NCCN Guidelines for Patients: Non-Small Cell Lung Cancer

Total Page:16

File Type:pdf, Size:1020Kb

NCCN Guidelines for Patients: Non-Small Cell Lung Cancer NCCN.org/patients/surveyPlease complete our online survey at NCCN Guidelines for Patients® Version 1.2016 Lung Cancer NON–SMALL CELL LUNG CANCER Presented with support from: Available online at NCCN.org/patients Ü NCCN Guidelines for Patients® Version 1.2016 Lung Cancer NON-SMALL CELL LUNG CANCER Learning that you have cancer can be overwhelming. The goal of this book is to help you get the best cancer treatment. It explains which cancer tests and treatments are recommended by experts of non-small cell lung cancer. The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of 27 of the world’s leading cancer centers. Experts from NCCN have written treatment guidelines for doctors who treat lung cancer. These treatment guidelines suggest what the best practice is for cancer care. The information in this patient book is based on the guidelines written for doctors. This book focuses on the treatment of non-small cell lung cancer. Key points of the book are summarized in the related NCCN Quick Guide™. NCCN also offers patient resources on lung cancer screening as well as other cancer types. Visit NCCN.org/patients for the full library of patient books, summaries, and other patient and caregiver resources. ® NCCN Guidelines for Patients i Lung Cancer – Non-Small Cell, Version 1.2016 Endorsers and sponsors Endorsed and sponsored in part by LUNG CANCER ALLIANCE LUNG CANCER RESEARCH COUNCIL Lung Cancer Alliance is proud to collaborate with National Comprehensive As an organization that seeks to increase public awareness and Cancer Network to sponsor and endorse these NCCN Guidelines for understanding about lung cancer and support programs for screening and Patients®: Non–Small Cell Lung Cancer. www.lungcanceralliance.org early detection, the Lung Cancer Research Council strongly supports and endorses these NCCN Guidelines for Patients. www.lungcancerresearchcouncil.org Endorsed by AMERICAN LUNG ASSOCIATION The American Lung Association strongly supports efforts to help ensure FREE TO BREATHE all patients facing lung cancer get the highest standard of treatment and When a patient or loved one is diagnosed with lung cancer, it is important care. Helping patients understand treatment guidelines is one important to know what treatments are available to them. These NCCN Guidelines for step in empowering them to get the care they want and need. That is why Patients will help patients and their caregivers locate the information they we are pleased to endorse NCCN’S efforts to provide accessible treatment need to help determine the best treatment option for them. guidelines and information to patients through the NCCN Guidelines for www.freetobreathe.org Patients. www.Lung.org. LUNG CANCER CIRCLE OF HOPE BONNIE J. ADDARIO LUNG CANCER FOUNDATION Lung Cancer Circle of Hope (LCCH) emphatically endorses the NCCN The Bonnie J. Addario Lung Cancer Foundation is proud to endorse these Guidelines for Patients. Knowledge is power and with this comprehensive NCCN Guidelines for Patients. We believe that educated and empowered resource, patients and their families can proactively work with a qualified patients do better and live longer. This book should be in the hands of every physician to make informed decisions in the battle to conquer cancer. patient diagnosed with lung cancer. www.lungcancerfoundation.org. www.lungcancercircleofhope.org CARING AMBASSADORS LUNG CANCER INITIatIVE OF NORTH CAROLINA The Caring Ambassador Lung Cancer Program is pleased to endorse these As an organization specializing in connecting patients, survivors and loved NCCN Guidelines for Patients: Lung Cancer. Patients and their loved ones ones with the medical research community, the Lung Cancer Initiative of need reliable resources to achieve the best possible outcomes for their NC fully supports tehse NCCN Guidelines for Patients. These guidelines disease. This resource provides just that. www.lungcancercap.org. set the standard for patient education and access to care. www.lungcancerinitiativenc.org DUSTY JOY foundatION With patients’ best interest at heart, NCCN defines the standard of care for LUNGEVITY FOUNDATION patients and physicians through proven scientific methods and expectations LUNGevity Foundation supports the NCCN Guidelines for Patients as an for new discoveries leading to improved patient outcomes. As a lung cancer excellent resource, as we strongly believe in providing education for all advocacy nonprofit, our organization wholeheartedly supports NCCN those affected by the disease. www.LUNGevity.org Guidelines for Patients. www.LiveLung.org. FREE ME FROM LUNG CANCER As a lung cancer survivor and President and CEO of Free ME from Lung Cancer, I am pleased to endorse this vitally important resource so that lung cancer patients can have the information needed to make informed decisions about their treatment. www.freeMEfromLungCancer.org. ® NCCN Guidelines for Patients ii Lung Cancer – Non-Small Cell, Version 1.2016 Turning tragedy into action