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.

6. 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

7. BREIF ANATOMY OF THE LUNGS

8. The thorax

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

10. 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

12. 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

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

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

15. 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.

16. 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.

17. 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

18. 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.

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

20. 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.

21. Grp Staging of carcinoma of the lungs

23. 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

24. 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).

26. 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.

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