Page 38 - NCCN Guidelines for Patients® | Non-Small Cell Lung Cancer

38 NCCN Guidelines for Patients®: Non-Small Cell Lung Cancer
Version 1.2013
Part 5: Tests by cancer stage
Supraclavicular or scalene biopsy
Stage IIIB lung cancer may have spread to the
supraclavicular or scalene lymph nodes. These nodes
should be tested to confirm if cancer is present.
There is more than one way to access these nodes.
A mediastinoscopy, fine needle aspiration, or other
methods may be used. A mediastinoscopy was described
on page 24. A fine needle aspiration inserts a needle
through skin that has been numbed and into the node
to remove tissue.
Pericardiocentesis
Thoracentesis and thoracoscopy were described in
Part 3.3 on page 25. Pericardiocentesis is much like
thoracentesis. Like the lungs, the heart has a tissue lining
around it called the pericardium. There is fluid between
the two layers of the pericardium. Excess fluid may
build up if cancer invades it. This excess fluid is called
pericardial effusion. Pericardiocentesis removes the
excess fluid with a needle inserted through the chest to
test for cancer cells.
5.4 Molecular tests
Cancer stage Test name
Non-squamous and some
squamous widespread IV
(M1b) tumors
EGFR (epidermal growth
factor receptor) mutation
ALK (anaplastic
lymphoma kinase)
gene rearrangement
If the cancer has spread to more than one area outside
the chest, treatment depends on the histologic subtype
and results of molecular testing. As discussed in Part 4.1,
the histologic subtypes are squamous cell carcinoma,
adenocarcinoma, large-cell lung carcinoma, and other rare
types. Molecular testing looks for known changes in genes
for which there are treatments.
Very few people with squamous cell carcinoma have known
gene changes for which treatments are available. Therefore,
molecular testing of widespread squamous cell carcinoma
is recommended only for people who never smoked.
Molecular testing is recommended for all other histologic
subtypes. Molecular testing is done with biopsy samples, so
you may have more than one biopsy to collect enough cells.
Molecular testing looks for the following gene changes:
EGFR mutation
EGFR is a surface receptor. A surface receptor is a protein
in the membrane of cells that starts changes within the
cell when turned on. Changes (mutations) in the gene that
controls EGFR cause the receptors to be overactive, which
in turn causes new cancer cells to form quickly.