Squamous cell carcinoma of the lung staging: Difference between revisions

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{{Squamous cell carcinoma of the lung}}
{{Squamous cell carcinoma of the lung}}
{{CMG}}; {{AE}} {{SC}}
{{CMG}}; {{AE}} {{Trusha}}
 
==Overview==
==Overview==
Squamous cell carcinoma of the lung may be classified into several subtypes based on [[TNM]] and [[UICC]] staging system.<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 staging of lung cancer is based on the [[TNM|TNM classification]] of lung cancer. Lung [[cancer staging]] is an assessment of the degree of spread of cancer from its original source. It is an important factor affecting the [[prognosis]] and potential treatment of lung cancer. [[Non small cell lung cancer|Non-small cell lung carcinoma]] is staged from IA ("one A", best prognosis) to IVB ("four B", worst prognosis).  
 
== Staging ==
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>
 
===T: Primary Tumor===
{|
|-
| 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="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="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.
|-
| 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="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="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="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.
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="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.
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;"
|-
| 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="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="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="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]]
N1a - A [[lymph node]] invasion.
 
N1b - > 1 [[lymph node]] affected.
|-
| 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).]]
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


==Staging==
N2b - > 1 lymph node affected
'''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>
{| 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="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).]]
| style="padding: 5px 5px; background: #F5F5F5;" |The primary [[tumour]] cannot be assessed, or there are [[malignant]] [[cell (biology)|cells]] in the [[sputum]] or [[bronchoalveolar lavage]] but not seen on imaging or [[bronchoscopy]].
|}
 
===M: Distant Metastasis===
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T0
| 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;" |No evidence of primary tumor.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Tis
| 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;" |[[Carcinoma in situ]].
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" rowspan=3|T1
| 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;" |Tumour is 3 cm or less in size and has not spread to the visceral pleura or the main bronchi.
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |T1a – Tumour is smaller than 2 cm.
| 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).
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
 
|}
 
==Classification of Lung Cancer by Staging==
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |T1b – Tumour is larger than 2 cm, but smaller than 3 cm.
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''Stage'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''T'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''N'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''M'''
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" rowspan=3 |T2
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Occult carcinoma''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |TX|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N0|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |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.
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |T2a – Tumour is larger than 3 cm, but 5 cm or less in size.
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Stage 0''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Tis || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |T2b – Tumour is larger than 5 cm, but 7 cm or less in size
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Stage IA1''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1(mi)/T1a || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T3
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Stage IA2''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1b || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | M0
| style="padding: 5px 5px; background: #F5F5F5;" |A tumour with any of: Invasion of the chest wall, [[Thoracic diaphragm|diaphragm]], [[mediastinum|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.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T4
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | '''Stage IA3'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1c || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | M0
| style="padding: 5px 5px; background: #F5F5F5;" |A tumour with any of: Invasion of the mediastinum, [[heart]], great vessels, [[Vertebrate trachea|trachea]], [[oesophagus]], [[vertebra]], or carina; Separate tumour nodules in the same lobe; Malignant [[pleural effusion]].
|-
|-
| style="padding: 0 5px; background: #4479BA" colspan=3 |{{fontcolor|#FFF| Regional Lymph Nodes}}
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Stage IB''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2a || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | M0
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |NX
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Stage IIA''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2b || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |[[Lymph node]]s cannot be assessed.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |N0
| rowspan="5" style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Stage IIB''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1a || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | M0
| style="padding: 5px 5px; background: #F5F5F5;" |No lymph nodes involved.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |N1
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1c || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |[[Metastasis]] to [[ipsilateral]] peribronchial or ipsilateral hilar lymph nodes.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |N2
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2a || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis to ipsilateral mediastinal or subcarinal lymph nodes.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |N3
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2b || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis to any of: Ipsilateral supraclavicular lymph nodes; Ipsilateral scalene lymph nodes; [[Contralateral]] lymph nodes.
|-|-
| style="padding: 0 5px; background: #4479BA" colspan=3 |{{fontcolor|#FFF| Distant Metastasis}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |M0
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |No distant metastasis.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" rowspan=3|M1
| rowspan="13" style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Stage IIIA''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1a
| style="padding: 5px 5px; background: #F5F5F5;" |Distant metastasis is present.
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |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.
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1b || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |M1b – Distant metastasis.
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1c || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
|}
|-
 
