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Non-Small Cell Lung Cancer
Aka: Non-Small Cell Lung Cancer, Non-Small Cell Adenocarcinoma, Squamous Cell Lung Cancer, Lung Adenocarcinoma, Large Cell Lung Cancer
- See Also
- Lung Cancer
- Epidemiology
- Lung Cancer mortality dwarfs other causes of cancer death for the last 50 years
- Types Non-Small Cell Lung Cancer (75% of Lung Cancers)
- Squamous Cell Carcinoma (25%)
- Late metastases
- Central endobronchial lesions
- Presents with Hemoptysis, Pneumonia, Atelectasis
- Adenocarcinoma (40%)
- Peripheral lesions
- Early metastases
- Associated with underlying lung disease
- Types
- Acinar
- Bronchioalveolar
- Papillary
- Solid carcinoma with mucus formation
- Large cell carcinoma (10%)
- Poorly differentiated tumors
- Large peripheral lesions
- Types
- Neuroendocrine type
- Basaloid type
- Lymphoepithelial-like
- Rhabdoid Phenotype
- Other uncommon Lung Cancers (<5 of Lung Cancers)
- Adenosquamous carcinoma
- Carcinoid
- Bronchial gland carcinoma
- Evaluation: Resectable Disease
- Surgical Lymph Node evaluation is critical
- Step 1: General testing
- Complete History and Physical
- Pathology review
- CT chest and Abdomen
- Complete Blood Count
- Chemistry panel
- Tobacco Cessation
- Step 2: Stage Peripheral T1-2NO or Central T1-2N0
- Step 1 testing and
- Pulmonary Function Tests
- Bronchoscopy
- Mediastinoscopy
- PET Scan
- Step 3: Stage T1-2N1 or T1-3N2
- Step 2 testing and
- Brain MRI (for stage 2B, MRI only if non-squamous cell cancer)
- Step 4: Stage T1-2N1 or T1-3N2
- Step 3 testing and
- Spine MRI and thoracic inlet MRI
- Staging
- Resources
- Staging Calculator
- http://staginglungcancer.org/calculator
- Stage IA: Local (T1N0M0)
- Characteristics
- Primary tumor <3 cm
- No nodal involvement
- No distant metastases
- Prognosis
- Surgical cure rate: 80%
- Stage IB: Local (T2N0M0)
- Characteristics
- Primary tumor >3 cm
- No nodal involvement
- No distant metastases
- Prognosis
- Surgical cure rate: 60%
- Stage II: Locally advanced (T2N1M0, T3N0M0)
- Characteristics
- Primary tumor any size and confined to the lung
- Ipsilateral Bronchial or hilar node involvement
- No distant metastases
- Prognosis
- Surgical cure rate: 30 to 40%
- Stage IIIA: Locally advanced (T1N2M0, T2N2M0, T3N1-2M0)
- Characteristics
- Ipsilateral mediastinal Lymph Node involvement or
- Primary tumor with local extension
- Extension to pleura or chest wall or
- Extension to Pericardium or
- Extension to diaphragm or
- Extension to within 2 cm of carina
- Prognosis
- Surgical cure rate: 10 to 20%
- Stage IIIB: Advanced (T4N1-3M0)
- Characteristics
- Contralateral Lymph Node involvement or
- Primary tumor with local invasion
- Tumor invasion of mediastinum
- Malignant Pleural Effusion
- Prognosis
- Surgical cure rate: <5%
- Stage IV: Advanced (T1-4N1-3M1)
- Characteristics: Distant Metastases
- Prognosis
- Surgical cure rate: <5%
- Management: Approach by Stage
- Stage I
- Surgical resection
- Stage II
- Surgical resection
- Stage III
- Eradicate intrathoracic cancer
- Limit subsequent metastases with Chemotherapy and radiation
- Stage IV or low functional status
- Multidisciplinary management tailored to pathology and patient functional status
- Palliative Care (initiate early for optimal effects on quality of life)
- Management: Surgical Resection
- Most effective Non-Small Cell Lung Cancer management
- Long-term Cancer Survivorship associated with resection
- Recurrence rate following resection: 50%
- Indicated in only 30% of patients (I, II, IIIA)
- See evaluation above
- No significant distant metastases
- Locally resectable disease within the chest
- Management: Adjuvant Chemotherapy
- Standard of care for resected stage II-IIIA Non-Small Cell Lung Cancer if medically stable
- Cisplatin-based regimen for 12 weeks
- Management: Post-operative radiation (PORT)
- Indicated for residual disease following resection
- Post-operative radiation follows adjuvant Chemotherapy
- Management: New potential therapies
- Tarceva (Erlotinib)
- Monoclonal Antibody targeting tumor growth factors
- Prolongs survival by 2 months
- Causes Diarrhea, rash and LFT abnormalities
- Cost: $2000/month
- References
- (January 2005) Prescriber's Letter, p. 5
- Management: Follow-up surveillance
- Routine physical examination every 4-6 months for 2 years and then annually
- Chest CT
- Spiral contrast- enhanced CT every 4-6 months for 2 years, then
- Noncontrast-enhanced CT annually thereafter (controversial)
- Prevention
- Tobacco Cessation is critical
- References
- Hainsworth (1997) Am Fam Physician 55(6):2265-72 [PubMed]
- Latimer (2015) Am Fam Physician 91(4): 250-6 [PubMed]
- Mountain (1986) Chest 89(4 suppl):223S-33S [PubMed]