DANA REEVE HAD IT ALL. She was a beautiful woman, an actress who married “Superman” actor Christopher Reeve. They had a son, Will. Then, in 1995, Christopher Reeve suffered a catastrophic injury in a riding accident and was paralyzed from the neck down. Dana cared for him for almost 10 years, tirelessly crusading for research on paralysis and stem cells. Christopher Reeve died in 2004, but Dana pressed forward with her foundation and with raising their son, then an adolescent. Just a few months later, this vibrant, healthy, non-smoking Dana Reeve young woman was diagnosed with stage IV lung cancer. She lived for just seven months. Dana Reeve was my sister, and until Dana was diagnosed, I didn't understand how hard it can be for patients to find good information about their treatment options. I am a third- generation physician, pathologist, and an oncology researcher. After Dana's death, I began working with lung cancer advocacy groups to raise awareness of the needs of lung cancer patients. I began to realize that the overall understanding of lung cancer is very naive. People just don't understand the breadth and scope of the problem. In 2009, I joined NCCN after being asked to participate in the Roundtable discussion that opened the NCCN Annual Conference that year. That first acquaintance with NCCN struck a strong chord in me. When I was asked to join the newly formed NCCN Foundation Board one year later, I gladly accepted. And when they decided to dedicate the NCCN Guidelines for Patients®: Lung Cancer in memory of my sister, I was thrilled. NCCN plays a critical role in translating complicated treatment information into easily understandable patient resources. I use NCCN's clinical guidelines regularly, and know there is a tremendous need for patient-friendly versions. The more that this information gets into the hands of patients, the more patients can feed it back to their doctors and make informed decisions for themselves. NCCN Guidelines for Patients® are a powerful resource. - Debora Morosini, MD Sister of Dana Reeve Member, NCCN Foundation Board of Directors ® NCCN Guidelines for Patients 1 Lung Cancer – Non-Small Cell, Version 1.2016 Credits NCCN aims to improve the care given to patients with cancer. NCCN staff work with experts to create helpful programs and resources for many stakeholders. Stakeholders include health providers, patients, businesses, and others. One resource is the series of books for patients called the NCCN Guidelines for Patients®. Each book presents the best practice for a type of cancer. The patient books are based on clinical practice guidelines written for cancer doctors. These guidelines are called the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Clinical practice guidelines list the best health care options for groups of patients. Many doctors use them to help plan cancer treatment for their patients. Panels of experts create the NCCN Guidelines®. Most of the experts are from NCCN Member Institutions. Panelists may include surgeons, radiation oncologists, medical oncologists, and patient advocates. Recommendations in the NCCN Guidelines are based on clinical trials and the experience of the panelists. The NCCN Guidelines are updated at least once a year. When funded, the patient books are updated to reflect the most recent version of the NCCN Guidelines for doctors. For more information about the NCCN Guidelines, visit NCCN.org/clinical.asp. NCCN staff involved in developing the NCCN Guidelines for Patients include: Dorothy A. Shead, MS Alycia Corrigan Susan Kidney Director, Patient and Clinical Information Medical Writer Graphic Design Specialist Operations Rachael Clarke Laura J. Hanisch, PsyD Guidelines Data and Layout Coordinator Medical Writer/Patient Information Specialist Supported by NCCN Foundation® NCCN Foundation supports the mission of the National Comprehensive Cancer Network® (NCCN®) to improve the care of patients with cancer. One of its aims is to raise funds to create a library of books for patients. Learn more about the NCCN Foundation at NCCN.org/foundation. National Comprehensive Cancer Network (NCCN) 275 Commerce Drive • Suite 300 Fort Washington, PA 19034 215.690.0300 © 2016 National Comprehensive Cancer Network, Inc. All rights reserved. The NCCN Guidelines for Patients® and illustrations herein may not be reproduced in any form for any purpose without the express written permission of NCCN. ® NCCN Guidelines for Patients 2 Lung Cancer – Non-Small Cell, Version 1.2016 Contents Lung Cancer NON-SMALL CELL LUNG CANCER 4 How to use this book 59 Part 6 Treatment guide: One 5 Part 1 primary tumor Lung cancer basics Presents treatment options for one or more Explains where lung cancer starts and how related masses of cancer cells. it spreads. 93 Part 7 11 Part 2 Treatment guide: Multiple Assessing lung nodules primary tumors Discusses care for when a small lung mass Presents treatment options for two or more is found. unrelated masses of cancer cells. 21 Part 3 103 Part 8 Cancer staging Making treatment decisions Defines the groups of lung cancer used for Offers tips for choosing the best treatment.
