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Oncology Non-Small Cell Lung Cancer NSCLC is categorized as early stage, locally advanced, or metastatic. Early stage disease is resectable. l,ocally advanced disease is defined by clinically detectable mediastinal lymphadenopathy or invasion into local structures. Metastatic disease is defined as spread of the tumor to distant sites. PET scan/CT and whole body PET scan are used for staging. Brain MRI is indicated in the presence of neurologic signs or symp toms or in patients being considered for surgery or combined modality (chemoradiation) therapy fbr early stage lung cancer. Treatment 5TUtrY fABLE: Treatment of SCLC lf you see this... Select this... Limited-stage disease Concurrent, platinum-based combined chemotherapy and radiation therapy Extensive-stage disease Platinum-based combined chemotherapy and immunotherapy Complete or partial response to therapy (limited-stage disease and Add prophylactic cranial irradiation possibly extensive-stage disease with good performance status) Symptomatic brai n metastases Radiation STUDY ?ABIE: Treatment of NSCLC lf you see this... Select this... Early-stage disease Surgical resection for cure Locally advanced disease Platinum-based chemotherapy and radiation therapy; immunotherapy added for responders Metastatic disease Tyrosine kinase inhibitor-specific therapy for tumors with driver mutations (see following); immunotherapy, platinum-based chemotherapy, or both for tumors without a driver mutation Solitary brain metastasis Surgical excision and postoperative brain radiation For patients with EGFR/ALKIROSI mutations, use targeted therapy with a tyrosine kinase inhibitor

STUDY ?ABIE: Treatment of NSCLC lf you see this... Select this... Early-stage disease Surgical resection for cure Locally advanced disease Platinum-based chemotherapy and radiation therapy; immunotherapy added for responders Metastatic disease Tyrosine kinase inhibitor-specific therapy for tumors with driver mutations (see following); immunotherapy, platinum-based chemotherapy, or both for tumors without a driver mutation Solitary brain metastasis Surgical excision and postoperative brain radiation For patients with EGFR/ALKIROSI mutations, use targeted therapy with a tyrosine kinase inhibitor Use glucocorticoids and radiation therapy for patients with multiple brain metastases. Select thoracic irradiation for pulmonary airway obstruction, SVC syndrome, and spinal cord metastases (following surgical decompression). Radiation therapy relieves pain from metastatic disease. Treat symptomatic pleural effusions with thoracentesis and indwelling pleural catheter or pleu rodesis if necessary. DOil'T BE TRICKED . Avoid chemotherapy in patients with NSCLC with poor performance status (extreme fatigue or weakness, weight loss >10%, severe symptoms). TESTYOURSELF A 59 year-old woman has a right lower lobe mass, bulky mediastinal lymph nodes, and hilar lymphadenopathy. Biopsy confirms non small cell lung cancer. No evidence of metastatic disease is seen. ANSWER: For treatment, select combined chemotherapy and radiation. Gastric Cancer Diagnosis Most patients have locally advanced or metastatic disease at diagnosis. The most common symptoms are abdominal pain, anorexia, bleeding, dysphagia, nausea, and weight loss. 316