Background and treatment recommendations Flashcards
Overall paradigm of T stage
T stage is by tumor size OR extent of invasion, whichever resulst in higher stage
T1a tumors
< 2 cm
No invasion of mainstem bronchus, visceral pleura and no atelectasis
T1b tumors
More than 2 cm but 3 cm or less in size
No invasion of mainstem bronchus, visceral pleura and no atelectasis
T2a tumors
Greater than 3 cm but not more than 5 cm
or
tumors that invade the visceral pleura, mainstem bronchus > 2 cm distal to the carina, or that are associated with atlectasis or pneumonitis that does not involve the entire lung
T2b tumors
Tumors that are more than 5 cm but 7 cm or less in size
T3 tumors
Tumors more than 7 cm
or
tumors that invade
- Parietal pleura
- Chest wall
- Diaphragm
- Phrenic nerve
- Mediastinal pleura
- Parietal pericardium
- Main bronchus w/in 2cm from carina (but not involving carina)
- A/w atelectasis or pneumonitis involving entire lung
- Separate tumor nodule in same lobe
T4 tumors
Any size tumor that invades:
Mediastinum
Heart
Great vessels
Tracheda
Recurrent laryngeal nerve
Esophagus
Vertebral body
Carina
Separate tumor nodule in different ipsilateral lobe
N1
Ipsilateral peribronchial and/or hilar nodes, intrapulmonary nodes
N2
Ipsilateral mediastinal and/or subcarinal nodes
N3
Contralateral mediastinal or hilar adenopathy
Ipsilateral or contralateral scalene or supraclavicular nodes
Stage IA
T1a or T1b N0
Stage IB
T2a N0
Stage IIA
T2b N0
T1 N1
T2a N1
Stage IIB
T2b N1
T3 N0
Stage IIIA
T3 N1
T1-3 N2
T4 N0-1
Stage IIIB
N3 or T4 N2
What images are needed to complete work up of NSCLC?
- Diagnostic CT scan of the chest and upper abdomen (adrenals)
- MR of brain if Stage IIB or higher
- PET/CT scan
What counseling should be offered before treatment?
- Smoking cessation counseling
What nodes do we cover with RT?
- Nodes > 1 cm on CT
- PET positive nodes