Lung Cancer Flashcards
T1
tumor 3 cm or less in greatest diameter, surrounded by lung or visceral pleura, not in the main bronchus
t1a below 1cm
t1b 1-2cm
t1c 2-3 cm
T2
tumor more than 3 cm but less than 5 cm and
involves main bronchus regardless of distance to the carina but without involvement of carina
invades visceral pleura
associated with atelectasis or obstructive pneumonitis that extends to the hilar region either involving part of or the entrire lung
T3
more than 5 cm but below 7 cm in greatest diameter
T3 structures involved
parietal pleura chest wall phrenic nerve parietal pericardium separate tumor nodule in the same lobe as primary
T4 tumor
more than 7 cm or of any size that invades
T4 tumor structures
diaphragm mediastinum heart great vessels trachea recurrent laryngeal nerve esophagus vertebral body carina seperate tumor nodules in a different ipsilateral lobe to thet of the primary
N1 means
ipsilateral peribronchial and or ipsilateral hilar LN and intrapulmonary LN
N2 means
ipsilateral mediastinal and or subcarinal lymph nodes
N3 means
contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene or supraclavicular LN.
M1a
separate tumor nodule in a contralateral lobe, tumor with pleural or pericardial nodules
or pleural or pericardial effusions
M1b
single extrathoracic metastasis in a single organ
M1c
multiple extrathoracic metastasis in a single or multiple organs
Tumor upto 5 cm with ipsilateral peribronchial or hilar LN
stage II T2N1
tumor more than 4 cm below 7 cm but no node
stage II T3N0
Discontinuous tumor nodule outside the parietal pleura in the chest wall or in the diaphragm
M1b or M1c
Indication of CT in early stage
tumor size >4cm poorly differentiated tumor high risk patient LVSI wedge resection unknown LN status visceral pleura involvement
Indication of RT in early stage
Surgical margin close/positive
mediastinal LN+-extracapsular extension of LN
tumor volume 5 cm
wedge resection/ segmentectomy
Operable cases in lung cancer
FEV1>1.5L or >1.2L
stage I, II NSCLC
performance status - 0,1.
Role of CT in NSCLC
Neoadjuvant: borderline resectable (stage I-IIIA)
adjuvant CT: N+ve, margin positive, high risk
concurrent and sequential chemo -radiation (IIIB, IIIC and superior sulcus tumor)
palliative: stage IV
High risk patient for adjuvant CT
Examples of high-risk factors may include poorly differentiated tumors (including
lung neuroendocrine tumors [excluding well-differentiated neuroendocrine
tumors]), vascular invasion, wedge resection, tumors >4 cm, visceral pleural
involvement, and unknown lymph node status (Nx). These factors independently
may not be an indication and may be considered when determining treatment
with adjuvant chemotherapy
ALK positive tumor treatment
ALK Rearrangement Positive • First-line therapy Alectinib Brigatinib Ceritinib Crizotinib Lorlatinib • Subsequent therapy Alectinib Brigatinib Ceritinib Lorlatinib
EGFR mutated first line targeted therapy
EGFR Exon 19 Deletion or L858R • First-line therapy Afatinib Erlotinib Dacomitinib Gefitinib Osimertinib Erlotinib + ramucirumab Erlotinib + bevacizumabc (nonsquamous) • Subsequent therapy Osimertinib
IF PD 1 positive
if >1%
or if >50%
PD-L1 ≥1% • First-line therapyd -Pembrolizumab -(Carboplatin or cisplatin)/pemetrexed/ pembrolizumab (nonsquamous) -Carboplatin/paclitaxel/bevacizumabc/ atezolizumab (nonsquamous) -Carboplatin/(paclitaxel or albumin-bound paclitaxel)/pembrolizumab (squamous) -Carboplatin/albumin-bound paclitaxel/ atezolizumab (nonsquamous) -Nivolumab/ipilimumab -Nivolumab/ipilimumab/pemetrexed/ (carboplatin or cisplatin) (nonsquamous) -Nivolumab/ipilimumab/paclitaxel/carboplatin (squamous) PD-L1 ≥50% (in addition to above) • First-line therapy Atezolizumab Cemiplimab-rwlc
Preferred chemotherapy for non squamous cell lung cancer
Preferred (nonsquamous)
• Cisplatin 75 mg/m2 day 1, pemetrexed 500 mg/m 2 day 1 every 21 days for 4 cycles.
