Surgical Intervention

Malaysia
Search
Sign In

Oncology

Oncology

Home News Diseases Conferences Special Reports Multimedia

LUNG CANCER

Lung cancer is having a malignant tumor in the lungs especially in the cells lining air passages.
Primary tumor-related signs and symptoms are cough, dyspnea, hemoptysis, and chest discomfort.
Signs and symptoms due to intrathoracic spread may involve the nerves (hoarseness, dyspnea, muscle wasting of upper limb, Horner's syndrome), chest wall and pleura (chest pain, dyspnea) and vascular structures (facial swelling, dilated neck veins, cardiac tamponade) & viscera (dsyphagia).
The signs and symptoms due to metastatic spread are bone pain with or without pleuritic pain, neurologic symptoms, limb weakness, unsteady gait, cervical lymphadenopathy, and skin nodules.

Treatment

Surgery for Non-Small Cell Lung Cancer (NSCLC)

Resectability of tumor should be fully assessed
May offer the best chance of survival & possible cure in non-small cell lung cancer (NSCLC) patients with Stage I-II disease
- May be considered in patients with N2 disease responsive to induction chemotherapy
Surgery is recommended for patients with the following:
- ≥8 mm solid nodule on LDCT screening that has high probability of cancer as shown on PET/CT scan
- ≥8 mm solid nodule that increased in size in chest CT &/or PET/CT scan with high probability for cancer
- ≥15 mm solid nodule with the same measurements in LDCT after 6 months or in PET/CT scan with high probability for cancer
- ≥6 mm part solid nodule with ≥8 mm solid component in follow-up LDCT with high probability for cancer in PET/CT scan
- New or growing part solid nodule with ≥4 mm solid component in LDCT with high probability for cancer in chest CT scan with or without contrast &/or PET/CT scan
- New or growing NS nodule ≥20 mm in size during follow-up or annual LDCT
Treatment of choice for stage I & II non-small cell lung cancer (NSCLC)
- In the absence of medical contraindications to surgery, complete resection (ie lobectomy) with clear surgical margins should be achieved as much as possible
- In patients with comorbidities who are not able to tolerate lobectomy (eg patients with impaired pulmonary function), sublobar resection (segmentectomy or wedge resection) is recommended
- Nodal dissection is preferred over simple intraoperative sampling for mediastinal lymph node
- Sleeve lobectomy is recommended for total resection of centrally or locally advanced non-small cell lung cancer (NSCLC)
- Segmental or wedge resection is recommended for patients with impaired pulmonary function

Surgery in stage IIIA N2 lung cancer is controversial
- Surgery is considered in resectable stage IIIA N0-1 tumors, followed by adjuvant chemotherapy
- Usually not recommended if with involvement of N2; patient may undergo chemotherapy prior to surgery to decrease the tumor size, eliminate micrometastases & to improve patient’s tolerance to procedure

Video-assisted thoracic surgery (VATS) is a less invasive & reasonable approach for patients with no anatomic or surgical contraindication
For highly selected patients with recurrent NSCLC, stereotactic radiation surgery & surgical resection of isolated cerebral metastasis are recommended

Surgery for Small Cell Lung Cancer (SCLC)

Considered only for patients with clinical stage I-IIA & in limited disease (LD) patients with sufficient pulmonary function & no evidence of metastases to mediastinal or supraclavicular lymph nodes
- Patients with clinical stage in excess of T1-2, N0 do not benefit from surgery

Lobectomy or pneumonectomy should be done followed by detailed dissection of the mediastinal lymph nodes
Platinum-based adjuvant chemotherapy is recommended after complete resection

Asia's trusted medical magazine for healthcare professionals. Get your MIMS Oncology - Malaysia digital copy today!

GnRHa safe, improves fertility in breast cancer patients

Natalia Reoutova, 21 Nov 2019

Final analysis of the POEMS (Prevention of Early Menopause) study finds that breast cancer (BC) patients treated with the gonadotrophin-releasing hormone agonist (GnRHa) goserelin, in addition to chemotherapy, are more likely to avoid premature menopause and to become pregnant without negatively impacting disease-related outcomes.

Ultrasound-guided core biopsy foretells treatment outcome in breast cancer

Jairia Dela Cruz, 4 days ago

In breast cancer, especially hormone-negative tumours, an ultrasound-guided core biopsy (CNB) is useful for predicting pathologic complete response (pCR) to chemotherapy and may thus help to avoid surgery for some patients, a study has found.

Icotinib improves PFS and ORR in Chinese NSCLC patients with brain metastases

Christina Lau, 08 Dec 2016

Icotinib improves progression-free survival (PFS) and objective response rate (ORR) vs whole-brain irradiation (WBI) plus chemotherapy in Chinese patients with non-small-cell lung cancer (NSCLC) and brain metastases, according to a phase III study presented recently at the 17th World Conference on Lung Cancer (WCLC).