Transcript Lung Cancer
Lung cancer Gene Kukuy, MD Cardiothoracic Surgery Overview • • • • Lung cancer is bad Statistics Staging Treatment CA CANCER J CLIN 2013;63:11–30 Stage at presentation Estimate for LA Total Prostate Lung Breast Colon NHL 20,950 3,410 3,320 2,530 2,060 920 Lung cancer distribution: • • • • • Small cell 18% Adenocarcinoma 32% Squamous 29% Large cell 9% Carcinoid 5% NSCLC Staging NCCN.org v2.2010 Survival by stage Clinical Pathological J Thorac Oncol. 2007;2: 706–714 Initial workup • Abnormal CXR Workup • • • • • • CT chest PET/CT Bronch PFT MRI brain Cardiac stress PET/CT Bronchoscopy Lymph node sampling • Mediastinoscopy – Access to 2/4/7 • Chamberlain – Access to 5/6 • VATS • EBUS • Resection – Which resection? – Enough lung? • Spirometry FEV 1 and DLCO (diffusing capacity) V/Q Sleeve resection • Possible complications? Residual Tumor After Resecion • R0 - No residual (No identifiable tumor remaining; negative surgical margins) • R1 - Microscopic residual (Microscopically positive margins but no visible tumor remaining) • R2 - Gross residual (Gross (visible or palpable) tumor remaining) SCLC • Prognosis — The most important prognostic factor in patients with SCLC is the extent of disease (stage) at presentation. For patients with limited stage disease, median survivals range from 15 to 20 months, and the reported five-year survival rate is 10 to 13 percent. In contrast, for patients with extended stage disease, the median survival is 8 to 13 months, and the five-year survival rate is 1 to 2 percent. Specific targeted therapies are widely used for patients with two molecular subsets of NSCLC • ●Activating mutations in the epidermal growth factor receptor (EGFR) define a subset of patients with adenocarcinoma that more frequently affect patients who are never smokers, women, and/or of Asian ethnicity. These patients are generally highly responsive to EGFR tyrosine kinase inhibitors (erlotinib, gefitinib, afatinib) and have a significantly better prognosis than those without EGFR mutations. • ●The presence of the EML4-ALK fusion oncogene defines another NSCLC subset that is more frequent in nonsmokers or former smokers and occurs at a younger age. These patients are highly responsive to crizotinib, an inhibitor of the anaplastic lymphoma kinase (ALK). Final Review • Evaluate stage • ? Resection candidate • ? Neoadjuvant therapy • Surgery