Lung Oncology Flashcards
What are the Stages by primary tumour size?
TIS: tumour in situ, less than 3cm, no invasive component
T1: tumour less than 3cm, invasive component, but not into bronchus
T2: 3-5cm
o invades the main bronchus (but not the carina)
o invades visceral pleura
o associates with atelectasis or obstructive pneumonitis that extends to the hila
T3 5-7cm
o associates with separate tumour nodules in the same lobe
T4 >7cm
o associates with separate tumour nodules in a different ipsilateral lobe
What do you use to assess the potential for curative Rx
PET-CT
What do you do If nodal status affects Rx plan
prioritise high risk intrathoracic lymph nodes > 1o
lesion
What is classed as a Central lesion?
within 3cm proximal bronchial tree, heart, great vessels, trachea, other mediastinal structures
What are features of an Adenocarcinoma?
- location
- smoking/non smoking
- Differentiation
- tumour marker proteins
- precancerous
More peripheral
Most common in non-smokers
Glandular differentiation, mucin-containing elements
Thyroid Transcription Factor 1, Napsin A
Precancerous = adenocarcinoma in situ
What are features of an Squamous cell carcinoma ?
- location
- smoking/non smoking
- Differentiation
- tumour marker proteins
- precancerous
More central- Can grown into lumen (obstruction/infection) or out into parenchyma
Assoc. w/smoking
Keratin production- in form of squamous pearls or eosinophilic cytoplasm
p63 and p40 markers
precancerous = carcinoma in situ
What are features of an Large cell carcinoma ?
- location
- smoking/non smoking
- Differentiation
- tumour marker proteins
Epithelial, undifferentiated malignant tumour
large nuclei, prominent nucleoli, moderate cytoplasm. . Lacks the features of other forms of lung cancer.
diagnosis of exclusion – negative for all characteristic markers
What are features of an Small cell carcinoma ?
- location
- smoking/non smoking
- Differentiation
- tumour marker proteins
Major bronchi/lung periphery
Strong link to smoking, Most aggressive, usually metastasised by diagnosis
Small round/spindle-shaped cells, little cytoplasm, ill-defined
borders, ill-defined borders, and finely granular nuclear chromatin (salt-and-pepper pattern). Shows areas of necrosis.
Non epithelial origin
High expression neuroendocrine markers e.g., chromogranin, CD57
Assoc. w/ectopic hormone production.
What is the ECOG/WHO performance status:
0 → fully active
1 → light work
2 → selfcare but no work activities
3 → limited selfcare, bed/chair
confined >50% of time
4 → completely disabled, no selfcare
5 → dead
What is the investigative methods for Central Lesions
Flexible bronchoscopy if central lesions on CT
What is the investigative methods for Peripheral Lesions
Peripheral 1otumour → CT guided biopsy
What is the investigative methods for Paratracheal and Peri-bronchial intra-parenchymal lesion
EBUS-TBNA (endobronchial ultrasound-guided transbronchial needle aspiration)
What are the different stages of N for TNM staging
- N0
- N1
- N2
- N3
N0: no nodes involved
N1: ipsilateral bronchopulmonary or hilar
N2: ipsilateral mediastinal or subcarinal
N3: contralateral hilar, mediastinal or supraclavicular
What are the different stages of M for TNM staging
- M0
- M1
M: distant metastasis
M0: no distant metastasis
M1: distant metastasis present
o M1a: nodules in a contralateral lobe, the pleura or the pericardium, or effusions in the pleural cavity or pericardium o M1b: single extra-thoracic metastasis o M1c: multiple extra-thoracic metastases in one
When is surgery and radiotherapy w/curative intent offered
Well enough + suitable for curative intent →
offer lobectomy
Only offer more extensive e.g., pneumonectomy
if needed to obtain clear margins
Do hilar + mediastinal lymph node sampling or
en bloc resection
T3 NSCLC w/chest wall involvement, aim for
complete resection using extra pleural or en bloc
chest wall resection.
