Lung Cancer Staging

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Lung Cancer Staging

TNM is the staging system used for staging of lung cancer.

T Staging

Tis – Pre-cancerous changes or carcinoma in situ. No spread to nearby lymph nodes or distant body parts.

T1mi– Cancer is minimally invasive adenocarcinoma </=3 cm in greatest dimension and invasion </=5 mm in greatest dimension. No spread to nearby lymph nodes or distant body parts.

T1a – A tumor </=1 cm in the greatest dimension without invasion of the pleural membrane or main bronchus. No spread to nearby lymph nodes or distant body parts.

T1b – A tumor >1 cm but </=2 cm in the greatest dimension without invasion of the pleural membrane or main bronchus. No spread to nearby lymph nodes or distant body parts.

T1c – A tumor >2 cm but </=3 cm in the greatest dimension without invasion of the pleural membrane or main bronchus. No spread to nearby lymph nodes or distant body parts.T1, tumor less than 3 cmT2a – A tumor >3 cm but </=4 cm in the greatest dimension that:

  • has invaded into the main bronchus but has not affected the carina (the point where the trachea divides into the 2 bronchi), or
  • invades the visceral pleura, or
  • is partially choking the airway

T2a, tumor 3 cm to 4 cmT2b – A tumor >4 cm but </=5 cm in the greatest dimension that:

  • has invaded into the main bronchus but has not affected the carina (the point where the trachea divides into the 2 bronchi)
  • has grown into the visceral pleura
  • is partially choking the airway

T2b, tumor 4 cm to 5 cmT3 – A tumor >5 cm but </=7 cm in the greatest dimension

  • that has invaded into the parietal pleura, chest wall, phrenic nerve, or the membranes surrounding the heart (parietal pericardium); or
  • there are 2 separate primary tumor nodules within the same lobe.

T3, spread to chest wall, pleura, ribsT3, spread to parietal pericardiumT3, invades phrenic nerveT3, cancer nodules in same lobeT4 – A tumor >7 cm in the greatest dimension that

  • has invaded into the diaphragm, mediastinum, heart, large blood vessels, trachea, recurrent laryngeal nerve, esophagus, backbone, or carina; or
  • there is another tumor nodule in the adjacent lobe of the same lung.

T4, size more than 7 cmT4, invades diaphragmT4 - tumor invades heartT4 - tumor invades major blood vesselsT4, invades esophagus or food pipeT4 - tumor invades carinaT4 - tumor invades vertebraT4, multiple tumors in different lobe of same lung

N Staging

N0 – No spread of cancer to nearby lymph nodes

N1 – Cancer has spread to nearby lymph nodes within the lung or along the bronchus or around the area where the bronchus enters the lungN1, spread to same side lung nodesN2 – Cancer has spread to subcarinal or ipsilateral mediastinal lymph nodesN2, same side mediastinal or subcarinal nodeN3 – Cancer has spread to mediastinal lymph nodes on the other side of the primary tumor, or nodes near the collarbone (supraclavicular nodes) N3, opposite side mediastinal, or scale

M Staging

M0 – Cancer has not spread to distant body parts

M1a – Spread of cancer cells into the pleura or pleural fluid (malignant pleural effusion) or into the pericardium or pericardial fluid (malignant pericardial effusion). M1a, spread to pleura or pericardium or effusionM1a, cancer in both lungsM1b – Single tumor deposit in a single distant organ (for example, liver, bones, brain, etc) or to a non-regional lymph node. M1b, spread to single area outside chestM1c – Multiple tumor deposits in single or multiple distant organs. M1c, multiple deposits outside chest

Stage 1

Stage 1 lung cancer may be stage 1A or 1B. Depending on TNM staging discussed above, lung cancer cases included in stage 1 are as following-

IA1

T1mi N0 M0

 OR

T1a N0 M0

IA2

T1b N0 M0

IA3

T1c N0 M0

IB

T2a N0 M0

Stage 2

Stage 2 lung cancer may be Stage 2A or 2B, as described below-

IIA

T2b N0 M0

IIB

T1a-2b N1 M0

OR

T3 N0 M0

Stage 3

Stage 3 may be further classified as Stage 3A, 3B or 3C, as described below-

IIIA

T1a-2b N2 M0

OR

T3 N1 M0

OR

T4 N0-1 M0

IIIB

T1a-2b N3 M0

OR

T3-4 N2 M0

IIIC

T3-4 N3 M0

Stage 4

And finally, Stage 4 may be Stage 4A or 4B as described below-

IVA

Any T Any N M1a

OR

Any T Any N M1b

IVB

Any T Any N M1c

Staging for Small Cell Lung Cancer

Additionally, SCLC is divided into following 2 stages based on the extent of disease spread and type of treatment approach to be followed:

Limited-Stage

This means that cancer is only on one side of the chest and might have spread to lymph nodes (including lymph nodes above the collarbone) on the same side. This type of SCLC is generally confined to a specific small region of the lung that can be treated with a single radiation field.

Extensive-Stage

This means that cancer has extensively spread throughout the lung, to other lung, lymph nodes on the other side of the chest, pleural membrane, distant lymph nodes, or distant organ. This type of SCLC cannot be treated with a single radiation therapy and require chemotherapy for their management.

 

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