1 Carcinoma broncogénico no a células pequeñasThe American Cancer Society presents Cancer Statistics 2006. ©2006, American Cancer Society, Inc. Daniel E. Tripoloni Profesor Adjunto Universidad Maimónides

2 A Presentation From the American Cancer SocietyCancer Statistics 2006 A Presentation From the American Cancer Society The American Cancer Society presents Cancer Statistics 2006. ©2006, American Cancer Society, Inc.

3 2006 Estimated US Cancer Deaths*Men 291,270 Women 273,560 Lung & bronchus 31% Colon & rectum 10% Prostate 9% Pancreas 6% Leukemia 4% Liver & intrahepatic 4% bile duct Esophagus 4% Non-Hodgkin % lymphoma Urinary bladder 3% Kidney 3% All other sites % 26% Lung & bronchus 15% Breast 10% Colon & rectum 6% Pancreas 6% Ovary 4% Leukemia 3% Non-Hodgkin lymphoma 3% Uterine corpus 2% Multiple myeloma 2% Brain/ONS 23% All other sites Lung cancer is, by far, the most common fatal cancer in men (31%), followed by colon & rectum (10%), and prostate (9%). In women, lung (26%), breast (15%), and colon & rectum (10%) are the leading sites of cancer death. ONS=Other nervous system. Source: American Cancer Society, 2006.

4 Cancer Death Rates*, for Men, US,1930-2002Rate Per 100,000 Lung Stomach Prostate Colon & rectum Most of the increase in cancer death rates for men prior to 1990 was attributable to lung cancer. However, since 1990, the age-adjusted lung cancer death rate in men has been decreasing. Stomach cancer mortality has decreased considerably since Death rates from prostate and colorectal cancers have also been declining. Pancreas Leukemia Liver *Age-adjusted to the 2000 US standard population. Source: US Mortality Public Use Data Tapes , US Mortality Volumes , National Center for Health Statistics, Centers for Disease Control and Prevention, 2005.

5 Cancer Death Rates*, for Women, US,1930-2002Rate Per 100,000 Lung Uterus Breast Lung cancer is currently the most common cause of cancer death in women, with the death rate more than two times what it was 25 years ago. In comparison, breast cancer death rates were virtually unchanged between 1930 and 1990, and have since decreased on average 2.3% per year. The death rates for stomach and uterine cancers have decreased steadily since 1930; colorectal cancer death rates have been decreasing for over 50 years. Colon & rectum Stomach Ovary Pancreas *Age-adjusted to the 2000 US standard population. Source: US Mortality Public Use Data Tapes , US Mortality Volumes , National Center for Health Statistics, Centers for Disease Control and Prevention, 2005.

6 Carcinoma Broncogénico Incidencia: SudaméricaPaís Varones Mujeres Período evaluado Argentina 39.7 5.3 Brasil 12.1 4.2 1999 (estimado) Colombia 9.8 4.9 Chile 21.7 6.1 Ecuador 7.4 2.9 Paraguay 11.7 2.3 Perú 6.8 2.7 Uruguay 54.7 4.1

7 Carcinoma Broncogénico Incidencia: Argentina

8 Diagnóstico: etiología, estadificación, operabilidadRx simple T.A.C. I.R.M. P.E.T. scan P.A.A.F. Fibrobroncoscopia Mediastinoscopia Videotoracoscopia Toracotomía Evaluación de la función respiratoria: Espirometría, difusión de CO, centellograma

9

10 Factor “T”: Tomografía Computada

11 Factor “T”:Punción trans-torácica con aguja fina (P.A.A.F.)Puncion espiñeyra

12 Punción trans-torácica con aguja fina (P.A.A.F.): Complicaciones

13 Estadificación TNM: Mapa ganglionar

14 Carcinoma Broncogénico: etapas TNM

15 Factor “T”: FibrobroncoscopiaEtiología Topografía bronquial Distancia de la carina Adenopatías

16 Factor “N”:Punción trans-traqueal con guía endoecográficaTransductor convexo (7,5 MHz) Balón Aguja de punción (22-G) Canal de trabajo

17 P.E.T. scan

18 Videotoracoscopia Estadificación Factor “M” (pleural)Factor “N” homolateral Resección Nódulos periféricos en pacientes de alto riesgo Lobectomía, neumonectomía Muestreo ganglionar

19 Videotoracoscopia Implantes pleurales sin derrameDerrame pleural neoplásico

20 Tratamiento QuirúrgicoIndicaciones Etapa Ia Etapa Ib Etapa IIa Etapa IIb Etapa IIIa Etapa IIIb Etapa IV Procedimientos Lobectomía + muestreo ganglionar Segmentectomía muestreo ganglionar Neumonectomía muestreo ganglionar Resección “en manguito” + muestreo ganglionar Resección “en cuña” Neoadyuvancia Quimioterapia Radioterapia

21 Resultados ¿Por qué mueren estos pacientes?La supervivencia a 5 años de pacientes en “etapa IA” es de 61% La supervivencia a 5 años de pacientes en “etapa” IB es de 38% ¿Por qué mueren estos pacientes? Recidivas ganglionares regionales Metástasis a distancia “tardías” o no diagnosticadas