Pulmonology Book

Cancer

Lymphatic Disorders

http://www.fpnotebook.com/

Non-Small Cell Lung Cancer

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  1. See Also
    1. Lung Cancer
  2. Types Non-Small Cell Lung Cancer (75% of Lung Cancers)
    1. Squamous Cell Carcinoma
    2. Adenocarcinoma
    3. Large cell carcinoma
  3. Staging
    1. Stage IA: Local (T1N0M0)
      1. Characteristics
        1. Primary tumor <3 cm
        2. No nodal involvement
        3. No distant metastases
      2. Prognosis
        1. Surgical cure rate: 80%
    2. Stage IB: Local (T2N0M0)
      1. Characteristics
        1. Primary tumor >3 cm
        2. No nodal involvement
        3. No distant metastases
      2. Prognosis
        1. Surgical cure rate: 60%
    3. Stage II: Locally advanced (T2N1M0, T3N0M0)
      1. Characteristics
        1. Primary tumor any size and confined to the lung
        2. Ipsilateral bronchial or hilar node involvement
        3. No distant metastases
      2. Prognosis
        1. Surgical cure rate: 30 to 40%
    4. Stage IIIA: Locally advanced (T1N2M0, T2N2M0, T3N1-2M0)
      1. Characteristics
        1. Ipsilateral mediastinal lymph node involvement or
        2. Primary tumor with local extension
          1. Extension to pleura or chest wall or
          2. Extension to Pericardium or
          3. Extension to diaphragm or
          4. Extension to within 2 cm of carina
      2. Prognosis
        1. Surgical cure rate: 10 to 20%
    5. Stage IIIB: Advanced (T4N1-3M0)
      1. Characteristics
        1. Contralateral lymph node involvement or
        2. Primary tumor with local invasion
          1. Tumor invasion of mediastinum
          2. Malignant Pleural Effusion
      2. Prognosis
        1. Surgical cure rate: <5%
    6. Stage IV: Advanced (T1-4N1-3M1)
      1. Characteristics: Distant Metastases
      2. Prognosis
        1. Surgical cure rate: <5%
  4. Management: Surgical Resection
    1. Most effective non-Small Cell Lung Cancer management
    2. Long-term cancer survivorship associated with resection
    3. Recurrence rate following resection: 50%
    4. Indicated in only 30% of patients (I, II, IIIA)
      1. No significant distant metastases
      2. Locally resectable disease within the chest
  5. Management: Vinorelbine Chemotherapy in Non-Small Cell
    1. Well tolerated chemotherapeutic
    2. Modestly effective with Cisplatin
    3. Prolongs survival
      1. Vinorelbine: 40 week survival
      2. Untreated: 20 week survival
    4. Expensive >$200 per week
    5. References
      1. Med Lett Drugs Ther (1995) 37(955):72
  6. Management: Tarceva (erlotinib)
    1. Monoclonal Antibody targeting tumor growth factors
    2. Prolongs survival by 2 months
    3. Causes Diarrhea, rash and LFT abnormalities
    4. Cost: $2000/month
    5. References
      1. (January 2005) Prescriber's Letter, p. 5
  7. Management: Cranial Irradiation in Small Cell Cancer
    1. Prophylactic cranial irradiation improves survival
    2. Auperin (1999) N Engl J Med 341:476
  8. References
    1. Hainsworth (1997) Am Fam Physician 55(6):2265
    2. Mountain (1986) Chest 89(4 suppl):223S

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