Lung cancer (staging - IASLC 7th edition - superseded)
The IASLC (International Association for the Study of Lung Cancer) 7th edition lung cancer staging system was proposed in 2010 and has now been updated and superseded by the 8th edition, published in 2016.
Small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) used to be staged differently, with this staging system initially proposed only for NSCLC. This has changed since 2013, with the IASLC staging now applying for both types of tumor.
TNM system
The old 7th edition (2010) staging is as follows 4:
Primary tumor (T)
The parameters assessed on the T stage include size, endobronchial location, local invasion, atelectasis, and separate tumor nodules.
- Tx: malignant cells on cytology but no tumor found on bronchoscopy or imaging.
- Tis: carcinoma in situ
-
T1
- tumor size equal or less than 3 cm
- not involving the main bronchus
- T1a: smaller than 2 cm in longest dimension
- T1b: larger than 2 cm but smaller or equal to 3 cm
-
T2:
- tumor size more than 3 cm but less/equal to 7 cm or
- involving the main bronchus but >2 cm from carina
- visceral pleural involvement
- lobar atelectasis extending to the hilum but not collapse of the entire lung
- T2a: larger than 3 cm but smaller than 5 cm
- T2b: larger than 5 cm but smaller than 7 cm
-
T3
- tumor size more than 7 cm or
- tumor <2 cm from carina but not involving trachea or carina
- involvement of the chest wall, including Pancoast tumor, diaphragm, phrenic nerve, mediastinal pleura or parietal pericardium
- separate tumor nodule(s) in the same lobe
- atelectasis or post-obstructive pneumonitis of the entire lung
-
T4
- any size tumor with:
- involvement of the trachea, esophagus, recurrent laryngeal nerve, vertebra, great vessels or heart
- separate tumor 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, including direct invasion
- 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 or pericardial effusion, pleural dissemination, or pericardial disease, and metastasis in opposite lung
- M1b: extrathoracic metastases
AJCC staging system
-
stage 0
- TNM equivalent: carcinoma in situ
- 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
Proposed lymph node zones
For prognostic purposes, thoracic lymph nodes can be divided into prognostic zones which is easier to remember than individual thoracic lymph node stations/levels 6:
- supraclavicular zone: nodal station 1
- upper zone: nodal stations 2-4
- aortopulmonary zone: nodal stations 5-6
- subcarinal and lower zones: nodal stations 7-9
- hilar/interlobar and peripheral zones: nodal stations 10-14
Nodal numbering system
- 1 = low cervical, supraclavicular and sternal notch nodes
-
2 = upper paratracheal nodes
- 2R = right upper paratracheal nodes
- 2L = left upper paratracheal nodes
- 3 = prevascular and retrotracheal nodes
-
4 = lower paratracheal nodes
- 4R = right lower paratracheal nodes
- 4L = left lower paratracheal nodes
- 5 = subaortic/ aortopulmonary nodes
- 6 = para-aortic nodes
- 7 = subcarinal nodes
- 8 = para-esophageal nodes
- 9 = pulmonary ligament nodes
-
10 = hilar nodes
- 10R = right hilar nodes
- 10L = left hilar nodes
-
11 = interlobar nodes
- 11R = right interlobar nodes
- 11L = left interlobar nodes
-
12 = lobar nodes
- 12R = right lobar nodes
- 12L = left lobar nodes
-
13 = segmental nodes
- 13R = right segmental nodes
- 13L = left segmental nodes
-
14 = subsegmental nodes
- 14R = right subsegmental nodes
- 14L = left subsegmental nodes
See also
Related Radiopaedia articles
Chest
- imaging techniques
-
chest x-ray
-
approach
- adult
- pediatric
- neonatal
-
airspace opacification
- differential diagnoses of airspace opacification
- lobar consolidation
-
atelectasis
- mechanism-based
