View source for Adenocarcinoma of the lung medical therapy metastatic cancer

__NOTOC__
{{Adenocarcinoma of the lung}}
{{CMG}}; {{AE}} {{SC}}

==Local or Regional Recurrence==
* The algorithm bellow shows the approach for a local or regional recurrence of a non small cell lung cancers are based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.<ref name=nccn>Lung cancer. National Comprehensive Cancer Network 2015. http://www.nccn.org/professionals/default.aspx</ref>

{{familytree/start}}
{{familytree | | | | | | | | | A01 | | | | | | | | | | A01=What is the site of the recurrence?}}
{{familytree | |,|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|.| | |}}
{{familytree | B01 | | B02 | | B03 | | B04 | | B05 | | | B01=[[Bronchus|Bronchial]] obstruction|B02=Mediastinal [[lymph node]]|B03=[[Superior vena cava]] obstruction|B04=Severe [[hemoptysis]]|B05=Resectable [[tumor]]}}
{{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |}}
{{familytree | C01 | | C02 | | C03 | | C04 | | C05 | | C01=Surgical correction of the obstruction: laser therapy, stent or any other surgical procedure<br>OR<br>[[Non small cell carcinoma of the lung radiation therapy|Radiation therapy]] (external-beam or brachytherapy)<br>OR<br>Photodynamic therapy|C02=Has the patient received [[radiation therapy]]?|C03=[[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus radiation therapy|Chemotherapy + radiation therapy]]<br>OR<br>External-beam [[Non small cell carcinoma of the lung radiation therapy|radiation therapy]]<br>OR<br>[[Superior vena cava]] stent collocation|C04=Surgery<br>OR<br>[[Non small cell carcinoma of the lung radiation therapy|Radiation therapy]] (external-beam or brachytherapy)<br>OR<br>Laser therapy, photodynamic therapy or [[tumor]] [[embolization]]|C05=[[Tumor]] resection (preferred option)<br>OR<br>[[Non small cell carcinoma of the lung radiation therapy|Radiation therapy]] ([[Non small cell carcinoma of the lung radiation therapy#Stereotactic Ablative Radiotherapy Usual Dosage|stereotactic ablative radiation therapy]] or external-beam [[Non small cell carcinoma of the lung radiation therapy|radiation therapy]])}}
{{familytree | |!| |,|-|^|-|.| |!| | | |!| | | |!| | | |}}
{{familytree | |!| D01 | | D02 |!| | | |!| | | |!| | | D01=Yes|D02=No}}
{{familytree | |!| |!| | | |!| |!| | | |!| | | |!| | | |}}
{{familytree | |!| E01 | | E02 |!| | | |!| | | |!| | | | E01=Administer systemic therapy ([[Non small cell carcinoma of the lung medical therapy metastatic cancer#Medical Therapy for Metastatic Non Small Cell Lung Cancer|Click here for the treatment of metastatic disease]])|E02=Administer [[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus radiation therapy|chemotherapy + radiation therapy]]}}
{{familytree | |`|-|^|-|-|-|^|-|+|-|-|-|^|-|-|-|'| | | |}}
{{familytree | | | | | | | | | F01 | | | | | | | | | | | F01=Are findings suggestive of disseminated disease present?}}
{{familytree | | | | | | |,|-|-|^|-|-|.| | | | |}}
{{familytree | | | | | | G01 | | | | G02 | | | | | G01=Yes|G02=No}}
{{familytree | | | | | | |!| | | | | |!| | | | | |}}
{{familytree | | | | | | H01 | | | | H02 | | | | | H01=[[Non small cell carcinoma of the lung medical therapy metastatic cancer#Medical Therapy for Metastatic Non Small Cell Lung Cancer|Click here for the treatment of metastatic disease]]|H02=Observation<br>OR<br>[[Non small cell carcinoma of the lung medical therapy metastatic cancer#Medical Therapy for Metastatic Non Small Cell Lung Cancer|Click here for the treatment of metastatic disease]]}}
{{familytree/end}}
<br>

==Systemic Metastasis==
* The algorithm bellow shows the approach for systemic metastasis of a non small cell lung cancers are based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.<ref name=nccn>Lung cancer. National Comprehensive Cancer Network 2015. http://www.nccn.org/professionals/default.aspx</ref>

