Surgery for BAC: Special Considerations

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While there is a lot of variability in the clinical behavior of bronchioloalveolar carcinoma (BAC), there are some commonly observed findings that are now leading lung cancer experts to consider it as a distinct clinical entity worthy of special consideration for management. Among the important areas for potentially special clinical management is in surgical management of early stage disease.

Limited Resection vs. Radiation for Marginal Patients with Early Stage NSCLC

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The standard of care for at least stage I and II NSCLC is surgery, sometimes followed by chemotherapy. We know, however, that not every patient who presents with early stage NSCLC is healthy enough to pursue surgery, whether due to general age-related or other illnesses, or due specifically to a low pulmonary reserves, usually from years of smoking.

Lung Cancer Special Case: Intro to Pancoast Tumors

Article

One subtype of lung cancer that we haven’t specifically talked about is called a Pancoast tumor, named for the doctor who first described them. A Pancoast tumor is a NSCLC that is located in a groove called the superior sulcus (Pancoast tumors are also sometimes referred to as superior sulcus tumors), at the top (or apex) of each of the lungs. Here's the appearance of one on a chest x-ray:

Imaging Factors Predictive of Higher or Lower Risk for Recurrence of Early Stage NSCLC

Article

Among the many variables that can potentially be helpful in predicting outcomes after surgery are some imaging results. One of these is cavitation, or hollowing out of the inside of some part of the tumor. Although most clinicians think of this as a feature of squamous cancers, it can also be seen with adenocarcinomas and other histologies less frequently.

Beyond Stage & Tumor Size: More Pathology Variables Associated with Risk of Recurrence after Surgery

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The decision about pursuing post-operative treatment is often difficult and requires carefully weighing the risks of treatment with potentially challenging and even dangerous chemotherapy against the potential to eradicate micrometastases and actually lead some people to be cured who otherwise wouldn't be. It's important to remember that some people are already cured, while others won't be cured even with treatment.

Tumor Size as a Critical Factor in Weighing Value of Adjuvant Chemo

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While there are good reasons to not pursue chemo after surgery for stage I NSCLC, there are several factors that argue at least for strong consideration of adjuvant chemotherapy for higher risk patients. Because stage IB generally has a less favorable prognosis than stage IA, it's not suprising that the debate about which patients should or should not be receiving post-op chemo has centered more on the stage IB population, which have much more commonly been included in trials testing the value of adjuvant chemotherapy.

The Case Against Post-Operative Chemotherapy for Stage I NSCLC

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Over the last several years, chemo for resected early stage NSCLC has become a standard of care, but while it's pretty widely accepted for stage II and IIIA patients after surgery, the role for chemo is much more debatable for stage I patients. I'll try to explain why, starting with the downside, and then turn to some of the reasons to consider it.

What are the Predictors for "Upstaging" Apparent Stage I NSCLC?

Article

Staging in lung cancer, as well has two categories, clinical and pathologic. The clinical staging is based on what appears on scans like the CT and PET scan that are now pretty routine parts of the staging workup. Our scans are better than ever before, but some lymph nodes with cancer involvement are not enlarged and have no visible abnormalities, and no scan can pick up lesions that are only visible as a small collection of cancer cells under a microscope.