Non small cell lung cancer medical therapy stage IV: Difference between revisions
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{{familytree | | | B01 | | | | | | B02 | B01=M1a|B02=M1b: solitary site systemic [[metastasis]]}} | {{familytree | | | B01 | | | | | | B02 | B01=M1a|B02=M1b: solitary site systemic [[metastasis]]}} | ||
{{familytree | | | |!| | | | | | | |!| | | |}} | {{familytree | | | |!| | | | | | | |!| | | |}} | ||
{{familytree | | | C01 | | | | | | C02 | | | C01=<div style="float: left; text-align: left; width: | {{familytree | | | C01 | | | | | | C02 | | | C01=<div style="float: left; text-align: left; width: 10em; padding:1em;">Perform the following tests:<br> | ||
* Perform [[thoracentesis]] and/or [[pericardiocenteis]]<br> | * Perform [[thoracentesis]] and/or [[pericardiocenteis]]<br> | ||
* Perform a [[thoracoscopy]] if [[thoracocentesis]] is inconclusive | * Perform a [[thoracoscopy]] if [[thoracocentesis]] is inconclusive | ||
</div>|C02=<div style="float: left; text-align: left; width: | </div>|C02=<div style="float: left; text-align: left; width: 10em; padding:1em;">Perform the following tests:<br> | ||
* [[Brain tumor MRI|Brain MRI]]<br> | * [[Brain tumor MRI|Brain MRI]]<br> | ||
* [[Bronchoscopy]]<br> | * [[Bronchoscopy]]<br> | ||
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{{familytree | E01 | | E02 | | E03 | | E04 | | | E01=Yes|E02=No|E03=[[Adrenal]]|E04=[[Brain]]}} | {{familytree | E01 | | E02 | | E03 | | E04 | | | E01=Yes|E02=No|E03=[[Adrenal]]|E04=[[Brain]]}} | ||
{{familytree | |!| | | |!| | | |!| | | |!| | |}} | {{familytree | |!| | | |!| | | |!| | | |!| | |}} | ||
{{familytree | F01 | | F02 | | F03 | | F04 | | F01=<div style="float: left; text-align: left; width: | {{familytree | F01 | | F02 | | F03 | | F04 | | F01=<div style="float: left; text-align: left; width: 10em; padding:1em;">Local therapy<br> | ||
* Ambulatory catheter drainage<br> | * Ambulatory catheter drainage<br> | ||
* [[Pleurodesis]]<br> | * [[Pleurodesis]]<br> | ||
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PLUS<br> | PLUS<br> | ||
Pathologic evaluation of surgical piece and [[lymph nodes]]</div>}} | Pathologic evaluation of surgical piece and [[lymph nodes]]</div>}} | ||
{{familytree | | | | | | | | | |!| | | |! | {{familytree | | | | | | | | | |!| | | |!| | | |}} | ||
{{familytree | | | | | | | | | G01 | | G02 | {{familytree | | | | | | | | | G01 | | G02 | | | G01=<div style="float: left; text-align: left; width: 10em; padding:1em;">If the [[lung]] disease is curable, administer local therapy for the [[adrenal]] lesion:<br> | ||
* Surgical [[adrenal]] resection<br>OR<br> | * Surgical [[adrenal]] resection<br>OR<br> | ||
* Radiation therapy<br> | * Radiation therapy<br> | ||
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</div>|G02=What is the TN stage of the lung [[tumor]]?}} | </div>|G02=What is the TN stage of the lung [[tumor]]?}} | ||
{{familytree | | | | | | | | | | | |,|-|^|-|.| | |}} | {{familytree | | | | | | | | | | | |,|-|^|-|.| | |}} | ||
{{familytree | | | | | | | | | | | H01 | | H02 | {{familytree | | | | | | | | | | | H01 | | H02 | | H01=<div style="float: left; text-align: left; width: 10em; padding:1em;"> | ||
* T1-2, No-1<br> | * T1-2, No-1<br> | ||
* T3, N0 | * T3, N0 | ||
</div>|H02=<div style="float: left; text-align: left; width: | </div>|H02=<div style="float: left; text-align: left; width: 10em; padding:1em;"> | ||
* T1-2, N2<br> | * T1-2, N2<br> | ||
* T3, N1-2<br> | * T3, N1-2<br> | ||
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* T4 regardless of the N stage</div>}} | * T4 regardless of the N stage</div>}} | ||
{{familytree | | | | | | | | | | | |!| | | |!| | | | | | |}} | {{familytree | | | | | | | | | | | |!| | | |!| | | | | | |}} | ||
{{familytree | | | | | | | | | | | I01 | | I02 | | | | I01=<div style="float: left; text-align: left; width: | {{familytree | | | | | | | | | | | I01 | | I02 | | | | I01=<div style="float: left; text-align: left; width: 10em; padding:1em;"> | ||
* Surgical resection of lung [[tumor]] + adjuvant chemotherapy<br>OR<br> | * Surgical resection of lung [[tumor]] + adjuvant chemotherapy<br>OR<br> | ||
* Neoadjuvant chemotherapy + surgical resection or stereotactic ablative radiation therapy<br>OR<br> | * Neoadjuvant chemotherapy + surgical resection or stereotactic ablative radiation therapy<br>OR<br> | ||
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|I02=<div style="float: left; text-align: left; width: 14em; padding:1em;">Administer therapy for metastatic disease in case of not curable lung lesions (click here for the treatment of local and systemic metastasis and neoplastic recurrence)</div>}} | |I02=<div style="float: left; text-align: left; width: 14em; padding:1em;">Administer therapy for metastatic disease in case of not curable lung lesions (click here for the treatment of local and systemic metastasis and neoplastic recurrence)</div>}} | ||
{{familytree/end}} | {{familytree/end}} | ||
==References== | |||
{{reflist|2}} | |||
Revision as of 14:58, 24 June 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alonso Alvarado, M.D. [2]
Overview
Medical Therapy for Stage IV Non-Small Cell Lung Cancer
Is pleural or pericardial effusion present (suggestive of M1a) or are findings suggestive of systemic metastasis (M1b) present? | |||||||||||||||||||||||||||||||||||||||||||||
M1a | M1b: solitary site systemic metastasis | ||||||||||||||||||||||||||||||||||||||||||||
Perform the following tests:
| Perform the following tests:
| ||||||||||||||||||||||||||||||||||||||||||||
Is the liquid extracted positive for malignant cells? | Are findings suggestive of adrenal metastasis or brain metastasis? | ||||||||||||||||||||||||||||||||||||||||||||
Yes | No | Adrenal | Brain | ||||||||||||||||||||||||||||||||||||||||||
Local therapy
PLUS | Perform a needle aspiration biopsy for metastasis confirmation | Surgical resection + adjuvant radiation therapy Radiation therapy alone:
PLUS | |||||||||||||||||||||||||||||||||||||||||||
What is the TN stage of the lung tumor? | |||||||||||||||||||||||||||||||||||||||||||||
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| Administer therapy for metastatic disease in case of not curable lung lesions (click here for the treatment of local and systemic metastasis and neoplastic recurrence) | ||||||||||||||||||||||||||||||||||||||||||||