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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