{{familytree/start}}
{{familytree | | | | | | | | | A01 | | | | | | | | | | A01=What are the characteristics of the [[metastasis]]?}}
{{familytree | |,|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|.| | |}}
{{familytree | B01 | | B02 | | B03 | | B04 | | B05 | | | B01=Diffuse [[brain]] metastasis|B02=[[Bone]] metastasis|B03=Localized symptoms||B04=Solitary [[metastasis]]|B05=Multiple [[metastasis]]}}
{{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |}}
{{familytree | C01 | | C02 | | C03 | | C04 | | C05 | | C01=External-beam [[Non small cell carcinoma of the lung radiation therapy#Palliative Radiation Therapy Regimens|radiation therapy]] (palliative)|C02=External-beam [[Non small cell carcinoma of the lung radiation therapy#Palliative Radiation Therapy Regimens|radiation therapy]] (palliative) + limb stabilization (prevention of pathological fractures)<br>Denosumab or biophosphonate therapy should be considered|C03=External-beam[[Non small cell carcinoma of the lung radiation therapy#Palliative Radiation Therapy Regimens|radiation therapy]](palliative)|C04=[[Non small cell carcinoma of the lung medical therapy stage IV|Click here for the treatment of stage IV M1b (solitary site metastasis]])|C05=[[Non small cell carcinoma of the lung medical therapy metastatic cancer#Medical Therapy for Metastatic Non Small Cell Lung Cancer|Click here for the treatment of metastatic disease]]}}
{{familytree | |`|-|-|-|+|-|-|-|'| | | | | | |}}
{{familytree | | | | | D01 | | | | | | | | | | D01=[[Non small cell carcinoma of the lung medical therapy metastatic cancer#Medical Therapy for Metastatic Non Small Cell Lung Cancer|Click here for the treatment of metastatic disease]]}}
{{familytree/end}}

==Medical Therapy for Metastatic Non Small Cell Lung Cancer==
* The algorithms for the treatment of metastatic non small cell carcinoma of the lung are based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.<ref name=nccn>Lung cancer. National Comprehensive Cancer Network 2015. http://www.nccn.org/professionals/default.aspx</ref>

{{familytree/start}}
{{familytree | | | | | | | | | | A01 | | | | | A01=What the specific subtype according to the specific histological characteristics of the [[tumor]]?}}
{{familytree | | | | | |,|-|-|-|-|^|-|-|-|-|.| | | |}}
{{familytree | | | | | B01 | | | | | | | | B02 | | | B01=<div style="float: left; text-align: left; width: 14em; padding:1em;">
* [[Adenocarcinoma]]<br>
* [[Large cell carcinoma of the lung]]<br>
* Not specified non-small cell lung cancer</div>|B02=Squamous cell carcinoma}}
{{familytree | | | | | |!| | | | | | | | | |!| | | }}
{{familytree | | | | | |!| | | | | | | | | C02 | | | C02=Is the patient a smoker or former smoker?}}
{{familytree | | | | | |!| | | | | | | |,|-|^|-|.| | | | |}}
{{familytree | | | | | |!| | | | | | | Y01 | | Y02 | | | | | Y01=Yes|Y02=No}}
{{familytree | | | | | |!| | | | | | | |!| | | |!| | | }}
{{familytree | | | | | Z01 | | | | | | Z02 | | |!| | | | | Z01=Perform specific [[EGFR]] and ALK [[mutation]] testing: What is the specific [[mutation]]?|Z02=Perform specific [[EGFR]] and ALK [[mutation]] testing: Is there a [[mutation]] in any of those genes present?}}
{{familytree | | | | | |!| | | | | |,|-|^|-|.| |!| | | |}}
{{familytree | | | | | |!| | | | | W01 | | W02 |!| | | | W01=Yes|W02=No}}
{{familytree | | | | | |`|-|-|v|-|-|'| | | |`|v|'| | | |}}
{{familytree | | | | |,|-|-|-|+|-|-|-|.| | | |!|}}
{{familytree | | | | D01 | | D02 | | D03 | | D04 | | | | D01=Sensitizing [[EGFR]] mutation|D02=ALK mutation|D03=Negative [[EGFR]] and ALK|D04=[[Non small cell carcinoma of the lung medical therapy metastatic cancer#Metastatic Squamous Cell Carcinoma|Click here for the squamous cell carcinoma specific treatment]]}}
{{familytree | | | | |!| | | |!| | | |!| | | | |}}
{{familytree | | | | E01 | | E02 | | E03 | | | E01=[[Non small cell carcinoma of the lung medical therapy metastatic cancer#Positive Sensitizing EGFR Mutation|Click here for the sensitizing EGFR mutation specific treatment]]|E02=[[Non small cell carcinoma of the lung medical therapy metastatic cancer#Positive ALK Mutation|Click here for the specific therapy for the ALK mutation specific treatment]]|E03=[[Non small cell carcinoma of the lung medical therapy metastatic cancer#Negative EGRF and ALK or Unknown Mutation|Click here for the treatment of negative sensitizing EGFR and ALK mutation metastatic disease]]}}
{{familytree/end}}
<br>

