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
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