Adenocarcinoma of the lung staging

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shanshan Cen, M.D. [2]

Overview

Adenocarcinoma of the lung may be classified into several subtypes based on TNM and UICC staging system.[1]

Staging

TNM staging[1]

TNM Definition
TX The primary tumour cannot be assessed, or there are malignant cells in the sputum or bronchoalveolar lavage but not seen on imaging or bronchoscopy.
T0 No evidence of primary tumor.
Tis Carcinoma in situ.
T1 Tumour is 3 cm or less in size and has not spread to the visceral pleura or the main bronchi.
T1a – Tumour is smaller than 2 cm.
T1b – Tumour is larger than 2 cm, but smaller than 3 cm.
T2 Tumour is larger than 3 cm, but smaller than 7 cm; or the tumour has any of the following features: Cancer has spread to the main bronchi, but is not closer than 2 cm to the carina; Cancer has spread to the visceral pleura; Tumour is associated with obstructive pneumonitis or atelectasis.
T2a – Tumour is larger than 3 cm, but 5 cm or less in size.
T2b – Tumour is larger than 5 cm, but 7 cm or less in size
T3 A tumour with any of: Invasion of the chest wall, diaphragm, mediastinal pleura, or parietal pericardium; Extending into the main bronchus, within 2 cm of the carina, but not involving the carina; Obstructive pneumonitis of the entire lung.
T4 A tumour with any of: Invasion of the mediastinum, heart, great vessels, trachea, oesophagus, vertebra, or carina; Separate tumour nodules in the same lobe; Malignant pleural effusion.
Regional Lymph Nodes
NX Lymph nodes cannot be assessed.
N0 No lymph nodes involved.
N1 Metastasis to ipsilateral peribronchial or ipsilateral hilar lymph nodes.
N2 Metastasis to ipsilateral mediastinal or subcarinal lymph nodes.
N3 Metastasis to any of: Ipsilateral supraclavicular lymph nodes; Ipsilateral scalene lymph nodes; Contralateral lymph nodes.
Distant Metastasis
M0 No distant metastasis.
M1 Distant metastasis is present.
M1a – Any one of the following: Separate tumour nodule(s) in the opposite lung; Tumour nodules on the parietal pleura; Pleural effusion or pericardial effusion.
M1b – Distant metastasis.

UICC staging[1]

Stage T N M
Occult carcinoma TX N0 M0
Stage 0 Tis N0 M0
Stage IA T1 N0 M0
Stage IB T2a N0 M0
Stage IIA T2b N0 M0
T1 N1 M0
T2a N1 M0
Stage IIB T2b N1 M0
T3 N0 M0
Stage IIIA T1 N2 M0
T2 N2 M0
T3 N1 M0
T3 N2 M0
T4 N0 M0
T4 N1 M0
Stage IIIB T4 N2 M0
Any T N3 M0
Stage IV Any T Any N M1

References

  1. 1.0 1.1 1.2 Stages of non–small cell lung cancer. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/lung/staging/?region=ab

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