Lung cancer staging: Difference between revisions
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{{CMG}}; '''Associate Editor(s)-In-Chief:''' Kim-Son H. Nguyen, M.D., M.P.A., Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, {{CZ}}; '''Assistant Editor(s)-In-Chief:''' [[User:Michael Maddaleni|Michael Maddaleni, B.S.]] | {{CMG}}; '''Associate Editor(s)-In-Chief:''' Kim-Son H. Nguyen, M.D., M.P.A., Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, {{CZ}}; '''Assistant Editor(s)-In-Chief:''' [[User:Michael Maddaleni|Michael Maddaleni, B.S.]] | ||
==Overview== | ==Overview== | ||
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:[[EUS-FNA]] (esophogeal endoscopic ultrasound guided fine needle aspiration).</br> | :[[EUS-FNA]] (esophogeal endoscopic ultrasound guided fine needle aspiration).</br> | ||
== | ==TNM Classification of Lung Cancer== | ||
===Primary tumor=== | ===T: Primary Tumor=== | ||
{| style="cellpadding=0; cellspacing= 0; width: 600px;" | |||
|- | |||
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align=center |'''T'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''Description''' | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |TX || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Primary tumor cannot be assessed.<br> OR <br>Tumor is demonstrated by the presence of malignant cells in bronchial washings or [[sputum]], but is not visualized by imaging or [[bronchoscopy]]. | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | T0 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |There is no evidence of primary tumor. | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Tis ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Carcinoma in situ | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T1 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |The tumor has the following characteristics: <br> The greatest dimension is <3 cm <br> AND <br>The tumor is surrounded by lung or [[visceral pleura]]<br> AND <br>The tumor does not extend to the main bronchus as demonstrated by the absence of bronchoscopic evidence of invasion more proximal than the lobar bronchus. | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T2 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |The tumor has the following characteristics:<br> | |||
The greatest dimension is >3cm | |||
<br> OR <br> | |||
The tumor involves the main bronchus, 2 cm or more distal to the [[carina]]. | |||
<br> OR <br> | |||
The tumor invades the [[visceral pleura]]. | |||
<br> OR <br> | |||
There is evidence of [[atelectasis]] or obstructive [[pneumonitis]] that extends to the hilar region without the involvement of the entire lung. | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T3 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |The tumor is of any size AND it directly invades any of the following: [[chest wall]] (including superior sulcus tumors), [[diaphragm]], mediastinal pleura, parietal [[pericardium]]. | |||
<br> OR <br>The tumor is localized in the main bronchus at a distance less than 2 cm distal to the [[carina]] but without the involvement of the [[carina]]. | |||
<br> OR <br>There is evidence of associated [[atelectasis]] or obstructive [[pneumonitis]] of the entire lung. | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T4 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |The tumor is of any size that invades any of the following: [[mediastinum]], [[heart]], great vessels, [[trachea]], [[esophagus]], [[vertebral body]], [[carina]]<br> OR <br>There is/are separate tumor nodule(s) in the same lobe. <br> OR <br> | |||
The tumor is associated with malignant [[pleural effusion]]. | |||
|} | |||
===Regional lymph node | ===N:Regional Lymph Nodes=== | ||
{| style="cellpadding=0; cellspacing= 0; width: 600px;" | |||
|- | |||
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align=center |'''T'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''Description''' | |||
|- | |||
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |NX ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |the regional [[lymph node]]s cannot be assessed. | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N0 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |There is no evidence of regional lymph node metastasis. | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N1 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |There is [[metastasis]] in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension. | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N2 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |There is [[metastasis]] in ipsilateral mediastinal and/or subcarinal lymph node(s). | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N3 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |There is [[metastasis]] in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s). | |||
|} | |||
=== | ===M: Distant Metastasis=== | ||
{| style="cellpadding=0; cellspacing= 0; width: 600px;" | |||
|- | |||
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align=center |'''T'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''Description''' | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |MX ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Distant metastasis cannot be assessed. | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M0 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |There is no evidence of distant [[metastasis]]. | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M1 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |There is evidence of [[distant]] metastasis which includes the presence of separate tumor nodule(s) in a different lobe (ipsilateral or contralateral). | |||
|} | |||
== | ==Classification of Lung Cancer by Staging== | ||
{| style="cellpadding=0; cellspacing= 0; width: 600px;" | |||
|- | |||
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''Stage'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''T'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''N'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''M''' | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Occult carcinoma''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |TX|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N0|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M0 | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Stage 0''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Tis ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M0 | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Stage IA''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M0 | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Stage IB''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N0 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | M0 | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Stage IIA''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M0 | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Stage IIB''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N1 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | M0 | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Stage IIB''' ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M0 | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Stage IIIA''' ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T1, T2|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N2 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M0 | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Stage IIIA''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T3|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N1, N2 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M0 | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Stage IIIB''' ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Any T|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |N3 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M0 | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Stage IIIB'''||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T4 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Any N ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M0 | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Stage IV'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Any T ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Any N ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |M1 | |||
|} | |||
==References== | ==References== |
Revision as of 19:51, 9 June 2014
Lung cancer Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Lung cancer staging On the Web |
American Roentgen Ray Society Images of Lung cancer staging |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Kim-Son H. Nguyen, M.D., M.P.A., Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, Cafer Zorkun, M.D., Ph.D. [2]; Assistant Editor(s)-In-Chief: Michael Maddaleni, B.S.
