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Non small cell lung cancer staging

Non-small cell lung cancer (NSCLC) staging can be accomplished both by the TNM system, or by the AJCC staging system.

For a general discussion of these tumours please refer to the article on non-small cell lung cancer (NSCLC).

TNM system

The current  7th edition NSCLC staging is as follows 4:

Primary tumour (T)
  • Tx: malignant cells on cytology but no tumour found on bronchoscopy or imaging.
  • Tis: carcinoma in situ
  • T1:
    • T1a: smaller than 2 cm in longest dimension 
    • T1b: larger than 2 cm but smaller or equal to 3 cm 
  • T2: >3 cm in size and >2 cm from carina, or visceral pleural involvement, or lobar atelectasis
    • T2a: larger than 3 cm but smaller than 5 cm
    • T2b: larger than 5 cm but smaller than 7 cm
  • T3:
    • <2 cm from carina but not involving trachea or carina
    • involvement of chest wall, diaphragm, mediastinal pleura or parietal pericardium, separate tumour nodule(s) in the same lobe
  • T4:
    • involvement of the trachea, oesophagus, vertebra, great vessels or heart 
    • separate tumour nodules in the same lung but not in the same lobe
Nodal status (N)
  • Nx: regional nodes cannot be assessed
  • N0: no regional nodal metastases
  • N1: ipsilateral peribronchial, hilar or intrapulmonary nodes
  • N2: ipsilateral mediastinal or subcarinal nodes
  • N3: contralateral nodal involvement ; ipsilateral or contralateral scalene or supraclavicular nodal involvement
Distant metastasis (M)
  • Mx: distant metastases cannot be assessed
  • M0: no distant metastases
  • M1: distant metastases present
    • M1a: presence of a malignant pleural effusion, pleural dissemination, or pericardial disease, intrathoracic metastases (metastasis in opposite lung)
    • M1b: extrathoracic metastases
AJCC staging system
  • stage 0
    • TNM equivalent: carcinoma in stiu
    • resectable: yes
  • stage I
    • TNM equivalent: T1 or T2, N0, M0
    • resectable: yes
    • 5 year survival: 47%
  • stage IIa
    • TNM equivalent: T1, N1, M0
    • resectable: yes
  • stage IIb
    • TNM equivalent: T2, N1, M0 or T3, N0, M0
    • resectable: yes
    • 5 year survival: 26%
  • stage IIIa
    • TNM equivalent: T1 or 2, N2, M0 or T3, N1 or 2, M0
    • resectable: yes

--------------- accepted cut off between resectable and non resectable ----------

  • stage IIIb
    • TNM equivalent: T1, 2 or 3, N3, M0 or T4, N0, 1, 2 or 3, M0
    • resectable: no
    • 5 year survival: 8%
  • stage IV
    • TNM equivalent: any T, any N with M1
    • resectable: no
    • 5 year survival: 2%
Histological grade
  • grade 1: well differentiated
  • grade 2: moderately differentiated
  • grade 3: poorly differentiated
  • grade 4: undifferentiated

See also

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