staging of lung cancer

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Introduction

Also see pretreatment staging for patients with lung cancer.

Staging of small cell carcinoma:

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:

* cytology specimens obtained via fine-needle aspiration biopsy are less sensitive than core biopsy specimens[5]

More general terms

More specific terms

Additional terms

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 672, 766
  2. AJCC Cancer Staging Manual. 6th ed. Springer 2002
  3. 3.0 3.1 Annema JT, Versteegh MI, Veselic M, Welker L, Mauad T, Sont JK, Willems LN, Rabe KF. Endoscopic ultrasound added to mediastinoscopy for preoperative staging of patients with lung cancer. JAMA. 2005 Aug 24;294(8):931-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16118383
  4. Fielding DI, Kurimoto N EBUS-TBNA/staging of lung cancer. Clin Chest Med. 2013 Sep;34(3):385-94. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23993811
  5. 5.0 5.1 5.2 5.3 Ahmad A. Lung Cancer Staging: Imaging Options Medscape. Oct. 20, 2016 http://reference.medscape.com/features/slideshow/lung-cancer-staging