Diagnosis and Staging

"Diagnosis" is what your healthcare team does to recognize whether or not you have non-small cell lung cancer, based on its outward signs and symptoms. "Staging" is a description of how far the cancer has spread, described as stages I through IV. Both the diagnosis and staging of lung cancer are multistep processes that are required in order for you and your healthcare team to make decisions about treatment.

Diagnostic Tests
Staging
Your Healthcare Team
Treatment Options

Diagnostic Tests
The process begins with your healthcare team learning about your health history, and conducting a physical exam. Your healthcare team may then order one or more of the following diagnostic tests:

Chest x-ray
A chest x-ray usually is the first test performed to detect lung cancer. An x-ray is a two-dimensional picture of the inside of your lungs that can help locate a tumor in the lungs.¹
CT and MRI scans
These tests are conducted by two different machines that show three-dimensional images of your body. Computerized tomography (also called "CT") and magnetic resonance imaging ("MRI") images, or "scans," produce highly detailed pictures that are like slices of your body. These can help determine the size, shape, and location of a cancerous tumor.¹
PET scans
A newer technology called "positron emission tomography" (also known by its initials, "PET") can make scans of your body that distinguish between normal cells and quickly multiplying cancer cells. These PET scans are often used as a follow-up to other tests to see if a tumor is "malignant" (cancerous) or "benign" (non-cancerous), or if the cancer has spread outside the lungs and into the chest cavity.¹
Bone scans
These scans are usually done when there is reason to think that cancer may have spread to the bones and other test results aren't clear. A small (and safe) amount of radioactive substance is injected into a vein, where the substance accumulates in areas of bone that might be abnormal due to cancer. These areas will be seen on the bone scan image as dense, gray-to-black areas that are called "hot spots."¹
Blood tests
These tests are not used to find lung cancer, but are instead done to get a sense of a person's overall health. A "complete" blood test is done if you are treated with chemotherapy, because these drugs can affect the blood-forming cells of the bone marrow. Other types of blood tests can spot problems in different organs such as the kidneys, liver, and bones.¹
Sputum cytology
If cancer cells are present in the bronchial tubes of the lungs, they are likely to be present in mucous, or "sputum" that is coughed up from the lungs. "Sputum cytology" examines the sputum under a microscope to look to see if there are any cancer cells there.¹
Biopsy
A biopsy is the examination of a small sample of the tumor through a microscope. It usually is done to confirm a cancer diagnosis, and to identify the type of cancer you may have and how far it has spread (its "stage").¹

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Staging
Lung cancer grows and spreads in stages, and the diagnostic process of "staging" is used to determine what kind of tumor you may have. Learning about your particular type of lung cancer can help you talk with your healthcare team and make decisions about your treatment.

The following table describes the stages for non-small cell lung cancer, and the common treatments for each.

*The shaded areas indicate the stages of non-small cell lung cancer that can be treated with GEMZAR.

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Your Healthcare Team
Non-small cell lung cancer is a serious disease that is usually treated by a team of healthcare professionals with different specialties. Members of a healthcare team might include a surgeon, radiation oncologist, medical oncologist, radiologist, pathologist, oncology nurse, and social worker, among others. Not everyone with non-small cell lung cancer should receive the same treatment. Your particular medical situation will determine the type of treatment you receive.

Each person's journey with cancer is different. Your own experience will depend on the stage of the cancer and other factors such as your general state of health and your treatment goals. You should talk openly with your healthcare team about your cancer stage and prognosis, and how they affect your treatment options.

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Treatment Options
Treatment options for non-small cell lung cancer typically include surgery and chemotherapy. The goal of surgery is to remove as much of the cancer as possible. However, depending on the stage of the cancer, some cancer cells may remain after surgery.

