staging of lung cancer
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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 ----------------------------------------------------------------- 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:
- CT of thorax
- CT-guided percutaneous lung biopsy*
- MRI of thorax
- allergies to iodinated contrast
- involvement of mediastinum[5]
- spatial resolution of chest MRI limited by respiratory & cardiac motion artifacts due to longer acquisition time than CT[5]
- flexible bronchoscopy
- diagnosis of central endobronchial lesions (sensitivity 88%)
- endoscopic ultrasound guided fine-needle aspiration*
- mediastinal lymph nodes[3]
- 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[5]
More general terms
More specific terms
Additional terms
References
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 672, 766
- ↑ AJCC Cancer Staging Manual. 6th ed. Springer 2002
- ↑ 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
- ↑ 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
- ↑ 5.0 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