Recommended publications
  • Mediastinoscopic Esophagectomy with Lymph Node Dissection Using a Bilateral Transcervical and Transhiatal Pneumomediastinal Approach
    Tokairin et al. Mini-invasive Surg 2020;4:32 Mini-invasive Surgery DOI: 10.20517/2574-1225.2020.23 Technical Note Open Access Mediastinoscopic esophagectomy with lymph node dissection using a bilateral transcervical and transhiatal pneumomediastinal approach Yutaka Tokairin1,2, Yasuaki Nakajima2, Kenro Kawad2, Akihiro Hoshin2, Takuya Okada2, Toshihiro Matsui2, Kazuya Yamaguchi2, Kagami Nagai2, Yusuke Kinugasa2 1Department of Surgery, Toshima Hospital Tokyo Metropolitan Health and Hospitals Corporation, Tokyo 173-0015, Japan. 2Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo 113-8510, Japan. Correspondence to: Dr. Yutaka Tokairin, Department of Surgery, Toshima Hospital Tokyo Metropolitan Health and Hospitals Corporation, 33-1 Sakaecho, Itabashi-ku, Tokyo 173-0015, Japan. E-mail: [email protected] How to cite this article: Tokairin Y, Nakajima Y, Kawad K, Hoshin A, Okada T, Matsui T, Yamaguchi K, Nagai K, Kinugasa Y. Mediastinoscopic esophagectomy with lymph node dissection using a bilateral transcervical and transhiatal pneumomediastinal approach. Mini-invasive Surg 2020;4:32. http://dx.doi.org/10.20517/2574-1225.2020.23 Received: 17 Feb 2020 First Decision: 17 Mar 2020 Revised: 24 Mar 2020 Accepted: 1 Apr 2020 Published: 16 May 2020 Science Editor: Itasu Ninomiya Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang Abstract We developed a method for mediastinoscopic esophagectomy via a bilateral transcervical and transhiatal approach under pneumomediastinum as a less-invasive radical operation. The right recurrent nerve is first identified using an open approach, and the right cervical paraesophageal lymph nodes and part of the right recurrent nerve lymph nodes are dissected, after which pneumomediastinum is initiated.
    [Show full text]
  • Alternative – Universal Extended Video Mediastinoscopy with Distending, Narrow Blades Extended Video Mediastinoscopy with Distending, Tapered Blade System
    THOR 19 2.0 11/2020-E Alternative – Universal Extended video mediastinoscopy with distending, narrow blades Extended video mediastinoscopy with distending, tapered blade system By creating visibility and space, video mediastinoscopy allows the precise display and dissection of mediastinal structures and is therefore valuable for lymph node staging. Mediastinal staging as well as extended or complex endoscopic interventions, including video-assisted mediastinoscopic lymphadenectomy (VAMLA), can be performed with the aid of a distending video mediastinoscope system. KARL STORZ offers an atraumatic, easy-to-use, compact blade system with a holding arm device and an integrated irrigation and suction channel for this purpose. Two adjustment wheels in the handle allow distal distension of the blades and height adjustment in parallel. Combined with a matching HOPKINS® wide angle telescope, this autoclavable blade system provides the operating surgeon with an optimal overview of the working area. In conjunction with a holding arm with KSLOCK, bimanual work is also possible. The corresponding DCI® camera head IMAGE1 S™ D1 is operated via the modular KARL STORZ IMAGE1 S™ camera platform. Consequently, the system is likely to experience a renaissance in the coming years. We also offer instruments and other accessories that are compatible with the system. © KARL STORZ 96082019 THOR 19 2.0 11/2020 EW-E 2 Components of the KARL STORZ video mediastinoscopy system for extended mediastinoscopy Monitor 27" FULL HD Monitor TM220 Camera System IMAGE1 S CONNECT®
