Transcript 7._Bronchial_Tumors_

BRONCHOIAL
TUMOURS
• STAGING OF BRONCHOGENIC CANCER
- Small cell lung cancer is staged as;
Limited , when the tumour confined to the ipsilateral hemithorax and supra clavicular LNs .
Extended , everything else.
- Non – small cell lung cancer , is commonly classified as
TNM staging system,
Primary tumour (T).
• Tx primary tumour cannot be assessed , or tumour
proven by presence of malignant cell in sputum or
bronchial washing, but not visualized by imaging or
bronchoscopy.
•
•
•
•
T0 no evidence of primary tumour
Tis carcinoma in situ
T1 tumour <3 cm surrounded by lung or viceral pleura.
T2 tumour >3 cm , or >2 cm from main carina, or
invading viceral pleura , or associate with atelectasis or
obstructive pneumonitis, that extend to the hilum.
• T3 tumour of any size invading chest wall , diaphragm,
parietal pericardium, mediastinal pleura, or tumour in the
main bronchus < 2cm from main carina.
• T4 tumour of any size invading, mediastinum, heart,
great vessels , trachea, oesophagus, carina, vertebral
body, or malignant pleural or pericardial effusion.
Regional nodes (N)
• Nx can’t be assessed
• N0 no regional LN metastasis
• N1 ipsilateral peribronchial and/or ipsilateral hilar nodes
• N2 ipsilateral mediastinal and/or subcarinal nodes.
• N3 contralateral mediastinal or hilar nodes , or any
scalene or supra clavicular nodes.
Distant metastasis (M)
• Mx cannot be assessed
• M0 no distant metastasis
• M1 distant metastasis present , including separate nodes
in different lung lobes.
Stage
0
IA
lB
ll A
ll B
lllA
lllB
lV
TNM subset
Tis
T1 M0 N0
T2 M0 N0
T1 N1 M0
T2 N1 M0
T3 N0 M0
T1 N2 M0
T2 N2 M0
T3 N1-2 M0
T4 N0-2 M0
T1-4 N3 M0
any T, any N , M1
Management of primary lung cancer
1- Non – small cell cancer
A- surgery
The aims of surgery for lung cancer are to completely
excise the tumour and local lymphatics, with minimal
removal of functioning lung parenchyma.
Stage l and ll NSCLC are usually amenable to surgery if
the patient is fit enough , therefore careful staging and
assessment of the patient's respiratory reserve and
cardiac status are essential requirement to surgery.
Surgery will offer 5 year survival rates of over 75% in stage
l and 55% in stage ll disease .
Contra indications to surgical resection in Lung Ca.
1- Distant Metastasis
2- Invasion of central mediastainum structures(T4)
3- Malignant pleural effusion (T4)
4- Contralateral mediastinal nodes (N3)
5-FEV1<0.8L
6- Unstable or severe cardiac or other medical conditions
B- Radiotherapy;
Radical radiotherapy can offer long term survival in
selected patients with localised disease in whom comorbidity precludes surgery. The greatest value of
radiotherapy is in palliation of distressing complications
such as, spinal cord compression , superior vena caval
obstruction, severe haemoptysis, pain caused by chest
wall invasion or skeletal metastasis, or trachea or main
bronchial obstruction.
Now a days there is CHART radiotherapy which is
( continuous hyper fractionated radiotherapy), in which a
similar dose of radical radiotherapy given in smaller and
frequent fractions.
C- Chemotherapy
Usually considered in patient with stage lll and lV disease
and only 40% respond to it temporarily.
Combination chemotherapy is usually superior to single
chemotherapy and the survival gained is usually 6-7
weeks compare with best supportive care only.
Adjuvant chemotherapy following surgery has been found
to have significant survival advantages.
2- Small cell lung cancer
A- Chemotherapy
The treatment of SCLC with combination cytotoxic drug
and some time in combination with radiotherapy, can
increase the median survival with this highly malignant
tumour from 3 months to over a year. regular cycle of
chemotherapy are usually used and nausea and
vomiting are the common side effects.
The combined chemotherapy are either (cyclophosphamide
, doxorubicin and vincristine) or (cisplatin and etoposide).
B- Radiotherapy
Patient with limited disease will benefit from consolidation
radiotherapy following chemotherapy ,some times
palliative radiotherapy can be given in patient with
extensive diseased.
• Prognosis
The overall prognosis in all types of lung cancer are poor ,
around 80% of patients die with in one year from
diagnosis , less than 6% surviving 5 years following
diagnosis.
The best prognosis is with well differentiated Squamas cell
cancer which have not metastasised and amenable to
surgery.