SandboxAlonso

Is pleural o pericardial effusion present (suggestive of M1a) or are findings suggestive of systemic metastasis (M1b) present?

M1a

M1b

Perform the following tests: Perform thoracentesis and/or pericardiocenteis Perform a thoracoscopy if thoracocentesis is inconclusive

Perform the following tests: Brain MRI Bronchoscopy Mediastinal lymph node biopsy If not previously done, PET scan or CT scan

Is the liquid extracted positive for malignant cells?

Are findings suggestive of adrenal metastasis or brain metastasis?

Yes

No

Adrenal

Brain

Local therapy Ambulatory catheter drainage Pleurodesis Mediastinal window PLUS Therapy for metastatic disease (click here for the treatment of local and systemic metastasis and neoplastic recurrence)

Treat according to tumor stage: I II III

Perform a needle aspiration biopsy for metastasis confirmation

Surgical resection + adjuvant radiation therapy Radiation therapy alone: Sterotactic radio surgery + Whole brain radiation therapy OR Sterotactic radio surgery alone PLUS Pathologic evaluation of surgical piece and lymph nodes

If the lung disease is curable, administer therapy for the local adrenal lesion: Surgical adrenal resection OR Radiation therapy OR Administer therapy for metastatic disease in case of not curable lung lesions (click here for the treatment of local and systemic metastasis and neoplastic recurrence)

What is the TN stage of the lung tumor?

T1-2, No-1 T3, N0

T1-2, N2 T3, N1-2 N3, regardless of the T stage T4 regardless of the N stage

Surgical resection of lung tumor + adjuvant chemotherapy OR Neoadjuvant chemotherapy + surgical resection or stereotactic ablative radiation therapy OR Stereotactic ablative radiation therpay alone

Administer therapy for metastatic disease in case of not curable lung lesions (click here for the treatment of local and systemic metastasis and neoplastic recurrence)