Lung Cancer Staging Explained Clearly by | Part 2

Lung Cancer Staging Explained Clearly by | Part 2

okay well welcome to another MedCram
lecture at med cram comm don’t forget to join us at med cram comm for all of the
free lectures okay so let’s talk about staging remember what we said again we
said that there was a T staging there was an N staging and an M staging and we
did the T 181 B all the way that c4 and what their criteria was and we did the
end staging and all of their criteria now you’ll notice here that we’ve got
stage Roman numeral one and twos and threes and they have A’s and B’s the way
I like to remember this if you’re trying to generate this on a test to remember
it we’re just on a piece of paper is that
stage one eight is the first stage and you’re going to go in to kind of a
mnemonic here two boxes for the first one stage 2a of course is the next one
and you’re going to go in three boxes one two and three and then finally stage
3a is the fifth one and you’re going to go in five boxes one two three four five
everything from there simply just goes up by one so for instance one a go up to
one a and then one a and then after that it just goes up incrementally 1 B 2 a 2
B 3 a the next one is going to go in three boxes that’s – a – a – a and then
from there it just goes up incremental e 2 B 3 a but instead of doing 3 B this
one is 3 a so that’s one that you have to remember now the next one up goes up
incrementally so one A two A three a goes in five boxes so 3 a 3 a 3 a 3 a 3
a and then the last one is just 3 B and then the last one is the easiest to
remember because they’re just all three B’s now if you notice each of these
stages has a different even though there’s a 1 a and a 1 B they are treated
differently so let’s take a look here this is all of the ones and they’re in
one area and then here are the twos all right and
then the rest are all the threes in this box anyway now why do I do that it’s
because they each have a different prognosis now finally the last one of
course is the M number which gives you a stage four so depending on whether or
not you have a stage 1 stage 2 stage 3 or a stage 4 there’s good to be
different treatments for these ok so if you have a stage one cancer the
treatment is going to be surgery and if you’re not operable then the treatment
is radiation therapy so surgery is to cure this ok the next thing that we do
for stage 2 is again we still do surgery but in surgery we do something called
adjuvant chemotherapy so adjuvant chemotherapy is the type of chemotherapy
that we do after surgery surgery first chemotherapy second something called
neoadjuvant chemotherapy is not really ready for primetime yet it’s where you
do chemotherapy before surgery that’s not what we’re saying here in stage 2
we’re saying you do surgery first then you do adjuvant chemotherapy stage 3 is
concurrent radiation and chemotherapy so stage 3 you do chemotherapy and
radiation therapy at the same time and stage 4
it’s just chemotherapy plus targeted therapy now if you don’t know what I’m
talking about when I say targeted therapy look at the lecture on cell
cycle because as the cell is going into the different phases for instance the S
phase or the M phase that synthesis of DNA and mitosis respectively
there are tyrosine kinase in hitter’s which can prevent the cell from
going into those stages and those are things that you should look at these are
things that are indicated in stage 4 lung cancer so in terms of the stages we
have different T stages and stages M stages we put it all together and we get
the overall stage and it’s the overall stage that determines what the treatment
is going to be now in terms of prognosis there is different ways of looking at
this there’s something called the clinical staging and there’s something
called the pathological staging let me explain a little bit what I’m talking
about so if we’re doing a clinical staging that means we’ve got a patient
with an x-ray or a CT scan and I can very simply read off on the CT or x-ray
what’s the size of the tumor whether or not there’s collapsing this is all a
clinical staging when I go to the lymph nodes I can see whether or not there are
lymph nodes that are active on the ipsilateral hilar side or the
contralateral hilar side or the mediastinal side and I can come up with
a clinical end stage also I can see whether or not the patient has a pleural
effusion so when I look at the patient clinically without doing biopsies I can
come up with something called the clinical stage now because cancer cells
are extremely small and they’re not always picked up typically the clinical
stage is lower than the pathological stage what is the pathological stage the
pathological stage is when I actually go in and I start taking biopsies of lymph
nodes it’s at that time that I might find a cell or two here or there of
cancer which would mean let’s say a clinical stage would be maybe a 2a but
once I actually get in there because I find that it’s not just hilar lymph node
involvement but there is some sub coronal involvement it’ll bump it from a
2 a 2 a 3 a so because of that when we look at clinical stages they have
typically for any specific stage they have a worse prognosis
than a pathological stage let me give you an example a stage 1a has a clinical
five-year survival of about 50% and that why is that why is it low at 50% it’s
because well a lot of these clinical 1 days are really two ways or maybe even
two B’s or something like that okay but if I have a pathologically
proven stage 1a that means these are real people with one A’s and their lymph
nodes are really negative well the five-year survival actually goes up from
50 percent to 73 percent so let me give you what those are so I’m
gonna write the clinical stages in yellow so for a stage 1a the clinical is
50% for a one B it is 47% for a 2 a 36% you can see that these are actually
going down for A to B it’s 26% for a 3 a 19% five-year survival for a 3 B 7
percent survival and for a stage 4 unfortunately is a 2 percent five-year
survival so now I’m going to go through and write in a light blue
what is the pathological survival so 1a is actually a 73% survival a 1 B is a
58% survival a 2a is a 46% survival to be 36 percent survival a 3 a 24%
survival a 3 B 9% survival and finally a stage 4 is actually a 13% survival so
we’ve talked about staging in terms of the T values the N values and the M
values and how to come up with actual Roman numeral combined staging
based on the Roman numeral combined staging that will tell you whether or
not you will get surgery or radiation therapy if you cannot go through surgery
and what we’re looking at there is how much lung will be left over
Stage two will give you surgery and something called adjuvant chemotherapy
so they take whatever they need to take out and give you chemotherapy afterwards
stage three is going to be chemotherapy and radiation at the same time and Stage
four is chemotherapy and targeted cellular agents so make note here that
the only stage for radiation therapy when you’re not doing it because you
can’t have surgery is stage three so whenever you see surgery if you cannot
do surgery you can always substitute it for radiotherapy or radiation therapy
well thanks for joining us and join us at med cram comm for more lectures and
things explained clearly you

9 Replies to “Lung Cancer Staging Explained Clearly by | Part 2”

  1. Sir you are gifted Your way of simplification is outstanding My you please make a video about cardiac and vascular function curves

  2. Cancer staging was developed in the 1940's and needs to be revised or replaced. The fact that different cancers can be set at the same stage but have such a large variation in 5 yr survival rate shows it is not particularly useful.

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