Pancoast tumor classification: Difference between revisions

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{{CMG}}; {{AE}}  
{{CMG}}; {{AE}}  
==Overview==
==Overview==
The [[Staging (pathology)|staging]] of the pancoast tumor is based on the [[TNM system]]. Pancoast tumors [[Cancer staging|staging]] starts at T3  always, as there is an [[Chest wall|invasion of the chest wall]]. [[Invasion]] of the [[vertebral body]] or the [[Subclavian|subclavian vessels]] is regarded as T4.
==Classification==
==Classification==
*The staging of pancoast tumor is based on the TNM system.
*The [[Staging of lung cancer|staging]] of pancoast tumor is based on the [[TNM system]].<ref name="pmid8353149">{{cite journal |vauthors=Naruke T |title=Significance of lymph node metastases in lung cancer |journal=Semin. Thorac. Cardiovasc. Surg. |volume=5 |issue=3 |pages=210–8 |year=1993 |pmid=8353149 |doi= |url=}}</ref><ref name="pmid12717414">{{cite journal |vauthors=Kraut MJ, Vallières E, Thomas CR |title=Pancoast (superior sulcus) neoplasms |journal=Curr Probl Cancer |volume=27 |issue=2 |pages=81–104 |year=2003 |pmid=12717414 |doi= |url=}}</ref><ref name="pmid3514171">{{cite journal |vauthors=Mountain CF |title=A new international staging system for lung cancer |journal=Chest |volume=89 |issue=4 Suppl |pages=225S–233S |year=1986 |pmid=3514171 |doi= |url=}}</ref>
*Pancoast tumors staging starts at T3  always, as there is invasion of chest wall. Invasion of vertebral body or the subclavian vessels is regarded as T4.
*Pancoast tumors staging starts at T3  always, as there is [[Chest wall|invasion of chest wall]]. [[Invasion]] of [[vertebral body]] or the [[Subclavian|subclavian vessels]] is regarded as T4.
{| class="wikitable" align="right"
{| class="wikitable" align="right"
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Stage'''
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Stage'''
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| style="background:#F5F5F5;" + |M0
| style="background:#F5F5F5;" + |M0
|-
|-
|IIIB
| style="background:#DCDCDC;" align="center" + |IIIB
|Any T
| style="background:#F5F5F5;" + |Any T
|N3
| style="background:#F5F5F5;" + |N3
|M0
| style="background:#F5F5F5;" + |M0
|-
|-
| style="background:#DCDCDC;" align="center" + |IV
| style="background:#DCDCDC;" align="center" + |IV
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! rowspan="4" style="background:#DCDCDC;" align="center" + | T
! rowspan="4" style="background:#DCDCDC;" align="center" + | T
| style="background:#DCDCDC;" align="center" + | T1
| style="background:#DCDCDC;" align="center" + | T1
| style="background:#F5F5F5;" + |Tumor size ≤3cm in greatest dimension
| style="background:#F5F5F5;" + |[[Tumor|Tumor size]] ≤3cm in greatest [[dimension]]
|-
|-
| style="background:#DCDCDC;" align="center" + |T2
| style="background:#DCDCDC;" align="center" + |T2
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
* Tumor size >3cm to ≤5cm
* [[Tumor|Tumor size]] >3cm to ≤5cm
* Tumor of any size that
* [[Tumor]] of any size that
** invades the visceral pleura
** invades the [[visceral pleura]]
** involves main bronchus, irrespective of distance to the carina
** involves [[main bronchus]], irrespective of distance to the [[carina]]
** shows an atelectasis or obstructive pneumonitis that extends to the hilum
** shows an [[atelectasis]] or [[Pneumonitis|obstructive pneumonitis]] that extends to the [[hilum]]
|-
|-
| style="background:#DCDCDC;" align="center" + |T3
| style="background:#DCDCDC;" align="center" + |T3
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
* Tumor size >5cm to 7cm  
* [[Tumor]] size >5cm to 7cm  
* Pancoast that involves thoracic nerve roots T1 and T2 only.
* Pancoast tumor that involves [[Thoracic nerve|thoracic nerve roots]] T1 and T2 only.
* Tumor of any size that
* [[Tumor]] of any size that
** invades the chest wall
** invades the [[chest wall]]
** invades the pericardium
** invades the [[pericardium]]
** invades the phrenic nerve
** invades the [[Phrenic nerves|phrenic nerve]]
** involves main bronchus, irrespective of distance to the carina
** involves [[main bronchus]], irrespective of distance to the [[carina]]
** shows one or more satellite nodules in the same lung lobe
** shows one or more satellite [[nodules]] in the same [[Lung|lung lobe]]
|-
|-
| style="background:#DCDCDC;" align="center" + |T4
| style="background:#DCDCDC;" align="center" + |T4
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
* Tumor size >7cm
* [[Tumor]] size >7cm
* Involvement of C8 or higher nerve roots, brachial plexus, subclavian vessels or spine
* Involvement of [[C8]] or [[Nerve root|higher nerve roots]], [[brachial plexus]], [[Subclavian|subclavian vessels]] or [[spine]]
* Tumor of any size that
* [[Tumor]] of any size that
** invades mediastinal fat or mediastinal structures
** invades [[mediastinal]] [[fat]] or [[Mediastinal|mediastinal structures]]
** invades the diaphragm
** invades the [[diaphragm]]
** involves the carina
** involves the [[carina]]
** shows one or more satellite nodules in another lobe on the ipsilateral side
** shows one or more satellite [[nodules]] in another [[lobe]] on the [[Ipsilateral|ipsilateral side]]
|-
|-
! rowspan="4" style="background:#DCDCDC;" align="center" + | N
! rowspan="4" style="background:#DCDCDC;" align="center" + | N
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|-
|-
| style="background:#DCDCDC;" align="center" + |N1
| style="background:#DCDCDC;" align="center" + |N1
| style="background:#F5F5F5;" + |Nodes are ipsilateral nodes within the lung up to hilar nodes.
| style="background:#F5F5F5;" + |[[Lymph node|Nodes]] are [[ipsilateral]] [[Lymph node|nodes]] within the [[lung]] up to [[Hilar|hilar nodes]].
|-
|-
!N2
| style="background:#DCDCDC;" align="center" + |N2
!Nodes represent ipsilateral mediastinal or subcarinal lymphadenopathy.
| style="background:#F5F5F5;" + |[[Lymph node|Nodes]] represent [[ipsilateral]] [[mediastinal]] or subcarinal [[lymphadenopathy]].
|-
|-
!N3
| style="background:#DCDCDC;" align="center" + |N3
!'''Nodes represent contralateral mediastinal or contralateral hilar lymphadenopathy or any scalene or supraclavicular nodes.'''
| style="background:#F5F5F5;" + |[[Lymph node|Nodes]] represent [[contralateral]] [[mediastinal]] or [[contralateral]] [[hilar]] [[lymphadenopathy]] or any [[scalene]] or [[supraclavicular]] [[Lymph node|nodes]].
|-
|-
! rowspan="2" style="background:#DCDCDC;" align="center" + | M
| rowspan="2" style="background:#DCDCDC;" align="center" + | M
| style="background:#DCDCDC;" align="center" + |M0
| style="background:#DCDCDC;" align="center" + |M0
| style="background:#F5F5F5;" + |No distant [[metastasis]]
| style="background:#F5F5F5;" + |No distant [[metastasis]]

