GRACE :: Lung Cancer


Lung cancer staging

Denise Brock

Lung Cancer Video Library – Spanish Language: Video #13 Lung Cancer Stages

GRACE Cancer Video Library - Lung


For our 13th video in the GRACE Spanish Lung Cancer Library, Dr. Brian Hunis, Medical Director, Head and Neck Cancer Program, Memorial Cancer Institute, Miami, Florida, joined GRACE to discuss the basics of Lung Cancer for Spanish-speaking patients and caregivers, in this video Dr. Hunis talks about lung cancer stages. 






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TRANSCRIPTS – Spanish and English
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Las Etapas en el Cáncer de Pulmón

La clasificación en el cancer de pulmón está basada en el sistema TMN, T de tamaño o tumor, N de nódulos linfáticos y M de metástasis por si el tumor se ha ido a otras partes que no sea el pulmón.

El estadio I es el estadio inicial y más temprano, en donde el tumor está localizado en una sola parte pulmón y por lo general es tratado con cirugía o con un tipo específico de radioterapia y es con fines curativos.

Es estadio II es cuando ese tumor ha crecido significativamente y se ha expandido o evolucionado a ganglio linfático de la zona cercana al pulmón. Con lo cual todavía se puede operar, pero esos pacientes van a tener que recibir tratamiento después de la cirugía con quimioterapia y a veces hasta con radioterapia.

El estadio III son tumores que ya han llegado al mediastino, en la zona entremedia de los pulmones, en donde están los grandes vasos del corazón y por lo general esos son tumores que no pueden ser operados con fines curativos.

El estadio IV es cuando el cancer se ha regado o expandido a otras partes del cuerpo, como en cerebro, hígado, hueso o en las glándulas suprarrenales.

En cuando al cáncer de pulmón de células no pequeñas, hay otro tipo de división en donde también se puede usar el sistema TNM, pero también se usa el sistema llamado el cáncer de pulmón de células no pequeñas de estadio extensivo o limitado

El estadio limitado está localizado al pulmón y al mediastino y el estadio extensivo es cuando el cancer de pulmón se ha extendido a otras partes del cuerpo.

Lung Cancer Stages

The classification in lung cancer is based on the system TMN, T of tumor, N of lymph nodes and M of metastasis in case the tumor has expanded to other parts that are not the lung.

In stage I, which is the first stage, the tumor is localized in a single part of the lung and in general is treated with surgery or with a special type of radiotherapy with healing purposes.

The stage II is when the tumor has grown and has expanded or evolved to a lymph node close to the lung. In this cases, we can still remove it surgically, but they have to receive treatment after the surgery with chemotherapy or sometimes even with radiotherapy.

In stage III, the tumors have gone to the mediastinum, the middle part of the lungs where the great vessels are. In general, these tumors cannot be surgically removed with healing purposes.

The stage IV is when cancer has expanded to other parts of the body like the brain, live, bone or the adrenal glands.

In the non-small cell lung cancer there is another method to divide them, we can also use the TNM system, but there is the non-small cell lung cancer system divided in extensive or limited.

The limited stage is when it is located in the lung or mediastinum and the extensive stage is when the lung cancer has expanded to other parts of the body.

Introduction to Small Cell Lung Cancer: Prevalence, Initial Symptoms, Work-Up, and Staging


General Introduction to Small Cell Lung Cancer

Lung cancer consists of two major types: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Approximately 85% percent of all lung cancer patients have NSCLC, and the remaining 15% have SCLC.

histology-breakdown-of-lung-cancer (click on image to enlarge)

In 2010, the American Cancer Society has estimated that approximately 222,000 new cases of lung cancer will be diagnosed, of which 35,000 will have SCLC. Even though both subtypes are lung cancers, they are considered as separate diseases in most ways, and the management of these two cancers is different. It is important to recognize that the treatments applicable for NSCLC, including many newer agents that have been approved and are the subject of increasing research and media attention, are not clearly relevant for patients with SCLC.

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Dr West

Dr. Gerard Silvestri, Pulmonologist, on Lung Cancer Workup and Staging


This is the first of the presentations by guest speakers at our NSCLC Patient Education Forum back in September. Dr. Gerard Silvestri is a pulmonologist, a lung disease specialist (not only cancer), and he is also one of the most important leaders in lung cancer within the field of pulmonology, as both a writer of some very important work and as a great speaker.

His talk was a general introduction to the process of the workup and approach to staging a lung cancer. Below you’ll find the links to audio and video versions of his presentation, the figures, and the transcript for his talk.

Silvestri Lung Cancer Workup and Staging Audio



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Clinical versus Pathologic Staging of Non-Small Cell Lung Cancer


When oncologists and surgeons talk about staging, we often distinguish between clinical and pathologic staging. Many in the health care field don’t understand or know the difference. Even more, why do we “stage” a cancer (NOT the patient!) at all? These are important questions, because they tell those of us involved in the treatment and care of such patients what is the extent of the disease, what the prognosis might be, and what the treatment plan should entail. That way, the caregivers are all “on the same page”.

It is quite important to know that staging is done, by tradition, ONLY at the discovery of the disease and a tissue diagnosis (by biopsy) obtained, and before the start of treatment. When and if there is a recurrence of the cancer, we do not give the cancer a new stage. It is then just that, a recurrence. Thus, the term “re-staging” is really a misnomer; the process would be better termed a “re-evaluation”. Another common misconception in staging and diagnosis among patients is related to the spread of the cancer from one organ to another: if a lung cancer has spread to the bone or liver, it’s still one process. It isn’t called a bone or liver cancer, but rather, it is lung cancer metastatic to those places.

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Dr West

PET/CT Scans in Staging to Reduce “Futile Thoracotomies”


Over the lasat decade, PET scans have become commonplace in the staging of NSCLC. There’s an older post that reviews the concept of PET scans in providing metabolic imaging, as well as a podcast that provides a more complete discussion of PET scanning in oncology, with a focus on lung cancer.

A recent paper in the New England Journal of Medicine highlights the main benefit seen with PET scans for lung cancer staging. This particular paper looked at the newer combination PET/CT scans that have become very common and largely replaced separate PET scanners in many parts of the world. PET/CT scanners now allow us to see the superimposed images that provide very good detail of the shape and size of internal parts of the body (the CT portion) along with the metabolic uptake of these areas (the PET portion).

This study was conducted in Denmark and randomized 189 patients in the process of staging for possible resectable NSCLC to either conventional staging with CT-based imaging and mediastinoscopy (required) or the same treatment with a PET/CT scan. They were looking for a significant difference in the frequency of “futile thoracotomies”, so basically trying to see if PET scans cut the frequency of people undergoing a major lung surgery for no benefit. Their definition of this was rather liberal, since it included not only patients who had higher stage disease than they intended to pursue surgery on (stage IIIA with N2 nodes, stage IIIB, or stage IV), those with an unsuspected benign cause, an exploratory surgery (which I imagine would have been to determine what the cause of the lesion was), or someone who had a recurrence within a year of their surgery. This last point is a controversial one, because we might think after the surgery that a person undergoing surgery should have gotten it if their staging after surgery wasn’t too high — but if they recurred very quickly, it’s clear that these patients didn’t benefit.

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