==Metastatic Adenocarcinoma, Large Cell Carcinoma and Not Specified Non-Small Cell Carcinoma==
* The algorithms for the treatment of metastatic adenocarcinoma, large cell carcinoma and not specified non small cell carcinoma of the lung are based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.<ref name=nccn>Lung cancer. National Comprehensive Cancer Network 2015. http://www.nccn.org/professionals/default.aspx</ref>

===Positive Sensitizing EGFR Mutation===
{{familytree/start}}
{{familytree | | | | | | | | | | | | | | | E01 | | | | | | | | |E01=Was the mutation discovered before the initiation of first line therapy?}}
{{familytree | | | | | | | | | | | | |,|-|-|^|-|-|.| | |}}
{{familytree | | | | | | | | | | | | F01 | | | | F02 | | |F01=Yes|F02=No|}}
{{familytree | | | | | | | | | | | | |!| | | | | |!| | | }}
{{familytree | | | | | | | | | | | | G01 | | | | G02 | | |G01=Initiate erlotinib or afatinib|G02=Suspend or complete [[chemotherapy]] and initiate erlotinib or afatinib<br>'''OR'''<br> Add erlotinib or afatinib to chemotherapy regimen|}}
{{familytree | | | | | | | | | | | | |`|-|-|v|-|-|'| | | | |}}
{{familytree | | | | | | | | | | | | | | | H01 | | | | | | | | |H01=Did the [[tumor]] progress or respond?|}}
{{familytree | | | | | | | | | | | | |,|-|-|^|-|-|.| | | | }}
{{familytree | | | | | | | | | | | | I01 | | | | I02 | | | |I01=[[Tumor]] progression|I02=Positive response or stable [[tumor]]}}
{{familytree | | | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | |}}
{{familytree | | | | | | | | J01 | | | | | | J02 | | | | | |J01=Symptomatic disease|J02=Asymptomatic disease}}
{{familytree | | | | |,|-|-|-|^|-|-|-|.| | | |!| | | | | | | |}}
{{familytree | | | | K01 | | | | | | K02 | | K03 | | | | |K01=Systemic [[metastasis]]|K02=Brain [[metastasis]]|K03=Continue treatment}}
{{familytree | | |,|-|^|-|.| | | |,|-|^|-|.| |!| | | | | | | |}}
{{familytree | | L01 | | L02 | | L03 | | L04 |!| | | | |L01=Multiple [[metastasis]]|L02=Single [[metastasis]]|L03=Multiple [[metastasis]]|L04=Single [[metastasis]]}}
{{familytree | | |!| | | |!| | | |!| | | |!| |!| | | | |}}
{{familytree | | M01 | | M02 | | M03 | | M04 |!| | | | |M01=Continue treatment, consider local therapy|M02=Continue treatment, consider [[Non small cell carcinoma of the lung radiation therapy#Palliative Radiation Therapy Regimens|whole brain radiation therapy]]|M03=Continue treatment, consider local therapy|M04=Consider [[Non small cell carcinoma of the lung chemotherapy#Cisplatin Based Therapy|platinum based chemotherapy]] <br>with or without<br> [[Bevacizumab]] <br>AND/OR<br> Erlotinib}}
{{familytree | | |`|-|-|-|^|-|-|-|+|-|-|-|^|-|'| | | |}}
{{familytree | | | | | | | | | | N01 | | | | | | | | N01=If findings suggestive of progression of the disease are present, [[Non small cell carcinoma of the lung medical therapy metastatic cancer#Third Line Therapy|click here for the third line therapy]]}}
{{familytree/end}}
<br>