    [Show full text]
  • Mediastinoscopy: a Clinical Evaluation of 400 Consecutive Cases
    Thorax: first published as 10.1136/thx.24.5.585 on 1 September 1969. Downloaded from Thorax (1969), 24, 585. Mediastinoscopy: A clinical evaluation of 400 consecutive cases C. L. SARIN1 AND H. C. NOHL-OSER From the Thoracic Surgical Unit, Harefield Hospital, Harefield, Middlesex Mediastinoscopy was carried out in 400 cases, including 296 of bronchogenic carcinoma. At the time of presentation the new growth had already spread to involve the mediastinal lymph nodes in slightly more than 50% of these. The incidence of involvement was 76% in oat-cell and 35% in squamous-cell carcinoma. Non-resectability at thoracotomy was encountered in seven out of 120 patients. We advocate this procedure in every case of bronchogenic carcinoma which is considered operable on other counts. In patients in whom the mediastinal lymph nodes are invaded by growth we prefer radical radiotherapy to surgery, as the long-term survival of the two methods is comparable. This procedure may be the only source of positive histological proof of diagnosis, not only in carcinoma but in other types of intrathoracic disease. We believe that this procedure reduces the number of unnecessary exploratory thoracotomies. Carlens (1959) introduced diagnostic exploration sible. Biopsy in such cases can be obtained from tissues inside the thoracic inlet. in the of the superior mediastinum. The space explored just Bleeding, copyright. is part of the superior mediastinum which is presence of incipient or developed superior vena caval of the obstruction, or dense fibrosis of the pre-tracheal situated around tihe intrathoracic part fascia, can make the procedure difficult or impossible.
    [Show full text]
  • Cervical Mediastinal L SUSAN ALEXANDER L for STAGING of LUNG CANCER
    Cervical Mediastinal l SUSAN ALEXANDER l FOR STAGING OF LUNG CANCER ervical mediastinal exp- bronchogenic lung cancer by sam- loration (CME), or pling selected lymph nodes in and mediastinoscopy, is a around the trachea, its major surgical procedure to bifurcation and the great vessels. C explore and sample Lymph nodes are removed and lymph nodes in the space between sent to pathology for tissue diag- the lungs, (the mediastinum), nosis to determine the histology when diagnostic imaging studies of the tumor. CME is performed (X-ray, CT scan, etc) suggest a primarily to stage lung cancer growth in the lungs or mediasti- and determine the extent of the nal region. The most common pur- disease and establish treatment pose of the CME is to diagnose options. DECEMBER 2002 The Surgical Technologist 9 224 DECEMBER 2002 CATEGORY 1 If cancer exists in the lymph nodes, the cell type nodes that are not accessible through CME. In (histology) identifies the type of cancer and one series of 100 patients with tumors in this extent of the lymph nodes involved. If tumor area, 22 were found to be inoperable despite hav­ involvement in the mediastinal area is demon­ ing a negative mediastinoscopy.5 Left anterior strated in the pathology review of the speci- mediastinotomy through the second intercostal men(s) (lymph nodes), the patient may be space is the preferred method to assess the oper­ spared an unnecessary thoracotomy; however, ability of these patients, as suggested by Pearson this means that the tumor is inoperable.5 and coworkers.5 Less than 50% of patients undergoing cura­ History tive resection for bronchogenic carcinoma sur­ CME was originally described by Harken and vive five years.