Latest revision as of 17:55, 15 March 2018


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

The staging of the pancoast tumor is based on the TNM system. Pancoast tumors staging starts at T3  always, as there is an invasion of the chest wall. Invasion of the vertebral body or the subclavian vessels is regarded as T4.

Classification

Stage T N M
IIB T3 N0 M0
IIIA T3 N1-2 M0
IIIB T4 Any N M0
IIIB Any T N3 M0
IV Any T Any N M1
TNM-8th Edition
T T1 Tumor size ≤3cm in greatest dimension
T2
T3
T4
N N0 No regional lymph node metastasis
N1 Nodes are ipsilateral nodes within the lung up to hilar nodes.
N2 Nodes represent ipsilateral mediastinal or subcarinal lymphadenopathy.
N3 Nodes represent contralateral mediastinal or contralateral hilar lymphadenopathy or any scalene or supraclavicular nodes.
M M0 No distant metastasis
M1 Distant metastasis

References

  1. Naruke T (1993). "Significance of lymph node metastases in lung cancer". Semin. Thorac. Cardiovasc. Surg. 5 (3): 210–8. PMID 8353149.
  2. Kraut MJ, Vallières E, Thomas CR (2003). "Pancoast (superior sulcus) neoplasms". Curr Probl Cancer. 27 (2): 81–104. PMID 12717414.
  3. Mountain CF (1986). "A new international staging system for lung cancer". Chest. 89 (4 Suppl): 225S–233S. PMID 3514171.

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