===Positive ALK Mutation===

{{familytree/start}}
{{familytree | | | | | | | | | | | | | | | A01 | | | | | | | |A01=Was the [[mutation]] discovered before the initiation of first line therapy?}}
{{familytree | | | | | | | | | | | | |,|-|-|^|-|-|.| | | | | | | | | | |}}
{{familytree | | | | | | | | | | | | F03 | | | | F04 | | | | | | | |F03=Yes|F04=No}}
{{familytree | | | | | | | | | | | | |!| | | | | |!| | | |}}
{{familytree | | | | | | | | | | | | G03 | | | | G04 | | | | |G03=Initiate crizotinib|G04=Suspend or complete [[chemotherapy]] and initiate crizotinib|G05=Progression|G06=Positive response or stable tumor}}
{{familytree | | | | | | | | | | | | |`|-|-|v|-|-|'| | | |}}
{{familytree | | | | | | | | | | | | | | | H01 | | | | | | | | |H01=Did the [[tumor]] progress or respond?}}
{{familytree | | | | | | | | | | | | |,|-|-|^|-|-|.| | | | | | | | | |}}
{{familytree | | | | | | | | | | | | I01 | | | | I02 | | | | | | | |I01=[[Tumor]] progression|I02=Positive response or stable [[tumor]]}}
{{familytree | | | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | | | | | |}}
{{familytree | | | | | | | | J01 | | | | | | J02 | | | | | | | | | |J01=Symptomatic disease|J02=Asymptomatic disease}}
{{familytree | | | | |,|-|-|-|^|-|-|-|.| | | |!| | | | | | | | | | | |}}
{{familytree | | | | K01 | | | | | | K02 | | K03 | | | | | | | | |K01=Systemic [[metastasis]]|K02=Brain [[metastasis]]|K03=Continue treatment or change to certinib according to the degree of disease}}
{{familytree | | |,|-|^|-|.| | | |,|-|^|-|.| |!| | | | | | | | | | | |}}
{{familytree | | L01 | | L02 | | L03 | | L04 |!| | | | | | | | |L01=Multiple [[metastasis]]|L02=Single [[metastasis]]|L03=Multiple [[metastasis]]|L04=Single [[metastasis]]}}
{{familytree | | |!| | | |!| | | |!| | | |!| |!| | | | | | | | |}}
{{familytree | | M01 | | M02 | | M03 | | M04 |!| | | | | | | | |M01=Continue treatment, consider local therapy|M02=Continue treatment, consider [[Non small cell carcinoma of the lung radiation therapy#Palliative Radiation Therapy Regimens|whole brain radiation therapy]]|M03=Continue treatment, consider local therapy|M04=Initiate certinib <BR>OR<BR> Consider [[Non small cell carcinoma of the lung chemotherapy#Cisplatin Based Therapy|platinum based chemotherapy]] <br>with or without<br> [[Bevacizumab]] <br>AND/OR<br> Erlotinib}}
{{familytree | | |`|-|-|-|^|-|-|-|+|-|-|-|^|-|'| | | |}}
{{familytree | | | | | | | | | | N01 | | | | | | | | N01=If findings suggestive of progression of the disease are present, [[Non small cell carcinoma of the lung medical therapy metastatic cancer#Third Line Therapy|click here for the third line therapy]]}}
{{familytree/end}}
<br>

