Difference between revisions of "Lung cancer staging"

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Lung cancer staging (view source)

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The article deals with '''lung cancer staging'''.  A general discussion of staging is found in ''[[cancer staging]]''.
The article deals with '''lung cancer staging'''.  A general discussion about staging is found in ''[[cancer staging]]''.
 
==General==
The clinical staging and pathologic staging are concordant in only approximately ~50% of cases.<ref name=pmid15734416>{{Cite journal  | last1 = López-Encuentra | first1 = A. | last2 = García-Luján | first2 = R. | last3 = Rivas | first3 = JJ. | last4 = Rodríguez-Rodríguez | first4 = J. | last5 = Torres-Lanza | first5 = J. | last6 = Varela-Simo | first6 = G. | title = Comparison between clinical and pathologic staging in 2,994 cases of lung cancer. | journal = Ann Thorac Surg | volume = 79 | issue = 3 | pages = 974-9; discussion 979 | month = Mar | year = 2005 | doi = 10.1016/j.athoracsur.2004.06.004 | PMID = 15734416 }}</ref>


==TNM staging system==
==TNM staging system==


===Tumour===
===Tumour===
AJCC 7th edition:<ref>{{Ref AJCC7HB|316}}</ref>
{| class="wikitable sortable"  
{| class="wikitable sortable"  
!T stage
!T stage
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| T1a
| T1a
| <=2 cm
| <=2 cm
| confined to lung, no [[VPI]], no main branch bronchus involvement
| confined to lung, no [[visceral pleural invasion|visceral pleural invasion (VPI)]], no main branch bronchus involvement
|
|
|-
|-
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|-
|-
| T2b
| T2b
| >5cm ''or'' VPI ''or'' main branch bronchus involvement, < 7cm
| >5cm, < 7cm
| confined to lung, no total lung collapse
| confined to lung, no total lung collapse
|
| may have VPI ''and/or'' main branch bronchus involvement
|-
|-
| T3
| T3
| >7 cm ''or'' 2 or more nodules ''or'' total lung collapse
| >7 cm ''or'' total lung collapse ''or'' presence of two or more tumour nodules in same lobe ''or'' minor extension beyond lung
| ''minor extension beyond lung'' includes any of the following: parietal plural of chest wall or mediastinal pleura, diaphragm, phrenic nerve, parietal pericardium
| ipsilateral tumour nodule(s) in a ''different'' lobe is T4
|-
| T4
| major extension beyond the lung ''or'' separate lesions in others lobes on the ipsilateral side
| ''major extension beyond the lung'' includes any of the following: carina, trachea, esophagus, recurrent laryngeal nerve, mediastinum, heart, great vessels,  vertebral body
| separate lesions on the contralateral side are M1a<ref>{{Ref AJCC7HB|317}}</ref>
|}
 
===Lymph nodes===
AJCC 7th edition:
{| class="wikitable sortable"
!N stage
!Criteria
!Comment
|-
| N0
| no lymph node metastases
|
|
|-
| N1
| metastasis in any ipsilateral node
| includes hilar, peribronchial & intrapulmonary nodes; direct extension also counts
|-
| N2
| metastasis in any ipsilateral mediastinal node or subcarinal node
|
|
|-
|-
| T4
| N3
| extension beyond the lung
| metastasis in any contralateral node, scalene node or supraclavicular node
|
|
|}
====Lymph nodes stations====
{| class="wikitable sortable"
! Station number
! Location
! N Staging ‡
|-
| Station 1
| lower cervical, supraclavicular, sternal notch
| N3 for supraclavicular,<ref name=pmid23543202>{{Cite journal  | last1 = Riquet | first1 = M. | last2 = Mordant | first2 = P. | last3 = Fabre-Guillevin | first3 = E. | last4 = Arame | first4 = A. | last5 = Foucault | first5 = C. | last6 = Dujon | first6 = A. | last7 = Le Pimpec Barthes | first7 = F. | title = Long-term survival with surgery as part of a multimodality approach for N3 lung cancer. | journal = Eur J Cardiothorac Surg | volume = 44 | issue = 6 | pages = 1117-22 | month = Dec | year = 2013 | doi = 10.1093/ejcts/ezt171 | PMID = 23543202 }}</ref><br> N2 for others
|-
| Station 2
| upper paratracheal nodes (left and right)
| N2
|-
| Station 3
| prevascular (anterior) and retrotracheal (posterior)
| N2
|-
| Station 4
| lower paratracheal (right and left)
| N2
|-
| Station 5
| subaortic/aorto-pulmonary window
| N2
|-
| Station 6
| para-aortic (phrenic or asc. aorta)
| N2
|-
| Station 7
| subcarinal
| N2
|-
| Station 8
| paraesophageal
| N2
|-
| Station 9
| pulmonary ligament
| N2
|-
| Station 10
| hilar nodes (left and right)
| N1
|-
| Station 11
| interlobar nodes (left and right)
| N1
|-
| Station 12
| lobar (left and right)
| N1
|-
| Station 13
| segmental (left and right)
| N1
|-
| Station 14
| subsegmental (left and right)
| N1
|}
Note:
*‡ Contralateral lymph node involvement is ''N3''.<ref name=pmid24624287>{{Cite journal  | last1 = Terán | first1 = MD. | last2 = Brock | first2 = MV. | title = Staging lymph node metastases from lung cancer in the mediastinum. | journal = J Thorac Dis | volume = 6 | issue = 3 | pages = 230-6 | month = Mar | year = 2014 | doi = 10.3978/j.issn.2072-1439.2013.12.18 | PMID = 24624287 }}</ref>
===Metastases===
AJCC 7th edition:
{| class="wikitable sortable"
!M stage
!Criteria
!Comment
|-
| M1a
| nodule in contralateral lung ''or'' malignant pleural effusion ''or'' malignant pericardial effusion
| malignant effusion in a previous edition were pT4<ref>{{Ref AJCC7HB|299}}</ref>
|-
| M1b
| distant metastasis (extrathoracic organs)
|
|
|}
|}
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==See also==
==See also==
*[[Lung tumours]].
*[[Lung tumours]].
*[[Lung adenocarcinoma]].
*[[Lung squamous cell carcinoma]].
==References==
{{Reflist|1}}


==External links==
==External links==
Michael
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