging And Prognosis
  • Hrach Ike Kasaryan

2
INTRODUCTION
  • Lung Cancer is the leading malignant cause of
    death in both men and women
  • Ahead of Breast in women
  • Ahead of Prostate in Men
  • It is important to have a good base of knowledge
    in internal medicine about how to stage Lung
    Cancers and what type of prognosis each stage
    carries.

3
Introduction
  • After discovering a patient has Lung Cancer, it
    is very important to stage the patient
    appropriately
  • There is a well established relationship between
    the ANATOMIC extent of the the disease and
    SURVIVAL DURATION
  • This is why staging a patient determines both
    prognosis and therapy

4
T/N/M system
  • The International System for Staging Lung Cancer
    is based on the TNM system
  • T-primary tumor
  • N-regional lymph nodes
  • M-distant metastasis
  • The system is applicable for the four major cell
    types of lung cancer adenocarcinoma, squamous
    cell carcinoma, large cell carcinoma, and small
    cell carcinoma.

5
T/N/M system
  • This is based on all diagnostic and evaluative
    information obtained before the start of
    treatment, including the results of invasive
    procedures, such as bronchoscopy, needle biopsy,
    mediastinoscopy, and diagnostic thoracoscopy
  • The importance of Staging cannot be
    overemphasized because this information is to
    serve as a guide for treatment planning

6
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7
Patients with Non-Small Cell Small Cell
Survival Curves based on staging
8
T- Primary Tumor
  • TX -Primary tumor cannot be assessed or tumor
    proved by the presence of malignant cells in
    sputum or bronchial washings but not visualized
    by imaging or bronchoscopy   
  • TO - No evidence of primary tumor   
  • Tis - Carcinoma in situ   
  • T1 Tumor 3 cm or less in greatest dimension,
    surrounded by lung or visceral pleura, without
    bronchoscopic evidence of invasion more proximal
    than the lobar bronchus (i.e., not in the main
    bronchus)   

9
T Primary Tumor
  • T2 - Tumor with any of the following features of
    size or extent
  • More than 3 cm in greatest dimension   
  • Involves main bronchus, 2 cm or more distal to
    the carina   
  • Invades the visceral pleura   
  • Associated with atelectasis or obstructive
    pneumonitis that extends to the hilar region but
    does not involve the entire lung

10
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11
T- Primary Tumor
  • T3 - Tumor of any size that directly invades any
    of the following
  • chest wall (including superior sulcus tumors),
    diaphragm, mediastinal pleura, or parietal
    pericardium
  • or tumor in the main bronchus less than 2 cm
    distal to the carina but without involvement of
    the canna
  • or associated atelectasis or obstructive
    pneumonitis of the entire lung

12
T- Primary Tumor
  • T4 - Tumor of any size that invades any of the
    following
  • mediastinum, heart, great vessels, trachea,
    esophagus, vertebral body, or caring
  • or tumor with a malignant pleural or pericardial
    effusion
  • or with satellite tumor nodule(s) within the
    ipsilateral primary tumor lobe of the lung

13
N- Regional Lymph Nodes
  • NX - Regional lymph nodes cannot be assessed   
  • NO - No regional lymph node metastasis   
  • N1 - Metastasis to ipsilateral peribronchial
    and/or ipsilateral hilar lymph nodes and
    intrapulmonary nodes involved by direct extension
    of the primary tumor   
  • N2 - Metastasis to ipsilateral mediastinal
    and/or subcarinal lymph node(s)   
  • N3 - Metastasis to contralateral mediastinal,
    contralateral hilar, ipsilateral or contralateral
    scalene, or supraclavicular lymph node(s)

14
M Distant Metastasis
  • MX - Presence of distant metastasis cannot be
    assessed   
  • MO - No Distant metastasis   
  • M1 - Distant metastasis present

15
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16
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17
What is the Stage?
  • Patient has a 1cm Squamous Cell Carcinoma in the
    Right Mainstem Bronchus on bronchoscopy, No
    metastasis is seen on CAT SCAN and Lymph nodes
    are negative on Throcoscopy.
  • T2 N0 M0

18
What is the Stage?
  • Patient has on CAT SCAN a 2cm mass in the middle
    of the Left Lower Lobe limited to terminal
    bronchioles on Bronchoscopy with no pleural
    invasion, with no extension seen, Ipsilateral
    Mediastinal Nodes positive and Liver Mets.
  • T1 N2 M1

19
What is the Stage?
  • Patient on Cat SCAN with a 1cm Nodule in the
    Right Apex, isolated with no extension, FNA shows
    Adenocarcinoma, and on RU-Lobectomy all nodes are
    negative with no sign of metastasis on CAT Scan
  • T1 N0 M0
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