===Negative EGRF and ALK or Unknown Mutation===

{{familytree/start}}
{{familytree | | | | | | | | | C02 | | | | | | | |C02=Which is the [[mutation]] present?|C02=What is the performance status (PS) of the patient?}}
{{familytree | | | | | |,|-|-|-|+|-|-|-|.| | | | | |}}
{{familytree | | | | | D03 | | D04 | | D05 | | | | |D03=0-1|D04=2|D05=3-4}}
{{familytree | | | | | |!| | | |!| | | |!| | | | | |}}
{{familytree | | | | | E03 | | E04 | | E05 | | | | | | |E03=Doublet [[chemotherapy]]<BR> OR <BR> [[Bevacizumab]] + [[Non small cell carcinoma of the lung chemotherapy|Chemotherapy]] <BR> OR <BR> [[Cetuximab]]/[[vinorelbine]]/[[cisplatin]]|E04=[[Chemotherapy]]|E05=Supportive care}}
{{familytree | | | | | |`|-|v|-|'| | | | | | | | | | |}}
{{familytree | | | | | | | F05 | | | | | | |F05=What was the [[tumor]] response to the treatment?}}
{{familytree | | | | |,|-|-|^|-|-|-|-|.| |}}
{{familytree | | | | G05 | | | | | | G06 | | | |G05=Progression|G06=Positive response or stable [[tumor]]}}
{{familytree | | | | |!| | | | | | | |!| | | | | |}}
{{familytree | | | | |!| | | | | | | Z01 | | | | | | |Z01=Administer 4-6 cycles and assess progression of the disease}}
{{familytree | | |,|-|^|-|.| | | |,|-|^|-|.| | |}}
{{familytree | | H03 | | H04 | | H05 | | | H06 | | | |H03=PS 0-2|H04=PS 3-4|H05=[[Tumor]] progression|H06=Positive response or stable [[tumor]]}}
{{familytree | | |!| | | |!| | | |!| | | | |!| | | | | |}}
{{familytree | | I05 | | I06 | | I07 | | | I08 | | | | | |I05=Initiate [[docetaxel]] or [[pemetrexed]] or erlotinib or [[gemcitabine]]|I06=Provide supportive care|I07=Initiate [[docetaxel]] or [[pemetrexed]] or erlotinib or [[gemcitabine]]|I08=Continuation maintenance ([[cetuximab]] or [[gemcitabine]]) <br>OR<br> Switch maintenance (erlotinib or [[decetaxel]]) <br>OR<br> Close observation}}
{{familytree | | |!| | | | | | | |!| | | | |!| | | | | | | |}}
{{familytree | | |!| | | | | | | |!| | | | K01 | | | | | |K01=Initiate [[docetaxel]] or [[pemetrexed]] or erlotinib or [[gemcitabine]]}}
{{familytree | | |`|-|-|-|-|-|-|-|+|-|-|-|-|'| | | | |}}
{{familytree | | | | | | | | | | L01 | | | | | | | | | L01=If findings suggestive of progression of the disease are present, [[Non small cell carcinoma of the lung medical therapy metastatic disease#Third Line Therapy|click here for the third line therapy]]}}
{{familytree/end}}
<br>

