1 / 27

STAGING OF LUNG CANCER

STAGING OF LUNG CANCER. BY DR ANEFU, N .E CTU/PULMONOLOGY PRESENTATION 04/11/2010 AHMADU BELLO UNIVERSITY TEACHING HOSPITAL,ZARIA,NIGERIA. OUTLINE INTRODUCTION DIAGNOSIS STAGING MANAGEMENT CONCLUSION. Introduction.

demetrius-duran
Download Presentation

STAGING OF LUNG CANCER

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. STAGING OF LUNG CANCER BY DR ANEFU, N .E CTU/PULMONOLOGY PRESENTATION 04/11/2010 AHMADU BELLO UNIVERSITY TEACHING HOSPITAL,ZARIA,NIGERIA

  2. OUTLINE • INTRODUCTION • DIAGNOSIS • STAGING • MANAGEMENT • CONCLUSION

  3. Introduction • The staging of any tumor is an attempt to measure / estimate the extent of disease • The information help to determine the patient's prognosis • The staging of solid epithelial tumors is based on the AJCC- TNM staging system • The "T" status provides information about the primary tumor itself, such as its size and relationship to surrounding structures • the "N" status provides information about regional lymph nodes • the "M" status provides information about the presence or absence of metastatic disease.

  4. INCIDENCE OF LUNG CANCER • 173,700 Americans Diagnosed/yr-2004,NEJM,Art,Rev • M >F • 4oyrs+ • 164,440 mortality • 14% 5yr survival • May be curable in early stages • Good px enhances long survival & ameliorate symtoms

  5. BREIF ANATOMY OF THE LUNGS

  6. The thorax

  7. DIAGNOSIS STAGING WORK-UP • History • Physical examinations • Basic laboratory evaluations:

  8. Investigations • RADIOLOGY- • CXR PA view • Features of the mass • Features of complications e.g pleural effusion, collapsed lobe, Atelectasis, cavitation, consolidation, mediastinal shadow, hilar shadow, diffuse shadow

  9. Investigations cont… • CT-Scan • Tumour • Site, size, relation to structures • Metastatic deposits- liver, bones • Lymph nodes • ULTRASONOGRAPHY- Liver, Adrenals • MRI-chest wall or med. Invasion • Screening of the diagphragm-phrenic Nr paralysis • PET- Used alone or combined with CT- scan

  10. Investigations cont… • Sputum –cytology, shows malig. 60% in exp hands • Others- M/C/S, AFBx3 • BRONCHOSCOPY-Biopsy • Assess operability, vocal cords • Trachea,Carina, Bronchus

  11. Inv cont.. • Mediasinoscopy- Biopsy, assessments as in bronchoscopy • Ba swallow • Brain Imaging • Bone scan • FBC, ESR, LFT,

  12. AJCC-TNM STAGING • TNM Classification (Applicable only in Non – sclc) • T - 1Tumour • Tx – proven by cytology, but Imaging or endoscopically negative. Cannot be determined as in px staging. • T0 – No Evidence of primary T. • Tis – Ca - in - situ • T1 - T 3cm. Surrounded by lung tissue or visceral pleura and without proximal lobar bronchus extension at Bronchoscogy.

  13. T2 -T3cm. -T of any size invading the viscera pleural • -Atelectasis or obstructive pneumonitis, extending to the hilum; involving less than whole lung. • -Any extension to lobar bronchus • must be confined transluminally • and  2cm distal to the carina.

  14. T3 –Any size of T invading: • Chest wall including sup.sulcus • Diaphragm • Mediastinal pleura • Pericardium without thoracic visceral( heart,grtvssl, trachea or oesoph)involvement • Prox. Ext.within 2cm of carina at bronchoscopy • Atelectasis or obstructive pneumonitis of entire lung

  15. T4 – Any size of T with invasion of: • Mediastinum • Thoracic visceral( grtvssl, trachea, oesoph ) involvement,Carina • Malignant pleural or pericardial effusion • Satellite T nodules in Ipsilateral prim. T-lobe.

  16. N-NODAL INVOLVEMENT. • No – No regional LN metastasis demonstrated • N1 – Positive peri-bronchial LN • Ipsilateralhilar LNs. • N2 – Ipsilateral med LNs or sub-carinal LNs.

  17. N3 – Contralateral med. LN, HilarLN,ipsi or contra lateral,scalene LNs, supraclavicular LNs-ipsi/contra. • M – Distant Metastasis • M0 – No (known) Distant Metastasis • M1 – Distant metastasis present/specify sites.

  18. Grp Staging of carcinoma of the lungs

  19. TREATMENT • Rx - Depends on Types • SCLC – Medical Mx – 5- 10% • NSCLC – Combination therapy – surgical resection • - Radiotherapy • - Chemotherapy • i Surgical resection – offers the best cure & Rx of • choice mainly - Palliative. • - 20% considered suitable for exploration & 2% • actually resectable. • Lobectomy • Radical Pneumonectomy • Sq. cell Ca – Best prognosis

  20. Treatment cont… • ii Radiotherapy – mainly used in relief of symptoms • such as • SVC obstruction. • Bleeding & Haemoptysis • - Bone pain • Isolated Brain Metastasis. • Dose: 4,000 – 5,000 CCG in fractionated doses • iii Chemotherapy (Cytotoxics) • VAC - Vincristine/Vinblastine • - Adriamycin (Doxorubdicin) • - Cyclophosphanide • b. - Cisplastin • - Etoposide • - Cyclophosphanide • vi. Others – Laser therapy (As in Radiotherapy).

  21. CONCLUSION • Staging of lung cancer is a veritable principle in the management; in deciding modalities of treatment and prognosis • Presentation at stages 1-11 and appropriate treatments; offer longer survival and better symptom ameliorations • More community awareness is required to encourage early presentations.

  22. THANK YOU FOR LISTENING

More Related