Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map
Self-Assessment Questions


Answer 4
  1. Stage IIIB. Lung cancers are classified as either non–small cell or small cell carcinomas. The majority (80%) of tumors in the lung are non–small cell carcinomas.13 This patient has squamous cell carcinoma classified as a NSCLC. NSCLC and SCLC are staged and treated differently, largely because SCLCs are aggressive tumors that have metastasized at the time of diagnosis, and they also tend to respond well to chemotherapy. While surgical intervention (ie, resection) in combination with chemo- and radiotherapy is more common in early stages of NSCLC, chemo- and radiotherapy are the treatments of choice for SCLC. For a patient with NSCLC, lymph node involvement other than ipsilateral bronchopulmonary or hilar nodes (N1 lesions) excludes stages IIA and IIB.13 Involvement of the contralateral hilar or mediastinal lymph nodes, ipsilateral or contralateral scalene, or supraclavicular lymph nodes excludes classification in stage IIIA.13 Additionally, this patient presented with newly diagnosed malignant pleural effusions, which characterizes this patient’s disease as stage IIIB. Stage IV represents metastasis to other organs of the body, which is not present in this case. This patient’s advanced NSCLC stage IIIB was unresponsive to initial chemotherapy. If this patient’s functional status is good and he has minimal comorbidities, he may be a candidate for other agents. However, his prognosis is extremely poor.14

    13. Greene FL, Page DL, Fleming ID, et al, editors. AJCC cancer staging manual. 6th ed. New York: Springer-Verlag; 2002.

    14. Spira A, Ettinger DS. Multidisciplinary management of lung cancer. N Engl J Med 2004;350:379–92.

Click here to return to the questions


Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 2/27/09 • nvf