Lung mass staging

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

According to the American Joint Committee on Cancer (AJCC) staging system, there are 4 stages of malignant lung mass, based on 3 factors: tumor size, lymph node invasion, and metastasis.[1] Each stage is assigned a letter and a number that designate T for tumor size, N for node invasion, and M for metastasis.

Staging

The following table depicts the TNM classification for lung cancer.

TNM classification of lung cancer [2]
T: Primary tumor
TX Any of: Primary tumor cannot be assessed
Tumor cells present in sputum or bronchial washing, but tumor not seen with imaging or bronchoscopy
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor size less than or equal to 3 cm across, surrounded by lung or visceral pleura, without invasion proximal to the lobar bronchus
T1a Tumor size less than or equal to 2 cm across
T1b Tumor size more than 2 cm but less than or equal to 3 cm across
T2 Any of: Tumor size more than 3 cm but less than or equal to 7 cm across
Involvement of the main bronchus at least 2 cm distal to the carina
Invasion of visceral pleura
Atelectasis/obstructive pneumonitis extending to the hilum but not involving the whole lung
T2a Tumor size more than 3 cm but less than or equal to 5 cm across
T2b Tumor size more than 5 cm but less than or equal to 7 cm across
T3 Any of: Tumor size more than 7 cm across
Invasion into the chest wall, diaphragm, phrenic nerve, mediastinal pleura or parietal pericardium
Tumor less than 2 cm distal to the carina, but not involving the carina
Atelectasis/obstructive pneumonitis of the whole lung
Separate tumor nodule in the same lobe
T4 Any of: Invasion of the mediastinum, heart, great vessels, trachea, carina, recurrent laryngeal nerve, esophagus, or vertebra
Separate tumor nodule in a different lobe of the same lung
N: Lymph nodes
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis to ipsilateral peribronchial and/or hilar lymph nodes
N2 Metastasis to ipsilateral mediastinal and/or subcarinal lymph nodes
N3 Any of: Metastasis to scalene or supraclavicular lymph nodes
Metastasis to contralateral hilar or mediastinal lymph nodes
M: Metastasis
MX Distant metastasis cannot be assessed
M0 No distant metastasis
M1a Any of: Separate tumor nodule in the other lung
Tumor with pleural nodules
Malignant pleural or pericardial effusion
M1b Distant metastasis

References

  1. Stages of non–small cell lung cancer. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/lung/staging/?region=ab
  2. Chheang, S; Brown K (June 2013). "Lung cancer staging: clinical and radiologic perspectives". Seminars in Interventional Radiology. 30 (2): 99–113. doi:10.1055/s-0033-1342950. PMC 3709937. PMID 24436525.