Lung cancer staging
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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.[1]
TNM staging system
Tumour
AJCC 7th edition:[2]
| T stage | Size/criteria | Other requirements | Comment |
|---|---|---|---|
| T0 | (no tumour) | rare | |
| Tis | no invasion | rare | |
| T1a | <=2 cm | confined to lung, no visceral pleural invasion (VPI), no main branch bronchus involvement | |
| T1b | >2 cm, <=3 cm | confined to lung, no VPI, no main branch bronchus involvement | |
| T2a | >3cm or VPI or main branch bronchus involvement, <= 5cm | confined to lung, no total lung collapse | |
| T2b | >5cm, < 7cm | confined to lung, no total lung collapse | may have VPI and/or main branch bronchus involvement |
| T3 | >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[3] |
Lymph nodes
AJCC 7th edition:
| 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 | |
| N3 | metastasis in any contralateral node, scalene node or supraclavicular node |
Lymph nodes stations
| Station number | Location | N Staging ‡ |
|---|---|---|
| Station 1 | lower cervical, supraclavicular, sternal notch | N3 for supraclavicular,[4] 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.[5]
Metastases
AJCC 7th edition:
| 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[6] |
| M1b | distant metastasis (extrathoracic organs) |
See also
References
- ↑ López-Encuentra, A.; García-Luján, R.; Rivas, JJ.; Rodríguez-Rodríguez, J.; Torres-Lanza, J.; Varela-Simo, G. (Mar 2005). "Comparison between clinical and pathologic staging in 2,994 cases of lung cancer.". Ann Thorac Surg 79 (3): 974-9; discussion 979. doi:10.1016/j.athoracsur.2004.06.004. PMID 15734416.
- ↑ American Joint Committee on Cancer (2010). AJCC Cancer Staging Handbook: From the AJCC Cancer Staging Manual (7th ed.). New York: Springer. pp. 316. ISBN 978-0387884424.
- ↑ American Joint Committee on Cancer (2010). AJCC Cancer Staging Handbook: From the AJCC Cancer Staging Manual (7th ed.). New York: Springer. pp. 317. ISBN 978-0387884424.
- ↑ Riquet, M.; Mordant, P.; Fabre-Guillevin, E.; Arame, A.; Foucault, C.; Dujon, A.; Le Pimpec Barthes, F. (Dec 2013). "Long-term survival with surgery as part of a multimodality approach for N3 lung cancer.". Eur J Cardiothorac Surg 44 (6): 1117-22. doi:10.1093/ejcts/ezt171. PMID 23543202.
- ↑ Terán, MD.; Brock, MV. (Mar 2014). "Staging lymph node metastases from lung cancer in the mediastinum.". J Thorac Dis 6 (3): 230-6. doi:10.3978/j.issn.2072-1439.2013.12.18. PMID 24624287.
- ↑ American Joint Committee on Cancer (2010). AJCC Cancer Staging Handbook: From the AJCC Cancer Staging Manual (7th ed.). New York: Springer. pp. 299. ISBN 978-0387884424.