| Staging:
Definition of TNM: |
|
Primary
Tumor (T):
|
|
TX
|
Primary
tumor cannot be assessed, or tumor proven by the
presence of malignant cells in sputum or bronchial
washings but not visualized by imaging or bronchoscopy |
|
T0
|
No
evidence of primary tumor |
|
Tis
|
Carcinoma
in situ |
|
T1
|
Tumor
3 cm or less in greatest dimension, surrounded
by lung or visceral pleura, without bronchoscopic
evidence of invasion more proximal than the lobar
bronchus,* (i.e., not in the main bronchus)
|
|
T2
|
Tumor
with any of the following features of size or
extent:
| |
More
than 3 cm in greatest dimension |
| |
Involves
main bronchus, 2 cm or more distal to the
carinav |
| |
Invades
the visceral pleura |
| |
Associated
with atelectasis or obstructive pneumonitis
that extends to the hilar region but does
not involve the entire lung |
|
|
T3
|
Tumor
of any size that directly invades any of the following:
chest wall (including superior sulcus tumors),
diaphragm, mediastinal pleura, parietal pericardium;
or tumor in the main bronchus less than 2 cm distal
to the carina, but without involvement of the
carina; or associated atelectasis or obstructive
pneumonitis of the entire lung
|
|
T4
|
Tumor
of any size that invades any of the following: mediastinum,
heart, great vessels, trachea, esophagus, vertebral
body, carina; or separate tumor nodules in the same
lobe; or tumor with a malignant pleural effusion**
|
|
Regional
Lymph Nodes (N)
|
|
NX
|
Regional
lymph nodes cannot be assessed |
|
N0
|
No
regional lymph node metastasis |
|
N1
|
Metastatsis
to ipsilateral peribronchial and/or ipsilateral
hilar lymph nodes, and intrapulmonary nodes including
involvement by direct extension of the primary tumor |
|
N2
|
Metastasis
to ipsilateral mediastinal and/or subcarinal lymph
node(s) |
|
N3
|
Metastasis
to contralateral mediastinal, contralateral hilar,
ipsilateral or contralateral scalene, or supraclavicular
lymph node(s) |
|
Distant
Metastasis (M)
|
|
MX
|
Distant
metastasis cannot be assessed |
|
M0
|
No
distant metastasis |
|
M1
|
Distant
metastasis present
|
|
STAGE
GROUPING
|
| 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 |
|
|
T3 |
N0 |
M0 |
|
Stage
IIIA
|
T1 |
N2 |
M0 |
|
|
T2 |
N2 |
M0 |
|
|
T3 |
N1 |
M0 |
|
|
T3 |
N2 |
M0 |
| Stage
IIIB |
Any
T |
N3
|
M0 |
| |
T4
|
Any
N |
M0 |
| Stage
IV |
Any
T |
Any
N |
M1
|
|
|
|
*Note:
The uncommon superficial tumor of any size with its
invasive component limited to the bronchial wall,
which may extend proximal to the main bronchus, is
also classified T1.
**Note:
Most pleural effusions associated with lung cancer
are due to tumor. However, there are a few patients
in whom multiple cytopathologic examinations
of pleural fluid are negative for tumor. In these
cases, fluid is non-bloody and is not an exudate.
When these elements and clinical judgment dictate
that the effusion is not related to the tumor, the
effusion should be excluded as a staging element and
the patient should be staged T1, T2 or T3.
Note: M1 includes separate tumor nodule(s) in a different
lobe (ipsilateral or contralateral).
For
small cell cancer of the lung a different approach
is more commonly used. As previously mentioned, after
staging, although the number system of Stages I to
IV are still used, it is more common to refer to limited
(cancer confined to the chest) or extensive
(cancer outside the chest). This will determine what
treatments will be offered.
|
|
