A 60 year old male was diagnosed as carcinoma right lung. On CECT chest there was a tumor of 5x5 cm in upper lobe and another 2x2 cm size tumor nodule in middle lobe. The primary modality of treatment is :
Answer is C (surgery): The baffling aspect of the question is that it does not mention whether it is a small cell carcinoma or a non small cell carcinoma as this histological distinction is the bases of the primary modality of treatment. Non small cell carcinomas Small cell carcinomas For non small cell carcinomas the primary modality depends on the extent of disease * Localized diseases: (Stage 1 & H) * * Small cell lung carcinomas behave as systemic disease. Most small cell carcinomas have already spread at the time of presentation beyond the bounds of surgery and they are managed primarily by chemotherapy with or without radiotherapy. Primary modality of treatment is surgery -- pulmonary resection. * Advanced disease: Radiotherapy with curative intent is advocated (+- chemotherapy) * Metastatic disease (Stage IV) symptomatic/suppoive If we were to go by the information available in the question, The maximum tumor size (T) is = 5 cm ( 3), i.e. T2 There is no nodal involvement (No) There is no distal metastases (Mo) Thus it is T2 No Mo disease or stage I disease The treatment of choice for stage I disease is surgery i.e. Pulmonary resection The tumor in question has no nodal involvement and no metastases and hence is likely to be a non small cell carcinoma. Fuher, according to oxford textbook of surgery 2"d/2480 "Recent data suggest that staging small cell lung cancer using TNM system employed for non small cell carcinomas may be helpful. For patients with stage I disease surgical resection and postoperative adjuvant chemotherapy provides a better prognoses than non surgical therapy". Thus within the limits of information provided the primary modality of treatment here should be surgery. 5 Year Survival Rate, % Stage TNM Descriptors Clinical Stage Surgical Pathologic Stage IA T1 NO MO 61 67 IB T2 NO MO 38 57 IIA T1 NI MO 34 55 IIB T2 NI MO 24 39 IIB T3 NO MO 22 38 ILIA T3 NI MO 9 25 T1-2-3 N2 MO 13 23 IIIB T4 NO-1-2 MO 7 <5 T1-2-3-4 N3 MO 3 <3 IV Any T any N Ml I <I Tumor (T) status descriptor TO No evidence of a primary tumor TX Primary tumor cannot be assesed, or tumor proven by the presence of malignant cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy. TIS Carcinoma is situ T1 Tumor > 3 cm in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than lobar bronchus (i.e. not in main bronchus) T2 Tumor with any of following: > 3 cm in greatest dimension: inolves main bronchus, >= 2 cm distal to the carina: invades visceral pleura; associated with atelectasis or obstructive pneumonitis extending to hilum but does not involve entire lung. T3 Tumor of any size that directly invades any of the following: chest wall (including superior sulcus tumors), diaphragm, mediastinal pleura, parietal pericardium; or tumor in main bronchus < 2 cm distal to carina but without involvement of carina; or associated atelectasis or obstructive pneumonitis of entire lung. T4 Tumor of any size that invades any of the following: mediastinum, hea, great vessels, trachea, esophagus, veebral body, carina or tumor with a malignant pleural or paericardial effusion, or with satellite tumor nodule(s) within the ipsilateral primary-tumor lobe of the lung. Lymph node (N) involvement of descriptor NX Regional lymph nodes cannot be assessed NO No regional lymph node metastasis N1 Metastasis to ipsilateral peribronchial and/or ipsilateral hilar lymph nodes, and intrapulmonary nodes involved by direct extension of the primary tumor. N2 Metastasis to ipsilateral mediatinal. contralateral lymph node(s) N3 Metastasis to contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s) Distant metastasis (M) descriptor MX Presence of distant metastasis cannot be assessed MO No distant metastasis M 1 distant metastasis present
Radiotherapy
Chemotherapy
Surgery
Suppoive treatment