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{{familytree/start}}
{{familytree | | | | | | | | | | A01 | | | | | | | | | | | | | A01=What the specific subtype according to the specific histological characteristics of the tumor?}}
{{familytree | | | | | | | | | | A01 | | | | | A01=What the specific subtype according to the specific histological characteristics of the tumor?}}
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{{familytree | | | | | B01 | | | | | | | | B02 | | | B01=<div style="float: left; text-align: left; width: 14em; padding:1em;">
* Adenocarcinoma<br>
* Adenocarcinoma<br>
* Large cell carcinoma<br>
* Large cell carcinoma<br>
* Not specified non-small cell lung cancer</div>|B02=Squamous cell carcinoma}}
* Not specified non-small cell lung cancer</div>|B02=Squamous cell carcinoma}}
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{{familytree | E01 | | E02 | | E03 | | | E01=Click here for the sensitizing EGFR mutation specific treatment|E02=Click here for the specific therapy for the ALK mutation specific treatment|E03=Click here for the treatment of negative sensitizing EGFR and ALK mutation metastatic disease}}
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Revision as of 14:30, 20 June 2014

Stage IV

 
 
 
 
 
 
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:
 
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)
 
 
 

Metastatic disease

 
 
 
 
 
 
 
 
 
What the specific subtype according to the specific histological characteristics of the tumor?
 
 
 
{{{ }}}
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  • Adenocarcinoma
  • Large cell carcinoma
  • Not specified non-small cell lung cancer
 
 
 
 
 
 
 
Squamous cell carcinoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Perform specific EGFR and ALK mutation testing: What is the specific mutation?
 
 
 
 
 
 
 
Is the patient smoker or former smoker?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sensitizing EGFR mutation
 
ALK mutation
 
Negative EGFR and ALK
 
 
 
Click here for the squamous cell carcinoma specific treatment
 
{{{ }}}
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Click here for the sensitizing EGFR mutation specific treatment
 
Click here for the specific therapy for the ALK mutation specific treatment
 
Click here for the treatment of negative sensitizing EGFR and ALK mutation metastatic disease
 
{{{ }}}