- morphology-based
- lobar lung collapse
- chest x-ray in the exam setting
- cardiomediastinal contour
- chest radiograph zones
- tracheal air column
- fissures
- normal chest x-ray appearance of the diaphragm
- nipple shadow
-
lines and stripes
- anterior junction line
- posterior junction line
- right paratracheal stripe
- left paratracheal stripe
- posterior tracheal stripe/tracheo-esophageal stripe
- posterior wall of bronchus intermedius
- right paraspinal line
- left paraspinal line
- aortic-pulmonary stripe
- aortopulmonary window
- azygo-esophageal recess
- spaces
- signs
- air bronchogram
- big rib sign
- Chang sign
- Chen sign
- coin lesion
- continuous diaphragm sign
- dense hilum sign
- double contour sign
- egg-on-a-string sign
- extrapleural sign
- finger in glove sign
- flat waist sign
- Fleischner sign
- ginkgo leaf sign
- Golden S sign
- Hampton hump
- haystack sign
- hilum convergence sign
- hilum overlay sign
- Hoffman-Rigler sign
- holly leaf sign
- incomplete border sign
- juxtaphrenic peak sign
- Kirklin sign
- medial stripe sign
- melting ice cube sign
- more black sign
- Naclerio V sign
- Palla sign
- pericardial fat tag sign
- Shmoo sign
- silhouette sign
- snowman sign
- spinnaker sign
- steeple sign
- straight left heart border sign
- third mogul sign
- tram-track sign
- walking man sign
- water bottle sign
- wave sign
- Westermark sign
-
approach
- HRCT
-
chest x-ray
- airways
- bronchitis
- small airways disease
-
bronchiectasis
- broncho-arterial ratio
- related conditions
- differentials by distribution
- narrowing
-
tracheal stenosis
- diffuse tracheal narrowing (differential)
-
bronchial stenosis
- diffuse airway narrowing (differential)
-
tracheal stenosis
- diverticula
- pulmonary edema
-
interstitial lung disease (ILD)
- drug-induced interstitial lung disease
-
hypersensitivity pneumonitis
- acute hypersensitivity pneumonitis
- subacute hypersensitivity pneumonitis
- chronic hypersensitivity pneumonitis
- etiology
- bird fancier's lung: pigeon fancier's lung
- farmer's lung
- cheese workers' lung
- bagassosis
- mushroom worker’s lung
- malt worker’s lung
- maple bark disease
- hot tub lung
- wine maker’s lung
- woodsman’s disease
- thatched roof lung
- tobacco grower’s lung
- potato riddler’s lung
- summer-type pneumonitis
- dry rot lung
- machine operator’s lung
- humidifier lung
- shower curtain disease
- furrier’s lung
- miller’s lung
- lycoperdonosis
- saxophone lung
-
idiopathic interstitial pneumonia (mnemonic)
- acute interstitial pneumonia (AIP)
- cryptogenic organizing pneumonia (COP)
- desquamative interstitial pneumonia (DIP)
- non-specific interstitial pneumonia (NSIP)
- idiopathic pleuroparenchymal fibroelastosis
- lymphoid interstitial pneumonia (LIP)
- respiratory bronchiolitis–associated interstitial lung disease (RB-ILD)
- usual interstitial pneumonia / idiopathic pulmonary fibrosis (UIP/IPF)
-
pneumoconioses
- fibrotic
- non-fibrotic
-
lung cancer
-
non-small-cell lung cancer
-
adenocarcinoma
- pre-invasive tumors
- minimally invasive tumors
- invasive tumors
- variants of invasive carcinoma
- described imaging features
- adenosquamous carcinoma
- large cell carcinoma
- primary sarcomatoid carcinoma of the lung
- squamous cell carcinoma
- salivary gland-type tumors
-
adenocarcinoma
- pulmonary neuroendocrine tumors
- preinvasive lesions
-
lung cancer invasion patterns
- tumor spread through air spaces (STAS)
- presence of non-lepidic patterns such as acinar, papillary, solid, or micropapillary
- myofibroblastic stroma associated with invasive tumor cells
- pleural invasion
- vascular invasion
- tumors by location
- benign neoplasms
- pulmonary metastases
- lung cancer screening
- lung cancer staging
-
non-small-cell lung cancer