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| The Pre-Therapeuticc Assessment Of Lung Cancer
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F. Lamouime,, M.Rhaouti, I.Arramach , M.Lakranbi,, Y Ouadnouni,, M Smahi,
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Abstract:
Bronchopulmonary cancer remains a major public health problem despite the various anti-smoking campaigns. Over the past ten years, its diagnostic and therapeutic management has evolved with the appearance of new techniques of imaging, bronchial endoscopy and molecular biology to better characterize tumors. The TNM classification which allows a better prediction of the prognosis. Faced with a clinical suspicion of bronchopulmonary cancer, the first examination to be carried out remains the frontal and profile chest X-ray supplemented by a chest CT scan. The diagnosis of bronchopulmonary cancer must be confirmed by cytological or histological analysis of the tumor, often with additional immunohistochemical or molecular research. The samples are most often taken during a flexible bronchoscopy. In the absence of an accessible endobronchial tumour, other sampling methods are used (bronchial echoendoscopy, transoesophageal echoendoscopy, pleuroscopy, mediastinoscopy, biopsy of a suspected secondary lesion, lung biopsy). The proposed treatment depends on the extent of the disease and the cardiorespiratory functional status of the patient. The extension assessment, which makes it possible to determine the tumor (T), lymph node (N) and metastatic (M) status of the disease, must be exhaustive. Thoracic computed tomography and positron emission tomography are the key exams in this assessment. The evaluation of mediastinal lymph node invasion may require the use of invasive endoscopic techniques (transbronchial needle biopsy, bronchial echoendoscopy, esophageal echoendoscopy) or surgical techniques (mediastinoscopy). The pre-therapeutic functional assessment includes a cardiological assessment and a respiratory assessment with at least the measurements of the forced expiratory volume per second (FEV) and the transfer of carbon monoxide, which can be supplemented in the event of an anomaly by the measurement of the maximum consumption patient's oxygen.
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