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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 2cm in longest dimension 
    • T1b - larger than 2cm but smaller or equal to 3cm 
  • T2 - > 3cm in size and > 2cm from carina ; visceral pleura involvement ; lobar atelectasis
    • T2a - larger than 3cm but smaller than 5cm
    • T2b - larger than 5cm but smaller than 7cm
  • T3 - < 2cm 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, intra thoracic metastases (metastasis in opposite lung)
    • M1b - extra-thoracic 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
  • 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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