    [Show full text]
  • Experience with Video Mediastinoscopy at a Tertiary Cancer Center
    Oncology and Radiotherapy © 1 (50) 2020: 001-005 • RESEARCH ARTICLE From radiological assumption to pathological conviction: experience with video mediastinoscopy at a tertiary cancer center Nizamudheen MP, Abhay K Kattepur, Satheesan B Department of Surgical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India Purpose: To describe the role of mediastinoscopy in the setting of mediastinaladenopathy secondary to pulmonary and non-pulmonary cancers. INTRODUCTION Methods: Retrospective analysis of patients undergoing video mediastinoscopy SUMMARY from November 2016 to December 2018 at tertiary cancer center for Cervical mediastinoscopy is a time tested tool for the mediastinaladenopathy from lung cancer and non-pulmonary cancers with invasive staging of mediastinal nodes. Standard cervical mediastinal nodes. mediastinoscopy helpsin approaching lymph node stations viz. Results: Twelve patients were included out of which 11 patients underwent right upper paratracheal (station 2R), right lower paratracheal diagnostic mediastinoscopy. The median age was 58 years. Seven patients had lung cancer. The mean number of nodes sampled was 10.5 (range: (4R), left upper paratracheal (2L), right lower paratracheal 2-28 nodes). Five patients had mediastinaladenopathy from non-pulmonary (4L) and sub-carinal (7). Hilar nodes (station 10) can also cancer like endometrial, oropharyngeal and Hodgkin’s lymphoma. Recurrent laryngeal nerve palsy was noted in one patient. be accessed byexperienced surgeons, although it can be Conclusion: Mediastinoscopy serves as a valuable asset for staging of lung technically challenging. Overall, this procedure is accurate and cancer and in the assessment of suspicious nodes in the setting of non- carries minimal morbidity [1]. The role of mediastinoscopy pulmonary cancers. However, training and expertise is in the need of the hour to prevent redundancy of this valuable procedure.
    [Show full text]
  • 3D Printed Model of the Mediastinum for Cardiothoracic Surgery Resident Education Natalie S
    3D printed model of the mediastinum for cardiothoracic surgery resident education Natalie S. Lui MD1, Winston Trope1, H. Henry Guo MD PhD2, Kyle Gifford2, Prasha Bhandari MPH1, Jalen Benson1, Douglas Z. Liou MD1, Leah M. Backhus MD MPH1, Mark F. Berry MD1, Joseph B. Shrager MD1 Divisions of 1Thoracic Surgery and 2Radiology, Stanford University School of Medicine, Stanford, CA Purpose Results Conclusion Mediastinoscopy remains the gold standard for mediastinal lymph node There were 51 resident self assessments and 65 attending assessments completed over A novel, 3D printed model of the mediastinum was an staging, but residents are performing fewer of them with the development of two years. (Residents and attendings could complete more than one assessment). effective tool for teaching cardiothoracic surgery endobronchial ultrasound. We hypothesized that a three-dimensional (3D) General surgery, integrated cardiac residents, and traditional thoracic and cardiac track residents the anatomy and techniques for printed model of the mediastinum would be an effective tool for teaching fellows were included. mediastinoscopy, as measured by resident self assessment and attending assessment. 3D printing is a residents the anatomy and techniques for mediastinoscopy. Residents taught with the 3D model (n=22) were more likely to respond “well” or “very promising technology with many potential applications Methods well” for three of the four self assessment questions. Attendings were more likely to in cardiothoracic surgery resident education. Computed tomography images were segmented using Materialise Mimics respond “very well” to two of the assessment questions. (Figure 4) (Materialise, Leuven, Belgium), and a color model of the mediastinum was Figure 4. Resident self assessments (A) and attending assessments (B) comparing 3D printed using a Stratasys J735 (Stratasys, Eden Prairie, MN).
    [Show full text]
  • Patient Education Handbook As Soon As I Was Diagnosed with Lung Cancer
    NAVIGATING LUNG CANCER NAVIGATING LIFE DOESN’T COME WITH INSTRUCTIONS, BUT LIVING WITH LUNG CANCER NOW HAS THIS SURVIVOR’S GUIDEBOOK. NAVIGATING INSIDE YOU WILL GET THE MOST UP-TO-DATE NAVIGATION TOOLS ON: • THE DIAGNOSIS PROCESS • LIVING WITH LUNG CANCER • LUNG CANCER STAGING • FINANCING YOUR CARE LUNG CANCER • TREATMENT OPTIONS • HOPE FOR SURVIVING LUNG CANCER • CLINICAL TRIALS • AND MORE In my house we call it “the lung bible.” It has been an invaluable resource 360º OF HOPE for me, my family and (sadly) a newly diagnosed friend. FIFTH EDITION – FALL 2020 —Diane Broderick I love this handbook! It has great information that I have shared with my family and friends. I often pick it up and re-read. Each time I learn something new, or it triggers something that I need to talk to my doctor(s) about. —Kimberly Buchmeier 360º OF HOPE When my husband was first diagnosed with stage IV Adenocarcinoma we were paralyzed with fear and found ourselves starved for good information about the fight we were beginning. The University of Colorado/ Anchutz hospital advised us to contact the foundation and we were sent this wonderful handbook that answered all of our questions and enabled us to feel knowledgeable when choosing an oncologist and when facing surgery and treatments. It is an invaluable resource to us. —Peter & Donna Blum This is the most comprehensive manual I’ve ever seen written...focused for the lung cancer patient. BONNIE —Roy S. Herbst, MD, PhD BONNIE J. ADDARIO Ensign Professor of Medicine (Oncology), Professor of Pharmacology, Chief of Medical Oncology, Associate Director for Translational Research, Director—Thoracic Oncology SURVIVOR Research Program, Yale Comprehensive Cancer Center, Yale School of Medicine J.
