Adenocarcinoma of the lung staging: Difference between revisions

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


==Staging==
== Staging ==
'''TNM staging:'''<ref name="canadian">Stages of non–small cell lung cancer. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/lung/staging/?region=ab</ref>
The following is 2017 TNM classification of lung cancer.<ref>{{cite book | last =Mountain | first =CF | authorlink = | coauthors =Libshitz HI, Hermes KE | title =A Handbook for Staging, Imaging, and Lymph Node Classification | publisher =Charles P Young Company | date =2003 | url =http://www.ctsnet.org/book/mountain/index.html | accessdate =2007-09-01 }}</ref><ref name="Collins">{{cite journal | last = Collins | first = LG | coauthors = Haines C, Perkel R, Enck RE | title = Lung cancer: diagnosis and management | journal = American Family Physician | volume = 75 | issue = 1 | pages = 56–63 | publisher = American Academy of Family Physicians | date = Jan 2007 | url= http://www.aafp.org/afp/20070101/56.html | pmid =17225705 | accessdate =2007-08-10 }}</ref><ref name="HarmsKriegsmann2017">{{cite journal|last1=Harms|first1=A.|last2=Kriegsmann|first2=M.|last3=Fink|first3=L.|last4=Länger|first4=F.|last5=Warth|first5=A.|title=Die neue TNM-Klassifikation für Lungentumoren|journal=Der Pathologe|volume=38|issue=1|year=2017|pages=11–20|issn=0172-8113|doi=10.1007/s00292-017-0268-y}}</ref>
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF|TNM}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF| Definition}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |TX
| style="padding: 5px 5px; background: #F5F5F5;" |Primary tumor cannot be assessed, or tumor is proven by the presence of malignant cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy.
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T0
| style="padding: 5px 5px; background: #F5F5F5;" |No evidence of primary [[tumor]].
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Tis
| style="padding: 5px 5px; background: #F5F5F5;" |[[Carcinoma in situ]].
Squamous cell carcinoma in situ (SCIS)


Adenocarcinoma in situ (AIS):  adenocarcinoma with pure lepidic pattern, ≤ 3 cm in greatest dimension
===T: Primary Tumor===
{|
|-
|-
| rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" |T1
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''T'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''Description'''
| style="padding: 5px 5px; background: #F5F5F5;" |[[Tumor]] is 3 cm or less in size and has not spread to the [[visceral pleura]] or the main [[Bronchus|bronchi]].
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |T1a – [[Tumor]] is smaller than 2 cm.
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |TX || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Primary tumor cannot be assessed.<br> OR <br>Tumor is demonstrated by the presence of malignant cells in bronchial washings or [[sputum]], but is not visualized by imaging or [[bronchoscopy]].
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |T1b – [[Tumor]] is larger than 2 cm, but smaller than 3 cm.
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | T0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |There is no evidence of primary tumor.
|-
|-
| rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" |T2
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Tis || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Carcinoma in situ
| style="padding: 5px 5px; background: #F5F5F5;" |[[Tumor]] is larger than 3 cm, but smaller than 7 cm; or the [[tumor]] has any of the following features: [[Cancer]] has spread to the main [[Bronchus|bronchi]], but is not closer than 2 cm to the [[Carina of trachea|carina]]; [[cancer]] has spread to the [[visceral pleura]]; [[tumor]] is associated with obstructive pneumonitis or [[atelectasis]].
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |T2a – [[Tumor]] is larger than 3 cm, but 5 cm or less in size.
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |The tumor has the following characteristics:
* T1a: tumor ≤1 cm in the largest diameter.
 
