DR Medhat MRCP

Non-small cell carcinoma :
Squamous cell carcinoma
Typically central mass ,may cavitates.
Associated with ectopic PTH
secretion→ hypercalcemia (15%)
Strongly associated with finger
clubbing.
Hypertrophic pulmonary
osteoarthropathy (HPOA)
Adenocarcinoma
Typically located at lung periphery
It`s the commonest type of lung
cancer among non-smokers (although
the majority of patients who develops
lung adenocarcinoma are smokers)
• Management of non-small cell lung cancer
A) When to start TTT ? :
TTT should be started within 31 days of diagnosis & within 62 days from urgent referral.
B) Lines of TTT :
Operable cases (only 20% )→ Surgery (lobectomy or pneumonectomy)
- Stage I : (T1N0M0), (T2NOM0)
- Stage II : (T1N1M0), (T2N1M0) ,(T3N0M0).
- Stage IIIa : (T3N1M0),(T3,N2M0)→ Surgery + Chemotherapy.
- If unfit or patient refuse→ Radical radiotherapy (= continuous hyperfractionated
accelerated radiotherapy,CHART)→ C.I : tumor > 4cm or FEV1 < 50%.
Un-operable cases→ Radiotherapy.
- Stage IIIb : (T4N2M0) , (any T + N3 M0).
- Stage IV : (any T ,any N with metastasis).
C) Assessment of fitness for treatment :
Peri-operative mortality : using thoracoscore.
N.B : non-small lung cancer has
poor response to chemotherapy
Cardiovascular assessment :
- Avoid surgery within 30 days of MI.
- Do revascularization before surgery in stable angina.
- Maximum anti-ischemic TTT in peri-operative period
- If ≤ 2 risk factors + good cardiac function → do the surgery.
- If active cardiac problem , risk factors ≥ 3 with poor cardiac function → refer to
cardiologist.
Pulmonary assessment :
- If estimated post operative FEV1 < 40 % of predicted & DLCO > 40 % of
predicted with O2 sat. > 90 % in RA → average risk.
- If estimated post operative FEV1 < 40 % of predicted & DLCO < 40% of
predicted → high risk patient → for more restrictions or non-surgical TTT.