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

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.

External links