* T1b: tumor> 1 cm, but ≤2 cm in the largest diameter.
* T1c: tumor> 2 cm, but ≤3 cm in the largest diameter.<br> AND <br>The tumor is surrounded by lung or [[visceral pleura]]<br> AND <br>The tumor does not extend to the main bronchus as demonstrated by the absence of bronchoscopic evidence of invasion more proximal than the lobar bronchus.
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |T2b – [[Tumor]] is larger than 5 cm, but 7 cm or less in size
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |The tumor has the following characteristics:
* T2a: tumor> 3 cm, but ≤4 cm in the largest diameter.
* T2b: Tumor> 4 cm, but ≤5 cm in the largest diameter.<br>The tumor involves the main bronchus, 2 cm or more distal to the [[carina]]. <br> OR <br>The tumor invades the [[visceral pleura]]. <br> OR <br>There is evidence of [[atelectasis]] or obstructive [[pneumonitis]] that extends to the hilar region without the involvement of the entire lung.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T3
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Tumor > 5 cm, but ≤ 7 cm in size.
| style="padding: 5px 5px; background: #F5F5F5;" |A [[tumor]] with any of the following: Invasion of the chest wall, [[Thoracic diaphragm|diaphragm]], [[mediastinum|mediastinal]] pleura, or parietal [[pericardium]]; extension into the [[main bronchus]], within 2 cm of the [[Carina of trachea|carina]], but not involving the [[Carina of trachea|carina]]; obstructive pneumonitis of the entire lung.
AND
 
It directly invades any of the following: [[chest wall]] (including superior sulcus tumors), [[diaphragm]], mediastinal pleura, parietal [[pericardium]].<br> OR <br>The tumor is localized in the main bronchus at a distance less than 2 cm distal to the [[carina]] but without the involvement of the [[carina]].<br> OR <br>There is evidence of associated [[atelectasis]] or obstructive [[pneumonitis]] of the entire lung.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T4
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T4 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Tumor > 7 cm in size.
| style="padding: 5px 5px; background: #F5F5F5;" |A [[tumor]] with any of: [[Invasive (medical)|Invasion]] of the [[mediastinum]], [[heart]], great vessels, [[Vertebrate trachea|trachea]], [[esophagus]], [[vertebra]], or [[Carina of trachea|carina]]; Separate [[tumor]] [[Nodule (medicine)|nodules]] in the same lobe; malignant [[pleural effusion]].
The tumor invades any of the following: [[mediastinum]], [[heart]], great vessels, [[trachea]], [[esophagus]], [[vertebral body]], [[carina]]<br> OR <br>There is/are separate tumor nodule(s) in the same lobe. <br> OR
The tumor is associated with malignant [[pleural effusion]].
|}
 
===N:Regional Lymph Nodes===
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
|-
| colspan="3" style="padding: 0 5px; background: #4479BA" |{{fontcolor|#FFF| Regional Lymph Nodes}}
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''T'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''Description'''
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |NX
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |NX || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |the regional [[lymph node]]s cannot be assessed.
| style="padding: 5px 5px; background: #F5F5F5;" |[[Lymph node]]s cannot be assessed.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |N0
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |There is no evidence of regional lymph node metastasis.
| style="padding: 5px 5px; background: #F5F5F5;" |No [[Lymph node|lymph nodes]] involved.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |N1
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |[[Metastasis]] in [[Anatomical terms of location|ipsilateral]] peribronchial and/or [[Anatomical terms of location|ipsilateral]] [[Hilar lymphadenopathy|hilum]] or intrapulmonary [[Lymph node|lymph nodes]]  
| style="padding: 5px 5px; background: #F5F5F5;" |[[Metastasis]] to [[ipsilateral]] peribronchial or ipsilateral [[Hilum|hilar]] [[Lymph node|lymph nodes]].
N1a - A [[lymph node]] invasion.
 
N1b - > 1 [[lymph node]] affected.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |N2
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |There is [[metastasis]] in ipsilateral [[Mediastinum|mediastinal]] and/or subcarinal [[Lymph node|lymph node(s).]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Metastasis]] to ipsilateral [[Mediastinum|mediastinal]] or subcarinal [[Lymph node|lymph nodes]].
N2a1 - One lymph node infested without lymph node involvement of an N1-defined lymph node station.
|-
 
| style="padding: 5px 5px; background: #DCDCDC;" |N3
N2a2 - One lymph node infested with a lymph node of an N1-defined lymph node station
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis to any of: Ipsilateral supraclavicular [[Lymph node|lymph nodes]]; Ipsilateral scalene [[Lymph node|lymph nodes]]; [[Contralateral]] lymph nodes.
 
