Adjuvant Lung CA Flashcards
What are the risk factors for Lung cancer?
Smoking Radiation Hazardous chemicals Air pollution Genetic susceptibility Pre-existing lung disease
What is the median survival for Stage IA and IB Lung cancer?
IA:
95m
5y OS 65%
IB:
75m
5yOS 55%
What is the median survival for Stage II and III Lung cancer?
IIA:
45m
5yOS 40%
IIB:
30m
5yOS 35%
IIIA:
20m
5yOS 20%
IIIB:
10m
5yOS 7%
What is the median survival for Stage IV Lung CA
5m
5yOS 2%
When is invasive mediastinal staging indicated?
Central tumors
Potentially resectable T2-4
Radiological N1 involvement
Regardless whether CT/PET is positive or not.
If CT/PET negative, but clinical T1 disease, how often will we get an incidental N2 post-op?
5%
Tell me about the T staging for lung cancer according to AJCC 7th edition
T1
Tumor 3cm or less, surrounded by lung/visceral pleura with no invasion more proximal than lobar bronchus
T2
Tumor >3cm but 7cm or less; OR
Tumor with any of the following:
- involves main bronchus, 2cm or less distal to the Carina
- invades visceral pleura
- a/w atelectasis or obstructive pneumonitis tt extends to the hilar region, but does no involve entire lung
T3
Tumor>7cm; OR
- directly invades chest wall/diaphragm/phrenic nerve/mediastinal pleura/parietal pericardium/main bronchus
Tell me about the T1 staging for lung cancer
Tumor 3cm or less, surround by visceral pleura without invasion more proximal than lobar bronchus
T1a Tumor 2cm or less
T1b Tumor >2cm but 3cm or less
Tell me about the T2 staging
T2:
Tumor >3cm, but no more than 7cm OR
- Involves main bronchus, 2cm or more distal to Carina
- invades visceral pleura
- a/w atelectasis/obstructive pneumonitis that extends to hilar region, but does not affect whole lung
T2a: Tumor >3cm, but no more than 5cm
T2b: Tumor >5cm, but no more than 7cm
Tell me about T3
Tumor >7cm
OR
- Directly invades chest wall/diaphragm/phrenic nerve/mediastinal pleura/parietal pericardium/main bronchus
Tell me about T4
Tumor of any size that invades:
- mediastinum, heart, great vessels, trachea, vertebral body, recurrent laryngeal nerve, esophagus; OR
- tumor nodules in a different ipsilateral lobe
What Stage is T3N0M0
Stage IIB
What Stage is T3N1/2?
What Stage is T3N3?
Stage IIIA
Stage IIIB
What Stage is T4N0
Stage IIIA
What stage is TxN3?
Stage IIIB
What is a lobectomy?
Removing of one lobe
Ability to preserve pulmonary function
Thoracotomy/VATS procedure
Proximal tumors might be so readily resected by lobectomy
What is a sleeve lobectomy?
Lobe is removed, together with part of the bronchus attached to it.
Remaining lobe(s) is then reconnected to the remaining segment of the bronchus
Indicated for proximal tumors not resectable by lobectomy
Preferred over pneumonectomy, assuming that margin-negative resection is achieved