Lung cancer (staging - IASLC 7th edition) (historical)

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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 malignant cells on cytology but no tumour found on bronchoscopy or imaging.
  • Tis: - carcinoma carcinoma in situ
  • T1: -
    • T1a: - smaller smaller than 2cm2 cm in longest dimension 
    • T1b: - larger larger than 2cm2 cm but smaller or equal to 3cm3 cm 
  • T2: - > 3cm>3 cm in size and > 2cm;2 cm from carina ;, or visceral pleurapleural involvement ;, or lobar atelectasis
    • T2a:- larger larger than 3cm3 cm but smaller than 5cm5 cm
    • T2b:- larger larger than 5cm5 cm but smaller than 7cm7 cm
  • T3: - < 2cm
    • ​<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 regional nodes cannot be assessed
  • N0: - no no regional nodal metastases
  • N1: - ipsilateral ipsilateral peribronchial, hilar or intrapulmonary nodes
  • N2: - ipsilateral ipsilateral mediastinal or subcarinal nodes
  • N3: - contralateral contralateral nodal involvement ; ipsilateral or contralateral scalene or supraclavicular nodal involvement
Distant metastasis (M)
  • Mx: - distant distant metastases cannot be assessed
  • M0: - no no distant metastases
  • M1: - distant distant metastases present
    • M1a:- presence presence of a malignant pleural effusion, pleural dissemination, or pericardial disease, intra thoracicintrathoracic metastases (metastasis in opposite lung)
    • M1b:  - extra-thoracicextrathoracic 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