|- |-
N2b - > 1 lymph node affected
| colspan="3" style="padding: 0 5px; background: #4479BA" |{{fontcolor|#FFF| Distant Metastasis}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |No distant [[metastasis]].
|-
| rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" |M1
| style="padding: 5px 5px; background: #F5F5F5;" |Distant [[metastasis]] is present.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |M1a – Any one of the following: separate [[Tumor|tumour]] [[Nodule (medicine)|nodule]](s) in the opposite lung; tumor nodules on the [[parietal pleura]]; [[pleural effusion]] or [[pericardial effusion]].
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |M1b – Distant [[metastasis]].
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |There is [[metastasis]] in [[Anatomical terms of location|contralateral]] [[Mediastinum|mediastinal]], contralateral [[Hilum|hilar]], [[Anatomical terms of location|ipsilateral]] or [[Anatomical terms of location|contralateral]] scalene, or supraclavicular [[Lymph node|lymph node(s).]]
|}
|}


'''UICC staging'''<ref name="canadian">Stages of non–small cell lung cancer. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/lung/staging/?region=ab</ref>
===M: Distant Metastasis===
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
| valign="top" |
|+
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF|Stage}}
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF| T}}
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF| N}}
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF| M}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Occult carcinoma
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''T'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''Description'''
| style="padding: 5px 5px; background: #F5F5F5;" |TX
| style="padding: 5px 5px; background: #F5F5F5;" |N0
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Stage 0
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |MX || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Distant metastasis cannot be assessed.
| style="padding: 5px 5px; background: #F5F5F5;" |Tis
| style="padding: 5px 5px; background: #F5F5F5;" |N0
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Stage IA
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |There is no evidence of distant [[metastasis]].
| style="padding: 5px 5px; background: #F5F5F5;" |T1
| style="padding: 5px 5px; background: #F5F5F5;" |N0
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Stage IB
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |There is evidence of [[distant]] metastasis which includes the presence of separate tumor nodule(s) in a different lobe (ipsilateral or contralateral).
| style="padding: 5px 5px; background: #F5F5F5;" |T2a
M1a - Tumor foci separated from the primary tumor in a contralateral lung lobe; Tumor with pleural metastases or malignant pleural or pericardial effusion
| style="padding: 5px 5px; background: #F5F5F5;" |N0
 
| style="padding: 5px 5px; background: #F5F5F5;" |M0
M1b - Simple metastases in an organ
|-
 
| rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" |Stage IIA
M1c - Multiple metastases in one organ or one or more metastases in more than one organ
| style="padding: 5px 5px; background: #F5F5F5;" |T2b
 
| style="padding: 5px 5px; background: #F5F5F5;" |N0
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
| style="padding: 5px 5px; background: #F5F5F5;" |T1
| style="padding: 5px 5px; background: #F5F5F5;" |N1
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
| style="padding: 5px 5px; background: #F5F5F5;" |T2a
| style="padding: 5px 5px; background: #F5F5F5;" |N1
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" |Stage IIB
| style="padding: 5px 5px; background: #F5F5F5;" |T2b
| style="padding: 5px 5px; background: #F5F5F5;" |N1
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
| style="padding: 5px 5px; background: #F5F5F5;" |T3
| style="padding: 5px 5px; background: #F5F5F5;" |N0
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
| rowspan="6" style="padding: 5px 5px; background: #DCDCDC;" |Stage IIIA
| style="padding: 5px 5px; background: #F5F5F5;" |T1
| style="padding: 5px 5px; background: #F5F5F5;" |N2
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
| style="padding: 5px 5px; background: #F5F5F5;" |T2
| style="padding: 5px 5px; background: #F5F5F5;" |N2
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
| style="padding: 5px 5px; background: #F5F5F5;" |T3
| style="padding: 5px 5px; background: #F5F5F5;" |N1
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
| style="padding: 5px 5px; background: #F5F5F5;" |T3
| style="padding: 5px 5px; background: #F5F5F5;" |N2
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
| style="padding: 5px 5px; background: #F5F5F5;" |T4
| style="padding: 5px 5px; background: #F5F5F5;" |N0
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
| style="padding: 5px 5px; background: #F5F5F5;" |T4
| style="padding: 5px 5px; background: #F5F5F5;" |N1
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" |Stage IIIB
| style="padding: 5px 5px; background: #F5F5F5;" |T4
| style="padding: 5px 5px; background: #F5F5F5;" |N2
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Any T   
| style="padding: 5px 5px; background: #F5F5F5;" |N3
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Stage IV
| style="padding: 5px 5px; background: #F5F5F5;" |Any T 
| style="padding: 5px 5px; background: #F5F5F5;" |Any N
| style="padding: 5px 5px; background: #F5F5F5;" |M1
|}
|}


Revision as of 19:21, 21 February 2019

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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.

