Episode Details

How do we think about treatment of lung cancer?

Recap on staging (see Episode 025)

* Pro-tip: Highly recommend that you “forget” about the actual staging and focus more on the individual T, N, and M status 

* Tumor size:

**T1a <1 cm 

**T1b <2 cm 

**T1c <3 cm 

**T2a <4 cm 

**T2b <5 cm 

**T3 5-7 cm

**T4 cm 

*Nodal status:

**Double digit nodes = hilar or intrapulmonary (peripheral) = N1

**Single digit nodes = mediastinal (central ) = N2

**Contralateral nodes or supraclavicular = N3

*Sites of metastatic disease

Approach to treatment in a stepwise approach: 

*Goal: Whenever feasible, we want to consider getting the patient to surgery to remove the cancer. 

*Surgery or no surgery?

**How do we decide if someone is appropriate for surgery: 

***Do they want surgery?

***Do they have the pulmonary reserve if they were to get surgery ?

***Do they have the cardiac reserve to withstand surgery?

***Is the tumor size too big? (Usually >7cm)

***Is the tumor invading other structures?

****If invading other structures, surgery may not be possible; highly consider tumor board discussion

***Mediastinal lymph node involvement?

****Central lymph node involvement usually requires definitive chemotherapy + radiation (not surgery up-front)

***Supraclavicular lymph node or contralateral lymph node?

****This would be treated with chemotherapy and radiation

Speaking of surgery, what are the options for types of surgeries for lung cancer?

*Sub-lobar:

**Wedge (smallest resection)

**Segmentecomy - ideally we want to do at least a segmentectomy

*Lobar resection:

**Lobectomy

**Pneumonectomy

What if a patient’s tumor is amenable to surgery, but the patient’s underlying co-morbid conditions preclude him from getting a surgical intervention? 

*This is where we consider using radiation for treatment, specifically Stereotactic body radiation therapy (SBRT)

Characteristics of surgical report?

*The “R” status is if there is residual tumor after the surgery. This is a combination of evaluation by a pathologist AND by gross inspection by the surgeon

**R0: No evidence of disease

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