Download Lung Cancer

Lung cancer
Gene Kukuy, MD
Cardiothoracic Surgery
Overview
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Lung cancer is bad
Statistics
Staging
Treatment
CA CANCER J CLIN 2013;63:11–30
Stage at presentation
Estimate for LA
Total Prostate Lung Breast Colon NHL
20,950 3,410 3,320 2,530 2,060 920
Lung cancer distribution:
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Small cell 18%
Adenocarcinoma 32%
Squamous 29%
Large cell 9%
Carcinoid 5%
NSCLC
Staging
NCCN.org v2.2010
Survival by stage
Clinical
Pathological
J Thorac Oncol. 2007;2: 706–714
Initial workup
• Abnormal CXR
Workup
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CT chest
PET/CT
Bronch
PFT
MRI brain
Cardiac stress
PET/CT
Bronchoscopy
Lymph node sampling
• Mediastinoscopy
– Access to 2/4/7
• Chamberlain
– Access to 5/6
• VATS
• EBUS
• Resection
– Which resection?
– Enough lung?
• Spirometry
FEV 1 and DLCO (diffusing capacity)
V/Q
Sleeve resection
• Possible complications?
Residual Tumor After Resecion
• R0 - No residual (No identifiable tumor
remaining; negative surgical margins)
• R1 - Microscopic residual (Microscopically
positive margins but no visible tumor
remaining)
• R2 - Gross residual (Gross (visible or
palpable) tumor remaining)
SCLC
• Prognosis — The most important prognostic factor
in patients with SCLC is the extent of disease
(stage) at presentation. For patients with limited
stage disease, median survivals range from 15 to
20 months, and the reported five-year survival rate
is 10 to 13 percent. In contrast, for patients with
extended stage disease, the median survival is 8 to
13 months, and the five-year survival rate is 1 to 2
percent.
Specific targeted therapies are widely used for
patients with two molecular subsets of NSCLC
• ●Activating mutations in the epidermal growth factor
receptor (EGFR) define a subset of patients with
adenocarcinoma that more frequently affect patients who
are never smokers, women, and/or of Asian ethnicity.
These patients are generally highly responsive to EGFR
tyrosine kinase inhibitors (erlotinib, gefitinib, afatinib) and
have a significantly better prognosis than those without
EGFR mutations.
• ●The presence of the EML4-ALK fusion oncogene defines
another NSCLC subset that is more frequent in
nonsmokers or former smokers and occurs at a younger
age. These patients are highly responsive to crizotinib, an
inhibitor of the anaplastic lymphoma kinase (ALK).
Final Review
• Evaluate stage
• ? Resection candidate
• ? Neoadjuvant therapy
• Surgery