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2a || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
'''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>
|-
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2b || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
|valign=top|
|-
|+
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1a || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF|Stage}}
|-
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF| T}}
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1b || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF| N}}
|-
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF| M}}
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1c || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2a || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2b || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T4 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Occult carcinoma
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T4|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| 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
| rowspan="12" style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Stage IIIB''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1a|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| 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" |T1b || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| 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" |T1c || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |T2a
| style="padding: 5px 5px; background: #F5F5F5;" |N0
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" rowspan=3 |Stage IIA
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2a || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| 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="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2b || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |N1
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |T2a
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1a || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |N1
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" rowspan="2"|Stage IIB
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1b || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| 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="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1c || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |N0
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" rowspan=6|Stage IIIA
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2a || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| 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="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2b || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |N2
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |T3
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |N1
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |T3
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T4 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |N2
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |T4
| rowspan="2"  style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Stage IIIC'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |N0
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |T4
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T4 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |N1
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" rowspan="2"|Stage IIIB
| rowspan="2" style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Stage IVA'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Any T || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Any N || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M1a
| 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="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Any T || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Any N || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M1b
| style="padding: 5px 5px; background: #F5F5F5;" |N3
| style="padding: 5px 5px; background: #F5F5F5;" |M0
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Stage IV
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Stage IVB'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Any T || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Any N || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M1c
| style="padding: 5px 5px; background: #F5F5F5;" |Any T  
| style="padding: 5px 5px; background: #F5F5F5;" |Any N
| style="padding: 5px 5px; background: #F5F5F5;" |M1
|}
|}


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[[Category:Lung cancer]]
[[Category:Lung cancer]]
[[Category:Oncology]]
[[Category:Oncology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Pulmonology]]
[[Category:Surgery]]

Latest revision as of 18:26, 27 February 2019

Squamous Cell Carcinoma of the Lung Microchapters

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

Overview

The staging of lung cancer is based on the TNM classification of lung cancer. Lung cancer staging is an assessment of the degree of spread of cancer from its original source. It is an important factor affecting the prognosis and potential treatment of lung cancer. Non-small cell lung carcinoma is staged from IA ("one A", best prognosis) to IVB ("four B", worst prognosis).

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

Classification of Lung Cancer by Staging

Stage T N M
Occult carcinoma TX N0 M0
Stage 0 Tis N0 M0
Stage IA1 T1(mi)/T1a N0 M0
Stage IA2 T1b N0 M0
Stage IA3 T1c N0 M0
Stage IB T2a N0 M0
Stage IIA T2b N0 M0
Stage IIB T1a N1 M0
T1c N1 M0
T2a N1 M0
T2b N1 M0
T3 N0 M0
Stage IIIA T1a N2 M0
T1b N2 M0
T1c N2 M0
T2a N2 M0
T2b N2 M0
T1a N2 M0
T1b N2 M0
T1c N2 M0
T2a N2 M0
T2b N2 M0
T3 N1 M0
T4 N0 M0
T4 N1 M0
Stage IIIB T1a N3 M0
T1b N3 M0
T1c N3 M0
T2a N3 M0
T2b N3 M0
T1a N3 M0
T1b N3 M0
T1c N3 M0
T2a N3 M0
T2b N3 M0
T3 N2 M0
T4 N2 M0
Stage IIIC T3 N3 M0
T4 N3 M0
Stage IVA Any T Any N M1a
Any T Any N M1b
Stage IVB Any T Any N M1c

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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