The Eighth Edition Lung Cancer Stage Classification Frank C Detterbeck CHEST 2017 1511193203 P urpose E xtent of disease Assist in treatment decision Prognostic indicator Compare cohort measure outcome ID: 1038302
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1. TNM staging system for lung cancer
2. The Eighth Edition Lung Cancer Stage ClassificationFrank C. DetterbeckCHEST (2017); 151(1):193-203
3. PurposeExtent of diseaseAssist in treatment decisionPrognostic indicatorCompare cohort, measure outcome
4. Lung cancer-features-treatment-outcome(80-85%)Non small cellAdenoSquamouslarge cell(15-20%)Small cell, Neuroendocrine tumourfaster growth, more central/mediastinal, earlier distant mets, shorter survivalClinical limitedClinical extensive
5. Tumor N M Extent of primary tumour (how big is it?)01234567cmT1T2T3T4abcab
6. Tumor N M Extent of primary tumour 01234567cmT1T2T3T4abcabSurrounded by:-lung-visceral pleura-not involving main bronchus
7. Tumor N M Extent of primary tumour 01234567cmT1T2T3T4abcabSurrounded by:-lung-visceral pleura-not involving main bronchusInvolvement of:-main bronchus without carina regardless of distance from carina-atelectasis/post obstructive pneumonitis extending to hilum T2 Centr-visceral pleura T2 Visc Pl
8. Tumor N M Extent of primary tumour 01234567cmT1T2T3T4abcabSurrounded by:-lung-visceral pleura-not involving main bronchusInvolvement of:-main bronchus without carina regardless of distance from carina-atelectasis/post obstructive pneumonitis extending to hilum T2 Centr-visceral pleura T2 Visc PlAny size tumour invading:-chest wall-pericardium-phrenic nerve T3 Inv-satellite nodule in the same lobe T3 Satell
9. Tumor N M Extent of primary tumour 01234567cmT1T2T3T4abcabSurrounded by:-lung-visceral pleura-not involving main bronchusInvolvement of:-main bronchus without carina regardless of distance from carina-atelectasis/post obstructive pneumonitis extending to hilum T2 Centr-visceral pleura T2 Visc PlAny size tumour invading:-chest wall-pericardium-phrenic nerve T3 Inv-satellite nodule in the same lobe T3 SatellAny size tumour invading:-mediastinum-diaphragm-heart-great vessel-recurrent laryngeal nerve-carina-trachea-oesophagus-spine/vertebral bodies T4 Inv-tumour nodule/seperate tumour in different lobe of ipsilateral lung T4 Ipsi Nod
10. T Node M Lymph node involvement (mets to which nodes?)
11. T Node M Lymph node involvementN0 No regional node metastasesN1 ipsilateral pulmonary and/or hilar nodesN2 ipsilateral mediastinal and/or subcarinal nodesN3 contralateral mediastinal, contralateral hilar or any supraclavicular and scalene nodes
12. IASLC Lymph node mapRusch V, Asamura H, Watanabe H, et al. The IASLC Lung CancerStaging Project: a proposal for a new international lymph node mapin the forthcoming 7th edition of the TNM classification for lungcancer. J Thorac Oncol. 2009;4(5):568-577
13. Tumour right lungT Node M
14. Tumour left lungT Node M
15. T N Metastastic disease M0 no distant metastasesM1 distant metastases:M1a malignant pleural/pericardial effusion/nodules contralateral or bilateral pulmonary nodulesM1b single extrathoracic metastasesM1c multiple extrathoracic metastases either in a single organ or multiple organ
16. 2.5cm right lower lobe mass ipsilateral hilar nodes no distant metastases. What stage of disease does this patient have?
17. 2.5cm right lower lobe mass ipsilateral hilar nodes no distant metastases. What stage of disease does this patient have? T1c N1 M0
18. 66 year old female presented to GP with chest pain. She smokes 10 cigarettes daily since her teenage years giving an average of 25 pack years. She denies haemoptysis and tells you that her weight loss is intentional due to a combination of good diet and exercise. She is currently working as a cleaner in a clothing factory. A chest radiograph showed right side opacity and subsequent CT imaging confirmed 2.5cm spiculated right lower lobe mass extending to chest wall. There was pathological enlargement of ipsilateral hilar nodes but no distant metastases. CT guided biopsy confirmed lung adenocarcinoma. What stage of disease does this patient have?T1c N1 M0T1c N2 M0T2a N1 M0T3 N1 M0T4 N2 M0
19. 66 year old female presented to GP with chest pain. She smokes 10 cigarettes daily since her teenage years giving an average of 25 pack years. She denies haemoptysis and tells you that her weight loss is intentional due to a combination of good diet and exercise. She is currently working as a cleaner in a clothing factory. A chest radiograph showed right side opacity and subsequent CT imaging confirmed 2.5cm spiculated right lower lobe mass extending to chest wall. There was pathological enlargement of ipsilateral hilar nodes but no distant metastases. CT guided biopsy confirmed lung adenocarcinoma.What stage of disease does this patient have?T1c N1 M0T1c N2 M0T2a N1 M0T3 N1 M0T4 N2 M0N1: ipsilateral hilar, peribronchial and or intrapulmonary nodeT2a: visceral pleura
20. Lung cancer stage group1
21. Lung cancer stage group1StageMedian survival time (m)Overall survival (%)24 months60 monthsIA1-9792IA2-9483IA3-9077IB-8768IIA-7960IIB667253IIIA29.35536IIIB194426IIIC12.62413IVA11.52310IVB61001. Goldstraw. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (8th) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2016; 11:39
22. 5cm mass RLLmalignant nodule RULbilateral enlarged hilar lymph nodestaging?II BIII AIII BIII CIV A
23. 5cm mass RLLmalignant nodule RULbilateral enlarged hilar lymph nodestaging?II BIII AIII BIII CIV AT4-ipsilateral noduleBil hilar- N3No mets=T4N3M0
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25. Regardless of cancer stageStop smoking interventionNicotine replacementvareniclineCurative surgeryECOG PSFEV1, TLCOShuttle walk test, CPEX
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35. 66 year old female recently diagnosed adenocarcinoma of the lung. Staging is T2N1M0 tumour of the right upper lobe confirmed on PET CT. Patient is otherwise fit and well ECOG PS of 1Which of the following would be the most appropriate initial choice of treatment for this patient?ChemotherapyLobectomyPneumonectomyRadiotherapyWedge resection
36. 66 year old female recently diagnosed adenocarcinoma of the lung. Staging is T2N1M0 tumour of the right upper lobe confirmed on PET CT. Patient is otherwise fit and well ECOG PS of 1Which of the following would be the most appropriate initial choice of treatment for this patient?ChemotherapyLobectomyPneumonectomyRadiotherapyWedge resectionNSCLCCurative intent-lobectomyLung sparing (wedge)Complete resection can be achievedSmall tumoursBorderline fitness levels
37. EGFR-TK mutationALK gene rearrangementPDL1>50%ROS1 positiveNo gene mutation or fusion protein or PD-L1<50%Afatinib, erlotinibCeritinib, alectinibPemrolizumab, gemcitabinecrizotinib
38. 48 year old man attends clinic. He is receiving treatment with crizotinib. What is the mechanism of action for this drug?Checkpoint inhibitorK-RAS inhibitorMonoclonal antibodyPDL-1 inhibitorTyrosine kinase inhibitor
39. 48 year old man attends clinic. He is receiving treatment with crizotinib. What is the mechanism of action for this drug?Checkpoint inhibitorK-RAS inhibitorMonoclonal antibodyPDL-1 inhibitorTyrosine kinase inhibitor