==Metastatic squamous cell carcinoma==
* The algorithm for the treatment of metastatic squamous cell carcinoma are based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.<ref name=nccn>Lung cancer. National Comprehensive Cancer Network 2015. http://www.nccn.org/professionals/default.aspx</ref>
{{familytree/start}}
{{familytree | | | | | | | | | C02 | | | | | | | |C02=Which is the mutation present?|C02=What is the performance status (PS) of the patient?}}
{{familytree | | | | | |,|-|-|-|+|-|-|-|.| | | | | |}}
{{familytree | | | | | D03 | | D04 | | D05 | | | | |D03=0-1|D04=2|D05=3-4}}
{{familytree | | | | | |!| | | |!| | | |!| | | | | |}}
{{familytree | | | | | E03 | | E04 | | E05 | | | | | | |E03=[[Non small cell carcinoma of the lung chemotherapy#Cisplatin Based Chemotherapy|Cisplatin based chemotherapy]]<BR> OR <BR> [[Cetuximab]]/[[vinorelbine]]/[[cisplatin]]|E04=[[Non small cell carcinoma of the lung chemotherapy|Chemotherapy]]|E05=Suportive care}}
{{familytree | | | | | |`|-|v|-|'| | | | | | | | | | |}}
{{familytree | | | | | | | F05 | | | | | | |F05=What was the [[tumor]] response to the treatment?}}
{{familytree | | | | |,|-|-|^|-|-|-|-|.| |}}
{{familytree | | | | G05 | | | | | | G06 | | | |G05=Progression|G06=Positive response or stable [[tumor]]}}
{{familytree | | | | |!| | | | | | | |!| | | | | |}}
{{familytree | | | | |!| | | | | | | Z01 | | | | | | |Z01=Administer 4-6 cycles and assess progression of the disease}}
{{familytree | | |,|-|^|-|.| | | |,|-|^|-|.| | |}}
{{familytree | | H03 | | H04 | | H05 | | | H06 | | | |H03=PS 0-2|H04=PS 3-4|H05=[[Tumor]] progression|H06=Positive response or stable [[tumor]]}}
{{familytree | | |!| | | |!| | | |!| | | | |!| | | | | |}}
{{familytree | | I05 | | I06 | | I07 | | | I08 | | | | | |I05=Initiate [[docetaxel]] or  erlotinib or [[gemcitabine]]|I06=Provide suportive care|I07=Initiate [[docetaxel]] or erlotinib or [[gemcitabine]]|I08=Continue treatment([[cetuximab]] or [[gemcitabine]]) <br>OR<br> Switch mantainance (erlotinib or [[docetaxel]]) <br>OR<br> Close observation}}
{{familytree | | |!| | | | | | | |!| | | | |!| | | | | | | |}}
{{familytree | | |!| | | | | | | |!| | | | K01 | | | | | |K01=Initiate [[docetaxel]] or [[pemetrexed]] or erlotinib or [[gemcitabine]]}}
{{familytree | | |`|-|-|-|-|-|-|-|+|-|-|-|-|'| | | | |}}
{{familytree | | | | | | | | | | L01 | | | | | | | | | L01=If findings suggestive of progression of the disease are present, [[Non small cell carcinoma of the lung medical therapy metastatic cancer#Third Line Therapy|click here for the third line therapy]]}}
{{familytree/end}}
<br>

==Third line therapy==
* The algorithm below shows the third line therapy for metastatic disease according to the 2014 NCCN Non-Small Cell Lung Cancer guidelines.<ref name=nccn>Lung cancer. National Comprehensive Cancer Network 2015. http://www.nccn.org/professionals/default.aspx</ref>
{{familytree/start}}
{{familytree | | | | | | A01 | | | | | | A01=What is the performance status of the patient?}}
{{familytree | | | |,|-|-|^|-|-|.| | | | |}}
{{familytree | | | B01 | | | | B02 | | | | | | B01=PS 0-2|B02=PS 3-4}}
{{familytree | | | |!| | | | | |!| | | |}}
{{familytree | | | C01 | | | | C02 | | | | | C01=If not previously used, administer any of the following:<br>
* Docetaxel<br>
* Erlotinib<br>
* Gemcitabine<br>
* Pemetrexed
|C02=Administer erlotinib or provide suportive care}}
{{familytree | | | |!| | | | | | | | | | | |}}
{{familytree | | | D01 | | | | | | | | | D01=What is the performance status of the patients after the treatment?}}
{{familytree | |,|-|^|-|.| | | | | |}}
{{familytree | E01 | | E02 | | | | | | E01=PS 0-2 (stable [[tumor]])|E02=PS 3-4 ([[tumor]] progression)}}
{{familytree | |!| | | |!| | | | | | |}}
{{familytree | F01 | | F02 | | | | | F01=Provide supportive care or try experimental treatments|F02=Provide supportive care}}
{{familytree/end}}
<br>

==Multiple Lung Cancers==
The algorithm for the treatment of multiple non small cell lung cancers are based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.<ref name="NCCN">http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf</ref>