Staging

The following is 2017 TNM classification of lung cancer.[1][2][3]

T: Primary Tumor

T Description
TX Primary tumor cannot be assessed.
OR
Tumor is demonstrated by the presence of malignant cells in bronchial washings or sputum, but is not visualized by imaging or bronchoscopy.
T0 There is no evidence of primary tumor.
Tis Carcinoma in situ
T1 The tumor has the following characteristics:
  • T1a: tumor ≤1 cm in the largest diameter.
  • T1b: tumor> 1 cm, but ≤2 cm in the largest diameter.
  • T1c: tumor> 2 cm, but ≤3 cm in the largest diameter.
    AND
    The tumor is surrounded by lung or visceral pleura
    AND
    The tumor does not extend to the main bronchus as demonstrated by the absence of bronchoscopic evidence of invasion more proximal than the lobar bronchus.
T2 The tumor has the following characteristics:
  • T2a: tumor> 3 cm, but ≤4 cm in the largest diameter.
  • T2b: Tumor> 4 cm, but ≤5 cm in the largest diameter.
    The tumor involves the main bronchus, 2 cm or more distal to the carina.
    OR
    The tumor invades the visceral pleura.
    OR
    There is evidence of atelectasis or obstructive pneumonitis that extends to the hilar region without the involvement of the entire lung.
T3 Tumor > 5 cm, but ≤ 7 cm in size.

AND

It directly invades any of the following: chest wall (including superior sulcus tumors), diaphragm, mediastinal pleura, parietal pericardium.
OR
The tumor is localized in the main bronchus at a distance less than 2 cm distal to the carina but without the involvement of the carina.
OR
There is evidence of associated atelectasis or obstructive pneumonitis of the entire lung.

T4 Tumor > 7 cm in size.

The tumor invades any of the following: mediastinum, heart, great vessels, trachea, esophagus, vertebral body, carina
OR
There is/are separate tumor nodule(s) in the same lobe.
OR The tumor is associated with malignant pleural effusion.

N:Regional Lymph Nodes

T Description
NX the regional lymph nodes cannot be assessed.
N0 There is no evidence of regional lymph node metastasis.
N1 Metastasis in ipsilateral peribronchial and/or ipsilateral hilum or intrapulmonary lymph nodes

N1a - A lymph node invasion.

N1b - > 1 lymph node affected.

N2 There is metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s).

N2a1 - One lymph node infested without lymph node involvement of an N1-defined lymph node station.

N2a2 - One lymph node infested with a lymph node of an N1-defined lymph node station

N2b - > 1 lymph node affected

N3 There is metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s).

M: Distant Metastasis

T Description
MX Distant metastasis cannot be assessed.
M0 There is no evidence of distant metastasis.
M1 There is evidence of distant metastasis which includes the presence of separate tumor nodule(s) in a different lobe (ipsilateral or contralateral).

M1a - Tumor foci separated from the primary tumor in a contralateral lung lobe; Tumor with pleural metastases or malignant pleural or pericardial effusion

M1b - Simple metastases in an organ

M1c - Multiple metastases in one organ or one or more metastases in more than one organ

References

  1. ↑ Mountain, CF (2003). A Handbook for Staging, Imaging, and Lymph Node Classification. Charles P Young Company. Retrieved 2007-09-01. Unknown parameter |coauthors= ignored (help)
  2. ↑ Collins, LG (Jan 2007). "Lung cancer: diagnosis and management". American Family Physician. American Academy of Family Physicians. 75 (1): 56–63. PMID 17225705. Retrieved 2007-08-10. Unknown parameter |coauthors= ignored (help)
  3. ↑ Harms, A.; Kriegsmann, M.; Fink, L.; Länger, F.; Warth, A. (2017). "Die neue TNM-Klassifikation für Lungentumoren". Der Pathologe. 38 (1): 11–20. doi:10.1007/s00292-017-0268-y. ISSN 0172-8113.


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