    [Show full text]
  • Experience with Mediastinoscopy
    Thorax: first published as 10.1136/thx.27.4.463 on 1 July 1972. Downloaded from Thorax (1972), 27, 463. Experience with mediastinoscopy T. L. OTTO, J. ZASLONKA and M. LUKIA?4SKI Institute of Tuberculosis and Chest Diseases, Warsaw, Second Surgical Department, Medical Academy. Lodi, and Department of Thoracic Surgery, Institute of Postgraduate Studies, Zakopane, Poland Six hundred and eighty diagnostic mediastinoscopies are presented. Of these, 552 were classical, 114 anterior mediastinal, 12 posterior mediastinal, and 2 from below the sternum. In addition, 20 therapeutic mediastinoscopies were performed for the insertion of a pacemaker electrode or evacuation of a mediastinal cyst. Of 125 mediastinoscopies performed on patients with an initial diagnosis of sarcoidosis, in most the diagnosis was confirmed, the rate of false negative results being 2-4%. Extremely encouraging were the results in patients with an initial diagnosis of Hodgkin's disease. Out of 60 patients, a different diagnosis was established in 30 and further follow-up proved this to be correct. In mediastinal tumours the results were discouraging, the rate of false results being as high as 43%. Four hundred and ten patients were mediastinoscoped for lung cancer. In 52, mediastino- scopy was the first successful biopsy. Metastases to lymph nodes were found in 139 (33-9%). The percentage of exploratory thoracotomies following the introduction of mediastinoscopy fell from 22% to 14%. Mediastinoscopy was also used to investigate the spread of oesophageal cancer and enabled us to exclude patients who were obviously inoperable. Mediastinal and pulmonary diseases involving the phagus and to take biopsies of mediastinal tumours. http://thorax.bmj.com/ lymphatic system often present considerable diag- Carlens himself tried to introduce mediastinoscopy nostic difficulties.
    [Show full text]
  • Malignant Pleural Mesothelioma
    our Pleaseonline completesurvey at NCCN.org/patients/survey NCCN GUIDELINES FOR PATIENTS® Version 1.2016 Malignant Pleural Mesothelioma Presented with support from: Available online at NCCN.org/patients Ü Malignant Pleural Mesothelioma that you have cancer LEARNING can be overwhelming. The goal of this book is to help you get the best care. It explains which tests and treatments are recommended by experts for malignant pleural mesothelioma. The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of 27 of the world’s leading cancer centers. Experts from NCCN have written treatment guidelines for doctors who treat mesothelioma. These treatment guidelines suggest what the best practice is for cancer care. The information in this patient book is based on the guidelines written for doctors. This book focuses on the treatment of mesothelioma. Key points of the book are summarized in the NCCN Quick Guide™ series Malignant Pleural Mesothelioma. NCCN also offers patient books on breast cancer, lung cancer, melanoma, and many other cancer types. Visit NCCN.org/patients for the full library of patient books as well as other patient and caregiver resources. NCCN Guidelines for Patients®: Malignant Pleural Mesothelioma, Version 1.2016 1 About These patient guides for cancer care are produced by the National Comprehensive Cancer Network® (NCCN®). The mission of NCCN is to improve cancer care so people can live better lives. At the core of NCCN are the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). NCCN Guidelines® contain information to help health care workers plan the best cancer care. They list options for cancer care that are most likely to have the best results.
