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Oncology


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

    REFERENCES
    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.

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