Chemotherapy is any treatment involving the use of drugs to kill cancer cells. Cancer chemotherapy may consist of single drugs or combinations of drugs. It can be given through a vein, injected into a body cavity, or delivered orally in the form of a pill. Chemotherapy is different from surgery in that the cancer-fighting drugs circulate in the blood to parts of the body where the cancer may have spread; it can kill or eliminate cancers cells at sites far from the original cancer.⁴

The initial treatment of non-small cell lung cancer is called "first-line" therapy. If the cancer continues to grow with first-line therapy or returns after first-line therapy, additional treatment, called "second-line" therapy, may be given. If the tumor continues to grow after second-line therapy, the next therapy is called third-line therapy, and so on.

Clinical trials have been performed and reviewed by the FDA on each of these options to determine their effectiveness and safety. As you and your healthcare team consider options for cancer treatment, it is important to carefully consider the results of clinical trials and the side effects of all available therapies.

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Now let's see how GEMZAR can help.

References:

American Cancer Society. How Is Non-Small Cell Lung Cancer Diagnosed?
Available at: http://www.cancer.org/docroot/CRI/content/….
Accessed March 4, 2008.
American Cancer Society. How Is Non-Small Cell Lung Cancer Staged?
Available at: http://www.cancer.org/docroot/CRI/content/….
Accessed March 4, 2008.
The Wellness Community. Treatment of NSCLC by Stage.
Available at: http://www.thewellnesscommunity.org/education/lung/stage.php.
Accessed March 4, 2008.
American Cancer Society. Chemotherapy.
Available at: http://www.cancer.org/docroot/CRI/content/CRI_2_4_4x_Chemotherapy_15.asp?sitearea=
Accessed April 14, 2008.

About GEMZAR

GEMZAR is indicated in combination with cisplatin (another type of chemotherapy) for the first-line treatment of patients with locally advanced (stage IIIA or stage IIIB) or metastatic (stage IV or cancer that has spread) non-small cell lung cancer for whom surgery is not possible.

GEMZAR is indicated in combination with carboplatin (another type of chemotherapy) for the woman with ovarian cancer that has returned at least 6 months after the patient had finished platinum-based therapy.

GEMZAR in combination with paclitaxel is approved by the FDA for the first-line treatment of patients with metastatic breast cancer after they have received another type of chemotherapy called an anthracycline, unless their medical condition did not allow them to receive an anthracycline.

GEMZAR is indicated as a single agent (given alone) as the first-line treatment for patients with locally advanced (stage II or stage III when surgery is not an option) or metastatic (stage IV) adenocarcinoma of the pancreas. GEMZAR is also indicated for patients previously treated with 5-FU (another type of chemotherapy).

Important Safety Information

GEMZAR may not be appropriate for some patients.

If you are allergic to GEMZAR, tell your doctor you should not receive it. GEMZAR can suppress bone marrow function. There have been rare reports of serious kidney or liver toxicity with GEMZAR treatment, sometimes fatal. Serious lung toxicity has also been reported, sometimes fatal. If you think you are pregnant, are planning to be pregnant, or are nursing, please tell your healthcare team. GEMZAR may harm your unborn or nursing baby.

If you have had prior kidney or liver problems or impairment, please tell your healthcare professional. GEMZAR may not be right for you. GEMZAR has not been shown to work in children. Tell your doctor if you are taking other medicines, including prescription and nonprescription medicines, vitamins, or herbal supplements.

There is a risk of side effects associated with GEMZAR therapy. The most common side effects are low blood cell counts (red blood cells, white blood cells, and platelets); fever; infection; hair loss; tiredness; nausea, vomiting, constipation, and diarrhea; rash; shortness of breath; muscle aches; and numbness or tingling in your toes or fingers. These are not all of the side effects of GEMZAR. If you have any side effect that bothers you or that doesn't go away, be sure to talk with your healthcare professional. Call your healthcare professional right away if you have fever or chills. These symptoms could mean you have an infection.

You will have regular blood tests before and during your treatment with GEMZAR. Your doctor may adjust your dose of GEMZAR or delay your treatment based on the results of your blood test and on your general condition.

For more information about all of the side effects of GEMZAR, please talk with your healthcare team, see the complete Prescribing Information, or call 1-800-545-5979.

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