  • -<strong>Tx</strong> - malignant cells on cytology but no tumour found on bronchoscopy or imaging.</li>
  • +<strong>Tx:</strong> malignant cells on cytology but no tumour found on bronchoscopy or imaging.</li>
  • -<strong>Tis</strong> - carcinoma in situ</li>
  • +<strong>Tis:</strong> carcinoma in situ</li>
  • -<strong>T1</strong> -<ul>
  • +<strong>T1:</strong><ul>
  • -<strong>T1a</strong> - smaller than 2cm in longest dimension </li>
  • +<strong>T1a:</strong> smaller than 2 cm in longest dimension </li>
  • -<strong>T1b</strong> - larger than 2cm but smaller or equal to 3cm </li>
  • +<strong>T1b:</strong> larger than 2 cm but smaller or equal to 3 cm </li>
  • -<strong>T2</strong> - &gt; 3cm in size and &gt; 2cm from carina ; visceral pleura involvement ; lobar atelectasis<ul>
  • +<strong>T2:</strong> &gt;3 cm in size and &gt;2 cm from carina, or visceral pleural involvement, or lobar atelectasis<ul>
  • -<strong>T2a </strong>- larger than 3cm but smaller than 5cm</li>
  • +<strong>T2a:</strong> larger than 3 cm but smaller than 5 cm</li>
  • -<strong>T2b </strong>- larger than 5cm but smaller than 7cm</li>
  • +<strong>T2b:</strong> larger than 5 cm but smaller than 7 cm</li>
  • -<strong>T3</strong> - &lt; 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</li>
  • +<strong>T3:</strong><ul>
  • -<strong>T4 </strong>-<ul>
  • +<strong>​</strong>&lt;2 cm from carina but not involving trachea or carina</li>
  • +<li>involvement of chest wall, diaphragm, mediastinal pleura or parietal pericardium, separate tumour nodule(s) in the same lobe</li>
  • +</ul>
  • +</li>
  • +<li>
  • +<strong>T4:</strong><ul>
  • -<strong>Nx </strong>- regional nodes cannot be assessed</li>
  • +<strong>Nx:</strong> regional nodes cannot be assessed</li>
  • -<strong>N0</strong> - no regional nodal metastases</li>
  • +<strong>N0:</strong> no regional nodal metastases</li>
  • -<strong>N1</strong> - ipsilateral peribronchial, hilar or intrapulmonary nodes</li>
  • +<strong>N1:</strong> ipsilateral peribronchial, hilar or intrapulmonary nodes</li>
  • -<strong>N2</strong> - ipsilateral mediastinal or subcarinal nodes</li>
  • +<strong>N2:</strong> ipsilateral mediastinal or subcarinal nodes</li>
  • -<strong>N3</strong> - contralateral nodal involvement ; ipsilateral or contralateral scalene or supraclavicular nodal involvement</li>
  • +<strong>N3:</strong> contralateral nodal involvement ; ipsilateral or contralateral scalene or supraclavicular nodal involvement</li>
  • -<strong>Mx</strong> - distant metastases cannot be assessed</li>
  • +<strong>Mx:</strong> distant metastases cannot be assessed</li>
  • -<strong>M0</strong> - no distant metastases</li>
  • +<strong>M0:</strong> no distant metastases</li>
  • -<strong>M1</strong> - distant metastases present<ul>
  • +<strong>M1:</strong> distant metastases present<ul>
  • -<strong>M1a </strong>- presence of a malignant pleural effusion, pleural dissemination, or pericardial disease, intra thoracic metastases (metastasis in opposite lung)</li>
  • +<strong>M1a:</strong> presence of a malignant pleural effusion, pleural dissemination, or pericardial disease, intrathoracic metastases (metastasis in opposite lung)</li>
  • -<strong>M1b</strong> - extra-thoracic metastases</li>
  • +<strong>M1b: </strong>extrathoracic metastases</li>
  • -<li>TNM equivalent : carcinoma in stiu</li>
  • -<li>resectable : yes</li>
  • +<li>TNM equivalent: carcinoma in stiu</li>
  • +<li>resectable: yes</li>
  • -<li>TNM equivalent : T1 or T2, N0, M0</li>
  • -<li>resectable : yes</li>
  • -<li>5 year survival : 47%</li>
  • +<li>TNM equivalent: T1 or T2, N0, M0</li>
  • +<li>resectable: yes</li>
  • +<li>5 year survival: 47%</li>
  • -<li>TNM equivalent : T1, N1, M0</li>
  • -<li>resectable : yes</li>
  • +<li>TNM equivalent: T1, N1, M0</li>
  • +<li>resectable: yes</li>
  • -<li>TNM equivalent : T2, N1, M0 <em>or</em> T3, N0, M0</li>
  • -<li>resectable : yes</li>
  • -<li>5 year survival : 26%</li>
  • +<li>TNM equivalent: T2, N1, M0 <em>or</em> T3, N0, M0</li>
  • +<li>resectable: yes</li>
  • +<li>5 year survival: 26%</li>
  • -<li>TNM equivalent : T1 or 2, N2, M0 <em>or</em> T3, N1 or 2, M0</li>
  • -<li>resectable : yes</li>
  • +<li>TNM equivalent: T1 or 2, N2, M0 <em>or</em> T3, N1 or 2, M0</li>
  • +<li>resectable: yes</li>
  • -<li>TNM equivalent : T1, 2 or 3, N3, M0 <em>or</em> T4, N0, 1, 2 or 3, M0</li>
  • -<li>resectable : no</li>
  • -<li>5 year survival : 8%</li>
  • +<li>TNM equivalent: T1, 2 or 3, N3, M0 <em>or</em> T4, N0, 1, 2 or 3, M0</li>
  • +<li>resectable: no</li>
  • +<li>5 year survival: 8%</li>
  • -<li>TNM equivalent : any T, any N with M1</li>
  • -<li>resectable : no</li>
  • -<li>5 year survival : 2%</li>
  • +<li>TNM equivalent: any T, any N with M1</li>
  • +<li>resectable: no</li>
  • +<li>5 year survival: 2%</li>
  • -<strong>grade 1</strong> : well differentiated</li>
  • +<strong>grade 1</strong>: well differentiated</li>
  • -<strong>grade 2</strong> : moderately differentiated</li>
  • +<strong>grade 2</strong>: moderately differentiated</li>
  • -<strong>grade 3</strong> : poorly differentiated</li>
  • +<strong>grade 3</strong>: poorly differentiated</li>
  • -<strong>grade 4</strong> : undifferentiated</li>
  • +<strong>grade 4</strong>: undifferentiated</li>

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