| Non-small cell lung carcinoma | |
|---|---|
| Classification and external resources | |
| MedlinePlus | 007194 |
| eMedicine | med/1333 |
| MeSH | D002289 |
Non-small cell lung carcinoma (NSCLC) is any type of lung cancer other than small cell carcinoma (SCLC). As a class, NSCLCs are relatively insensitive to chemotherapy, compared to small cell carcinoma.
The most common types of NSCLC are squamous cell carcinoma, large cell carcinoma, and adenocarcinoma, but there are many other types that occur less frequently.[1] Sometimes the phrase non-small cell lung cancer is used, and carcinoid is included in this category.[1]
Contents |
Staging
Staging is an important part of the assessment of patients with non-small cell lung carcinoma. These patients undergo staging as part of the process of considering prognosis and treatment. The American Joint Committee on Cancer (AJCC) recommends TNM staging followed by further grouping.
TNM staging
The first part of the staging classification is the TNM system.
Primary tumour (T)
- TX: The primary tumour cannot be assessed, or there are malignant cells in the sputum or bronchoalveolar lavage but not seen on imaging or bronchoscopy.
- Tis: Carcinoma in situ.
- T0: No evidence of primary tumour.
- T1: Tumour less than 3 cm in its greatest dimension, surrounded by lung or visceral pleura and without bronchoscopic invasion into the main bronchus.
- T2: A tumour with any of: -
- More than 3 cm in greatest dimension.
- Extending into the main bronchus, but more than 2 cm distal to the carina.
- Obstructive pneumonitis, but not involving the entire lung.
- T3: A tumour with any of: -
- Invasion of the chest wall, diaphragm, mediastinal pleura, or parietal pericardium.
- Extending into the main bronchus, within 2 cm of the carina, but not involving the carina.
- Obstructive pneumonitis of the entire lung.
- T4: A tumour with any of: -
- Invasion of the mediastinum, heart, great vessels, trachea, oesophagus, vertebra, or carina.
- Separate tumour nodules in the same lobe.
- Malignant pleural effusion.
- )
Lymph nodes (N)
- NX: Lymph nodes cannot be assessed.
- N0: No lymph nodes involved.
- N1: Metastasis to ipsilateral peribronchial or ipsilateral hilar lymph nodes.
- N2: Metastasis to ipsilateral mediastinal or subcarinal lymph nodes.
- N3: Metastasis to any of: -
- Ipsilateral supraclavicular lymph nodes.
- Ipsilateral scalene lymph nodes.
- Contralateral lymph nodes.
Distant metastasis (M)
- MX: Distant metastasis cannot be assessed.
- M0: No distant metastasis.
- M1: Distant metastasis is present.
Mountain classification
Clifton Mountain, a surgeon in Texas, assigned further categories of staging on the basis of similarities in treatment and prognosis.[2]
| Grouping | TNM staging |
|---|---|
| Occult carcinoma | TX N0 M0 |
| Stage 0 | Tis N0 M0 |
| Stage IA | T1 N0 M0 |
| Stage IB | T2 N0 M0 |
| Stage IIA | T1 N1 M0 |
| Stage IIB | T2 N1 M0 |
| T3 N0 M0 | |
| Stage IIIA | T1 N2 M0 |
| T2 N2 M0 | |
| T3 N1 M0 | |
| T3 N2 M0 | |
| Stage IIIB | Any T N3 M0 |
| T4 Any N M0 | |
| Stage IV | Any T Any N M1 |
A recent study proposed changes for the new stage grouping were to upstage T2bN0M0 from stage IB to stage IIA, and to downstage T2aN1M0 from stage IIB to stage IIA and T4N0-N1M0 from stage IIIB to stage IIIA. [3]
Prognosis
| Grouping | Survival rate (percent) | ||||
|---|---|---|---|---|---|
| One year | Two years | Three years | Four years | Five years | |
| IA | 82% | 79% | 71% | 67% | 61% |
| IB | 72% | 54% | 46% | 41% | 38% |
| IIA | 79% | 49% | 38% | 34% | 34% |
| IIB | 59% | 41% | 33% | 26% | 24% |
| IIIA | 50% | 25% | 18% | 14% | 13% |
| IIIB | 34% | 13% | 7% | 6% | 5% |
| IV | 19% | 6% | 2% | 2% | 1% |
Treatment
More than one kind of treatment is often used, depending on the stage of the cancer, the individual's overall health, age, response to chemotherapy, and other factors such as the likely side effects of the treatment.
Treatment may include surgery if diagnosed at an early stage, often with adjuvant (ancillary) chemotherapy involving cisplatin. Other treatment choices are chemotherapy, radiation therapy (radiotherapy),[5] including radiosurgery (SRS), or targeted therapy. As a class, NSCLCs are relatively insensitive to chemotherapy.[6] A wide variety of chemotherapies are used in advanced (metastatic) NSCLC. [7] Some patients with particular mutations in the EGFR gene respond to EGFR tyrosine kinase inhibitors such as gefitinib.[8]
New methods of giving radiation treatment allow doctors to be more accurate in treating lung cancers. This means less radiation affects nearby healthy tissues. New methods being tried are Gamma knife, Cyberknife and Stereotactic linear accelerators.[9] Other new treatments being used are Radiofrequency ablation[10] and Chemoembolization.[11]
References
- ^ a b "Non-small cell lung cancer treatment - National Cancer Institute". http://www.cancer.gov/CANCERTOPICS/PDQ/TREATMENT/NON-SMALL-CELL-LUNG/PATIENT. Retrieved 2008-10-19.
- ^ Mountain, Clifton F; Herman I Libshitz, Kay E Hermes. A Handbook for Staging, Imaging, and Lymph Node Classification. Charles P Young Company. http://www.ctsnet.org/book/mountain/index.html.
- ^ Rami-Porta R, Crowley JJ, Goldstraw P (February 2009). "The Revised TNM Staging System for Lung Cancer". Ann Thorac Cardiovasc Surg 15 (1): 4–9. PMID 19262443. http://www.atcs.jp/pdf/2009_15_1/4.pdf.
- ^ Mountain, CF (1997). "Revisions in the international system for staging lung cancer". Chest (American College of Chest Physicians) 111: 1710–1717. http://www.chestjournal.org/cgi/reprint/111/6/1710.
- ^ Macmillan - radiotherapy
- ^ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease. St. Louis, Mo: Elsevier Saunders. p. 759. ISBN 0-7216-0187-1.
- ^ http://www.lungcanceronline.org/treatment-nsclc/chemo.html Lung Cancer online
- ^ http://theoncologist.alphamedpress.org/cgi/content/full/10/suppl_2/23?&RESULTFORMAT=&fulltext=Kris&resourcetype=HWCIT "How Today’s Developments in the Treatment of Non-Small Cell Lung Cancer Will Change Tomorrow’s Standards of Care" The Oncologist. 2005
- ^ Gamma Knife, CyberKnife and Stereotactic linear accelerators
- ^ Radiofrequency Ablation (RFA) of Lung Tumors
- ^ Cancer Research UK - Chemoembolisation
External links
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