staging of lung cancer

Introduction

Also see pretreatment staging for patients with lung cancer.

Staging of small cell carcinoma:

• limited:
  • single hemithorax
  • mediastinum
  • ipsilateral supraclavicular nodes
• extensive: anything beyond limited

TNM staging of Lung Cancer (non-small cell):

T: primary tumor
  T0: no evidence of primary tumor
  TX: cancer cells in respiratory secretions, no tumor on chest radiographs or at bronchoscopy
 Tis: carcinoma in situ
  T1: tumor <= 3 cm in greatest dimension, surrounded by lung or visceral pleura, no bronchoscopic evidence of tumor invasion proximal to lobar bronchus
  T2: any of the following:
      tumor >= 3 cm in diameter, involves pleural viscera, involves main bronchus 2 cm  or more distal to carina, associated with atelectasis or obstructive pneumonitis,
      extending to hilar region but not involving entire lung
  T3: any of the following:
      tumor involves chest wall, diaphragm, mediastinal pleura or pericardium;  is located =< 2 cm from carina, but does not involve carina; associated atelectasis or obstructive pneumonitis involving entire lung
  T4: tumor involves carina or trachea, or invades mediastinum, heart, great vessels,  esophagus, or vertebrae; separate tumor nodule in same lobe; malignant pleural effusion
N: nodal involvement
  NX: regional lymph nodes cannot be assessed
  N0: no demonstrable lymph node involvement
  N1: ipsilateral peribronchial or hilar lymph node involvement
  N2: metastases to ipsilateral mediastinal lymph nodes, or to subcarinal lymph nodes
  N3: metastases to contralateral mediastinal &/or hilar lymph nodes,  or to ipsilateral or contralateral scalene &/or supraclavicular lymph nodes
M: metastasis
  MX: presence of distant metastases cannot be assessed
  M0: no known distant metastasis
  M1: distant metastasis present [includes separate tumor nodule in different lobe  (ipsilateral or contralateral)]

    Stage 0:     carcinoma in situ
O
P   Stage 1A:    T1,N0,M0
E   Stage 1B:    T2,N0,M0
R
A   Stage 2A:    T1,N1,M0
B   Stage 2B:    T2,N1,M0 or T3,N0,M0
L
E   Stage 3A:    T3,N1,M0, T1,N2,M0, T2,N2,M0, or T3,N2,M0
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    Stage 3B:    any T,N3,M0 or T4,any N,M0

    Stage 4:     any T, any N, M1

Stage 3B & 4 tumors are inoperable.

Occult carcinoma is TX,N0,M0.

Staging procedures:

• biopsy of accessible lesion to establish diagnosis
• CT of thorax
  • CT-guided percutaneous lung biopsy*
• MRI of thorax
  • allergies to iodinated contrast
  • involvement of mediastinum
  • spatial resolution of chest MRI limited by respiratory & cardiac motion artifacts due to longer acquisition time than CT
• flexible bronchoscopy
  • diagnosis of central endobronchial lesions (sensitivity 88%)
  • endoscopic ultrasound guided fine-needle aspiration*
    • mediastinal lymph nodes
    • submucosal or peribronchial tumor
• mediastinoscopy
• thoracoscopy in management of malignant pleural effusions
• MRI of brain if neurologic signs present
• positron emission tomography (PET) scanning may be useful for
  • differentiateing benign from malignant pulmonary nodules
  • detecting distant metastases
• bone scan facilitates detection of bony metastases

* cytology specimens obtained via fine-needle aspiration biopsy are less sensitive than core biopsy specimens

More general terms

• staging of cancer

More specific terms

• pretreatment staging for patients with lung cancer

Additional terms

• lung cancer