lung cancer: a surgeon’s perspective
DESCRIPTION
Matthew Kilmurry, M.D. St. Mary’s General Hospital Grand River Hospital. Lung Cancer: A Surgeon’s Perspective. I have no conflicts of interest. The problem. 2003 numbers for Ontario 7500 new cases 6300 deaths Only 25% of cases are surgically resectable - PowerPoint PPT PresentationTRANSCRIPT
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Matthew Kilmurry, M.D.
St. Mary’s General Hospital
Grand River Hospital
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I have no conflicts of interest
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The problem
2003 numbers for Ontario7500 new cases6300 deaths
Only 25% of cases are surgically resectable
Breast cancer in 2007 was 8000 new cases and 2000 deaths
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Causes
Smoking Radon exposure Asbestos exposure Second hand smoke Genetics
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Types of Lung Cancer
Primary Secondary
Colonic metsOther primaries
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Resection of pulmonary mets Several prognostic factors
Disease free intervalNumber of metsResectability
30% long term survival Do not assume it is a met
Old study suggests 73% of pulmonary nodules in patients with previous cancer will be new primary
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Primary lung cancer
Small cell Non small cell
Accounts for 75-80 % of primary lung tumors
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Screening
No accepted screening methodStudies using CT, CXR and sputum
High index of suspicionsmokers
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Staging
Stage I: no lymph node involvement Stage II: lymph nodes involved or tumor
invading into chest wall Stage III: mediastinal nodal involvement
or bad tumour factors Stage IV: metastatic disease
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Nodal stations
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Surgical Approach
Diagnosis: Is this cancer? Metastases: Is there spread? Suitability: Is the patient healthy enough
for surgery?
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Diagnosis
History and physical Chest X-ray CT scan Percutaneous biopsy Bronchoscopy
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Metastases
History and physical Upper abdominal imaging Bone scan and CT head PET scan Mediastinoscopy
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Nodal stations
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Suitability
History and physical PFT’s Cardiac investigations
2D echoStress testNuclear medicine
CPET Quantitative V/Q scan
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Treatment
Stage I and II are generally offered surgery with stage II getting post op chemo
Some stage III can be offered surgery – usually after chemoradiotherapy
Rare stage IV patients can be offered surgerySolitary brain mets
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Treatment
Lobectomy preferred approachLimited resection has higher recurrence and
worse long term suvival
Stage survival, 5 yearsStage I – 60-70%Stage II – 40-50%Stage III – 15-25%Stage IV – 0-10%
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Case # 1
65 year old male previous smoking history
Chest X-ray done as part of annual health exam
CT confirmed mass in LULSmall lesion also noted in RUL
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Case # 1
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Case # 1
Bronchoscopy and mediastinoscopy showed no evidence of mets
Thoracotomy confirmed diagnosis and had lobectomy
Right upper lobe nodule unchanged over two years
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Case # 2
68 year old woman had pneumonia like symptoms which led to chest X-ray
Smoker of 1 pack per day for 45 years
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Case # 2
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Case # 2
CT chest showed large tumour with no evidence of mets
Biopsy shows NSCLC PET scan shows no evidence of
metastatic disease
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Case # 2
Mediastinoscopy showed metastatic disease in lymph nodes
Referred for chemoradiotherapy Possible candidate for surgery
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Palliation
Majority of work with chemo and radiotherapy
Pain and symptom management vital Surgery sometimes required
Pleural effusionsEndobronchial tumours
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Thoracic DAU
Run through Grand River Cancer Center Multidisciplinary clinic with respirologists
and thoracic surgeons Referrals accepted through GRCC
Main criteria is newly abnormal chest X-ray
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Thoracic Program
Combined thoracic surgery at St. Mary’s General Hospital
CCO pushing to eliminate low volume thoracic centers
Working to keep thoracic surgery in Kitchener-Waterloo
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Conclusions
Lung cancer is a major health concern in Ontario
Surgery offers best chance for cure in resectable cases
Multidisciplinary care required and available in our region