Lung Cancer: Non-Small Cell Lung Cancer PDF

Lung Cancer: Non-Small Cell Lung Cancer Dr. Van Den Berg Associate Professor Objectives Define risk factors for developing lung cancer Describe the common signs and symptoms of lung cancer. Recognize the diagnostic procedures involved in lung cancer Describe the oncogenes present in various lung can...

Lung Cancer: Non-Small Cell Lung Cancer Dr. Van Den Berg Associate Professor Objectives Define risk factors for developing lung cancer Describe the common signs and symptoms of lung cancer. Recognize the diagnostic procedures involved in lung cancer Describe the oncogenes present in various lung cancers and how they are used for molecularly targeted therapy. Distinguish between the staging for small cell and non-small cell lung cancer 2 Lung Cancer https://www.cancer.org/cancer/types/lung-cancer/detection-diagnosis-staging/staging-nsclc.html 3 Lung Cancer in the U.S. Incidence/Death (2024 estimate) New cases 234,580 new cases of lung cancer (116,310 in men and 118,270 in women) Deaths 125,070 (No. 1 for cancer deaths) Age: median age 70 5-year survival 28% for NSCLC (2012-2018) For a man, the lifetime is about 1 in 15; for a woman, the risk is about 1 in 17 4 Cell Type & Histology of Lung Cancer National Comprehensive Cancer Network 5 NSCLC is Highly Heterogeneous (With Different Driver Mutations) 6 Developmental Risk Factors Smoking/Tobacco Use Second-hand smoke Genetic factors Radon Lung Cancer National Comprehensive Cancer Network (NCCN) Lung. 4.2014 Occupational exposure 7 Signs and Symptoms Non-specific Localized symptoms Fatigue Weight loss Generalized pain Paraneoplastic syndrome (Small cell lung cancer) Cough Dyspnea Hoarseness Pleural effusion Hemoptysis SVC obstruction Pain (chest/shoulder) Cushing’s Syndrome-ectopic ACTH production Clubbing Anemia SIADH Hypercalcemia SIADH=syndrome of inappropriate antidiuretic hormone SVC=Superior Vena Cava 8 Diagnostic Work-up Chest X-ray/CT scan Head (if symptomatic) Endoscopic or ultrasound With biopsy (pathology) Genetic Drivers PFT’s Sputum cytology Bone scan Bone marrow biopsy ECG Chemistry/CBC/UA PFT=pulmonary function test; ECG= echocardiogram; CBC= complete blood count National Comprehensive Cancer Network,2016 9 Lung Cancer Staging: SCLC Limited Stage* Extensive Stage* Limited to one lung Spread to other organs Brain Tissues between lungs Nearby lymph nodes Tumor Liver Adrenal Bone *=Veteran’s Administration Lung Group 2-stage Classification NCCN: SCLC.1.2016 10 Lung Cancer Staging: NSCLC Stage Stage IA Stage IB Stage IIA Stage IIB Stage IIIA Stage IIIB Tumor Size Nodal Involvement Metastasis T1 N0 M0 T2 N0 M0 T1 N1 M0 T2 T3 N1 N0 M0 T1-2 T3 T4 N2 N1-2 N0-1 M0 T4 Any T N2-3 N3 M0 Any T Any N M1 Stage IV NCCN: NSCLC.1.2016 11 MANAGEMENT OF NON-SMALL CELL LUNG CANCER 12 Goals of Therapy Early Stage (I and II) Cure ~ 5-year survival roughly 60% Advanced Stage (III and IV) Surgical resection Subset of advanced disease Convert inoperable to operable Symptom relief/palliation Pain Pulmonary obstruction Extend life 13 Treatment According to Stage NCCN: NSCLC.1.2016 14 MANAGEMENT OF METASTATIC NSCLC EGFR Inhibitor EGFR: positive EGFR Status* Chemotherapy/ EGFR: negative Adenocarcinoma Large Cell NOS ALK: positive Metastatic Immuotherapy ALK Inhibitor ALK Status* Chemotherapy/ ALK: negative Immunotherapy Squamous Cell Chemotherapy/ Immunotherapy 15 Questions 16