    [Show full text]
  • Anesthesia for Patients with Mediastinal Masses
    14 Anesthesia for Patients with Mediastinal Masses Chih Min Ku Introduction .................................................................................................................. 201 Anatomy and Pathology ............................................................................................... 202 Clinical Presentation .................................................................................................... 202 Preoperative Evaluation ............................................................................................... 203 Surgical Approaches .................................................................................................... 203 Preoperative Treatment ................................................................................................ 203 Anesthetic Management ............................................................................................... 203 Complications and Risk Factors .................................................................................. 205 Anesthesia for Mediastinoscopy .................................................................................. 205 Summary ...................................................................................................................... 206 Clinical Case Discussion .............................................................................................. 207 Key Points • A careful anesthetic plan that is not irreversible is likely to result in a good outcome. • Patients with anterior mediastinal
    [Show full text]
  • Mediastinoscopy
    cancer.org | 1.800.227.2345 Mediastinoscopy What is mediastinoscopy? Mediastinoscopy is a procedure a doctor uses to look inside the mediastinum – the area behind the breastbone and between the lungs. This is done with a mediastinoscope, a thin, flexible tube with a light, small video camera and cutting tool on the end. The tube is put through a small cut made just above the breastbone and slowly moved into the mediastinum. Why do you need to have mediastinoscopy? Because the lymph nodes or the area between your lungs looks suspicious Mediastinoscopy is often done to remove or biopsy lymph nodes in the area between the lungs to check for cancer or to stage lung cancer1. It can also be used in people with thymoma2 (tumor of the thymus gland), esophagus cancer3, or lymphoma4 for the same reasons. What’s it like to have a mediastinoscopy? This is what typically happens before, during, and after a mediastinoscopy. But your experience might be a little different, depending on things like why you’re having the test, where you’re having the test done, and your overall health. Be sure to talk to your health care provider before having this test so you understand what to expect and ask questions if you’re not sure about something. Before the test Be sure your health care provider knows about any medicines you are taking, including 1 ____________________________________________________________________________________American Cancer Society cancer.org | 1.800.227.2345 vitamins, herbs, and supplements, as well as if you have allergies to any medicines. You might be asked to stop taking blood-thinning medicines (including aspirin) for several days before the test.
    [Show full text]
  • Surgical Instruments Catalog German Engineering
    surgical insTrumenTs caTalog German Engineering. American Design. World-Class Quality. Teleflex, KMedic and Pilling are trademarks or registered trademarks of Teleflex Incorporated or its affiliates. Teleflex is a global provider of medical products designed to enable healthcare providers to protect against infections and improve patient and provider safety. The company specializes in products and services for vascular access, respiratory, general and regional anesthesia, cardiac care, urology and surgery. Teleflex also provides specialty products for device manufacturers. © 2013 Teleflex Incorporated. All rights reserved. 2013-2241 Teleflex PO Box 12600 Research Triangle Park, NC 27709 Toll Free: 866.246.6990 Phone: +1.919.544.8000 Teleflex.com GENERAL INFORMATION Bougies/Dilators . 465 Tracheostomy Tubes . 469 Ear Instruments . 493 Nasal Instruments . 503 Mouth and Throat Instruments . 521 Scope and Light Carriers Identification Index . 534 CARDIAC, VASCULAR AND THORACIC INSTRUMENTS Overview . 542 CVT Forceps and Clamps . 544 Bulldog® and Micro Vessel Clamps . 560 Pilling® Vascular Clamps . 573 Vascular Clamps . 575 Aortic Vascular Clamps . 628 Scissors . 656 CVT Needle Holders . 674 Titanium Instruments: Forceps and Clamps . 686 Titanium Instruments: Scissors . 704 Titanium Instruments: Needle Holders . 707 Rib Instruments . 714 CVT Retractors . 720 Valve Instruments . 751 Aortic Punches . 762 Heparin Cannulae . 764 Suction Tubes . 765 Vascular Dilators . 768 Valvulotomes . 772 Mediastinoscopy . 774 Video-Assisted Thoracoscopy . 780 Miscellaneous CVT . 793 Specialty Sets . 798 ORTHOPEDIC INSTRUMENTS Overview . 804 KMedic® Wire And Pin Implants . 806 Kirschner Wires, Steinmann Pin, Vickers K-Wire Dispensers . 809 Vickers Easidriver . 812 KMedic® Gratloch™ Wire Bender . 814 Wire Twisters And Wire/Pin/Rod Cutters . 816 KMedic® Corwin Wire Twister . 819 KMedic® P .I . Wire Twister And Tightener .
    [Show full text]