Overview
Lung cancer staging is an assessment of the degree of spread of the cancer from its original source. It is an important factor affecting the prognosis and potential treatment of lung cancer.
Non-small cell lung carcinoma is staged from IA ("one A", best prognosis) to IV ("four", worst prognosis).[1] Small cell lung carcinoma is classified as limited stage if it is confined to one half of the chest and within the scope of a single radiotherapy field. Otherwise it is extensive stage.[2]
Procedures
There are currently multiple different procedures available to stage lung cancer. They can be broken down into two over-arching categories, invasive and minimally invasive.
The invasive procedures are:
- EUS-NA (esophageal endoscopic ultrasound with needle aspiration)
- TBNA (transbronchial needle aspiration)
- EBUS-NA (endobronchial ultrasound with needle aspiration)
- TTNA (transthoracic needle aspiration)
- VATS staging (video assisted thoracic surgery) aka thoracoscopy.
- Extended cervical mediastinoscopy
- Chamberlain procedure
The minimally invasive procedures are:
- EBUS-FNA (endobronchial ultrasound guided fine needle aspiration).
- EUS-FNA (esophogeal endoscopic ultrasound guided fine needle aspiration).
TNM Classification of Lung Cancer
T: Primary Tumor
T | Description |
TX | Primary tumor cannot be assessed. OR Tumor is demonstrated by the presence of malignant cells in bronchial washings or sputum, but is not visualized by imaging or bronchoscopy. |
T0 | There is no evidence of primary tumor. |
Tis | Carcinoma in situ |
T1 | The tumor has the following characteristics: The greatest dimension is <3 cm AND The tumor is surrounded by lung or visceral pleura AND The tumor does not extend to the main bronchus as demonstrated by the absence of bronchoscopic evidence of invasion more proximal than the lobar bronchus. |
T2 | The tumor has the following characteristics: The greatest dimension is >3cm
|
T3 | The tumor is of any size AND it directly invades any of the following: chest wall (including superior sulcus tumors), diaphragm, mediastinal pleura, parietal pericardium.
|
T4 | The tumor is of any size that invades any of the following: mediastinum, heart, great vessels, trachea, esophagus, vertebral body, carina OR There is/are separate tumor nodule(s) in the same lobe. OR The tumor is associated with malignant pleural effusion. |
N:Regional Lymph Nodes
T | Description |
NX | the regional lymph nodes cannot be assessed. |
N0 | There is no evidence of regional lymph node metastasis. |
N1 | There is metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension. |
N2 | There is metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s). |
N3 | There is metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s). |
M: Distant Metastasis
T | Description |
MX | Distant metastasis cannot be assessed. |
M0 | There is no evidence of distant metastasis. |
M1 | There is evidence of distant metastasis which includes the presence of separate tumor nodule(s) in a different lobe (ipsilateral or contralateral). |
Classification of Lung Cancer by Staging
Stage | T | N | M |
Occult carcinoma | TX | N0 | M0 |
Stage 0 | Tis | N0 | M0 |
Stage IA | T1 | N0 | M0 |
Stage IB | T2 | N0 | M0 |
Stage IIA | T1 | N1 | M0 |
Stage IIB | T2 | N1 | M0 |
Stage IIB | T3 | N0 | M0 |
Stage IIIA | T1, T2 | N2 | M0 |
Stage IIIA | T3 | N1, N2 | M0 |
Stage IIIB | Any T | N3 | M0 |
Stage IIIB | T4 | Any N | M0 |
Stage IV | Any T | Any N | M1 |
References
- ↑ Mountain, CF (2003). A Handbook for Staging, Imaging, and Lymph Node Classification. Charles P Young Company. Retrieved 2007-09-01. Unknown parameter
|coauthors=
ignored (help) - ↑ Collins, LG (Jan 2007). "Lung cancer: diagnosis and management". American Family Physician. American Academy of Family Physicians. 75 (1): 56–63. PMID 17225705. Retrieved 2007-08-10. Unknown parameter
|coauthors=
ignored (help)