staging - DM SEMINAR STAGING PROCEDURES FOR LUNG CANCER...

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DM SEMINAR MARCH 11, 2005 STAGING PROCEDURES FOR LUNG CANCER NAVNEET SINGH DEPARTMENT OF PULMONARY MEDICINE
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SCOPE • INTRODUCTION • NON-INVASIVE PROCEDURES • INVASIVE PROCEDURES • PRIORITIZATION OF PROCEDURES • PROBLEM SOLVING
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INTRODUCTION Steps in W/U of Suspected Lung Cancer I Risk factors + Clinical evaluation + CT – Presumptive diagnosis – Presumptive cell type (SCLC vs NSCLC) – Presumptive stage II – Confirmation of diagnosis + Stage III Treatment – Surgery/RT/CT/Multimodality therapy Detterbeck,Chest 2003; 123:167S–175
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SURGERY CT EARLY ADVANCED RT
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INTRODUCTION • Staging is the process of assessment of presence & extent of local spread of tumor to adjacent structures (pleura, chest wall, pericardium & blood vessels) as well as • Accurate staging is important b implications – Choosing most appropriate therapy – Prediction of survival
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INTRODUCTION • T issue Dx of mediastinal lesions difficult by nonsurgical methods (well protected by bony covering of thorax & surrounding lungs) • M.f cancer involving mediastinum is NSCLC • Use of traditional pre-op staging methods b – 10% of surgeries b explorative thoracotomy but NO Tumour Resection (advanced mediastinal disease not detected pre-op) – 25–35% of apparently curative resections unsuccessful due to early post-op recurrence
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INTRODUCTION • Surgery futile & unnecessary in up to 45% of operated pts of NSCLC because stage more advanced than expected pre-op • Recent advances in technology in both imaging and endoscopic techniques b greater accuracy in staging lung cancer • Confusion regarding indications and timing for each of these staging studies
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PROBLEMS • 59/M presented with 3 cm nodule in Lt lingular lobe on CT Chest b Bx poorly differentiated NSCLC. CT Abd b 2x4cm soft tissue mass adjacent to Lt adrenal suspicious for mets. Dx b Stage IV NSCLC • 68/M ex-smoker presented with h/o lethargy b CT chest b Rt paratracheal & subcarinal LNE - no primary mass lesion apparent. Stage? (Primary?) • 45/M presented with hemoptysis. CT b 4x3 cm mass in LUL with mediastinal LNE. FOB Growth LUL > 2 cm from carina – Sq CLC LUL. Dx b T 2 N 2 M 0 Stage IIIA NSCLC
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NON-INVASIVE
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CT • CT used to stage pts with lung cancer since its introduction in the early seventies. • CT ( CXR) b imp info on localization, size & extent of tumor + locoregional/distal spread • State-of-the-art spiral & multi-detector CT scanners b detailed 2D/3D images of tumor & its extent esp invasion of fissures, chest wall or mediastinum b decide resectability • Despite improved image quality b many cases with unresolved issues after CT
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CT For Lymph Node • CT incl newer systems have poor specificity in determining LN involvement • Common sign used by CT for predicting LN involvement is enlargement (not very reliable) • Bx confirmation of neoplastic LN involvement
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staging - DM SEMINAR STAGING PROCEDURES FOR LUNG CANCER...

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