A few words about lung cancer

Monday, September 22nd, 2014 No Commented
Categorized Under: Cancer

This border-zone subset of stage IIIA patients, which lies between the generally resectable stage I and II tumors and unresectable stage IIIB patients, has been the subject of a wide variety of clinical trials incorporating various combinations of chemotherapy, radiotherapy, and surgery. Unfortunately, most published studies have significant limitations since they are not randomized, lack rigorous pretreatment staging, or involve a significant lack of homogeneity in the study population, making interpretation of the results difficult. There are a few more rigorous randomized trials, which will be discussed subsequently, that suggest a combined modality approach may be beneficial in stage IIIA disease. The approach showing the greatest promise in selected patients employs initial treatment (induction or neoadjuvant therapy) with chemotherapy or chemoradiotherapy followed by surgery. Nevertheless, more widespread use of induction therapy followed by surgery for lung cancer has been used for only 7 years, and as a result there is little reliable data with larger patient groups. This lack of meaningful, larger, randomized data underscores the importance of enrolling patients in clinical trials whenever possible. Canadian health care mall shop

Since staging and treatment are so very interdependent, intraoperative staging with systematic mediastinal node sampling or dissection is critically important. Unless histologic conformation of mediastinal node status is obtained at the time of surgery, postoperative pathologic staging will be inaccurate, as will further treatment recommendations and the discussion of prognosis. Therefore, the standard of care in modern thoracic surgery dictates that mediastinal node sampling or dissection must be performed at the time of every lung resection for lung cancer.

Under the 1997 revised lung cancer staging system,1 stage IIIA encompasses all tumors with ipsilateral mediastinal lymph node metastases (T1–3, N2). Also included in this stage are tumors with resectable chest wall involvement and hilar node metastases (T3N1), added primarily because of similar survival rates. However, the treatment recommendations and applicable clinical trials for T3N1 are the same as for stage II. Therefore, for the purposes of these current guidelines, T3N1 tumors are discussed in the preceding chapter on stage II tumors. The present chapter will deal only with N2 disease.