{{familytree/start}}
{{familytree | | | | | | | | | A01 | | | | A01=Is there suspicion of multiple lung cancers?}}
{{familytree | | | | | | | |,|-|^|-|.| | |}}
{{familytree | | | | | | | B01 | | B02 | | | B01=Yes|B02=No}}
{{familytree | | | | | | | |!| | | |!| | | | |}}
{{familytree | | | | | | | C01 | | C02 | | | | C01=<div style="text-align: left; padding:1em;">Perform the following tests:<br>
* If not previously done, [[PET scan]] or [[CT scan]]<br>
* Contrast chest [[CT]]<br>
* [[Brain tumor MRI|Brain MRI]]
</div>|C02=Administer treatment according to the TNM stage of the [[tumor]]}}
{{familytree | | | | | | | |!| | | | | | | |}}
{{familytree | | | | | | | D01 | | | | | D01=Is the disease is confined to the [[chest]] or is there systemic proliferation?}}
{{familytree | | | | | |,|-|^|-|.| | | | |}}
{{familytree | | | | | E01 | | E02 | | | | E01=Disease confined to the [[chest]]|E02=Systemic proliferation}}
{{familytree | | | | | |!| | | |!| | | |}}
{{familytree | | | | | F01 | | F02 | | | F01=Assess the [[mediastinal]] [[lymph nodes]] in order to determine the N stage of the [[tumor]]|F02=[[Non small cell carcinoma of the lung medical therapy metastatic cancer#Medical Therapy for Metastatic Non Small Cell Lung Cancer|Click here for the treatment of systemic metastasis]]}}
{{familytree | | | | | |!| | | | | |}}
{{familytree | | | | | G01 | | | | | G01=What is the N stage of the [[tumor]]?}}
{{familytree | | | |,|-|^|-|.| | |}}
{{familytree | | | H01 | | H02 | | | H01=N0-1|H02=N2-3}}
{{familytree | | | |!| | | |!| | | |}}
{{familytree | | | I01 | | I02 | | | I01=Is the patient symptomatic?|I02=[[Non small cell carcinoma of the lung medical therapy metastatic cancer#Medical Therapy for Metastatic Non Small Cell Lung Cancer|Click here for the treatment of systemic metastasis]]}}
{{familytree | |,|-|^|-|.| | | | | |}}
{{familytree | J01 | | J02 | | | | | J01=Yes|J02=No}}
{{familytree | |!| | | |!| | | | | |}}
{{familytree | |!| | | K01 | | | | | K01=Is the lesion a solitary nodule or are there multiple nodules?}}
{{familytree | |!| |,|-|^|-|.| | |}}
{{familytree | |!| L01 | | L02 | | L01=Solitary nodule|L02=Multiple nodules}}
{{familytree | |!| |!| | | |!| | |}}
{{familytree | |!| |!| | | M01 | | | M01=What is the risk of turning into a symptomatic disease?}}
{{familytree | |!| |!| |,|-|^|-|.| |}}
{{familytree | |!| |!| N01 | | N02 | |N01=High|N02=Low}}
{{familytree | |`|-|+|-|'| | | |!| | |}}
{{familytree | | | O01 | | | | O02 | | O01=Is definitive local therapy possible?|O02=Observation}}
{{familytree | |,|-|^|-|.| | | |!| | | |}}
{{familytree | P01 | | P02 | | |!| | | | P01=No|P02=Yes}}
{{familytree | |!| | | |!| | | |!| | | |}}
{{familytree | Q01 | | Q02 | | |!| | | | Q01=Consider palliative chemotherapy with or without local [[Non small cell carcinoma of the lung radiation therapy|Radiation therapy]]|Q02=<div style="text-align: left; padding:1em;">Administer one of the following treatments:<br>
* Preferred option: Parenchymal sparing resection<br>
* [[Non small cell carcinoma of the lung radiation therapy|Radiation therapy]]<br>
* Ablation therapy</div>}}
{{familytree | |!| | | |`|-|v|-|'| | | |}}
{{familytree | R01 | | | | R02 | | | | R01=[[Non small cell carcinoma of the lung medical therapy metastatic cancer#Medical Therapy for Metastatic Non Small Cell Lung Cancer|Click here for the treatment of systemic metastasis]]|R02=Go to the appropriate algorithm according to the characteristics of the disease: [[Non small cell carcinoma of the lung medical therapy metastatic cancer#local or regional recurrence|local or regional recurrence]] or [[Non small cell carcinoma of the lung medical therapy metastatic cancer#Medical Therapy for Metastatic Non Small Cell Lung Cancer|metastasis]]}}
{{familytree/end}}
<br>


==References==
{{reflist|2}}

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[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Pulmonology]]
[[Category:Lung cancer]]
[[Category:Oncology]]