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Cancer Genetics

Adenocarcinomas in the Lung

09/30/1999

Question:

A male, age 49 has been diagnosed with adenocarcinomas; the primary internal source has been identified as the left lung. There is a tumor on the left shoulder and the left hip; both are in the bone. He also has a bloodclot behind the left knee and is being treated for this - a shot every twelve hours. He is taking radiation for the tumors on the shoulder and hip. Without seeing actual scans can you tell me what stage this cancer is at and what the prognosis and/or survival rate is for him.

Answer:

In 1985, the American Joint Committee on Cancer agreed to a worldwide staging system for lung cancer. Staging is determined by the size and characteristics of the primary tumor (T), the amount and type of lymph node involvement (N), and the absence or presence of metastatic disease (M). The TNM staging system then is used to determine a numerical stage.

Regardless of tumor or lymph node characteristics, the presence of any metastatic disease automatically places an individual in a Stage IV category.

In the individual described in your question, bony metastases are present in the shoulder and hip. He is, therefore, in Stage IV.

The prognosis for individuals with early stage lung cancer (I, II, and some III) is primarily determined by the size of the tumor and the presence or absence of lymph node spread. The type of cancer as seen under the microscope may also make a difference. The prognosis for individuals with advanced stage lung cancer (some III and all IV) is difficult to accurately predict from the TNM staging. Very few individuals with advanced lung cancer have survived 5 years after the diagnosis is made. The most important factors are stage, ability to perform physical tasks, and weight loss.

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Response by:

Judith A Westman, MD Judith A Westman, MD
Associate Professor, Clinical Internal Medicine, Pediatrics and Medical Biochemistry
College of Medicine
The Ohio State University