Lung cancer staging


 * Associate Editor(s)-In-Chief: Kim-Son H. Nguyen, M.D., M.P.A., Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, ; Assistant Editor(s)-In-Chief: Michael Maddaleni, B.S.

Overview
Lung cancer staging is an assessment of the degree of spread of the 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 IV ("four", worst prognosis). Small cell lung carcinoma is classified as limited stage if it is confined to one half of the chest and within the scope of a single radiotherapy field. Otherwise it is extensive stage.

Procedures
There are currently multiple different procedures available to stage lung cancer. They can be broken down into two over-arching categories, invasive and minimally invasive.

The invasive procedures are:


 * EUS-NA (esophageal endoscopic ultrasound with needle aspiration)
 * TBNA (transbronchial needle aspiration)
 * EBUS-NA (endobronchial ultrasound with needle aspiration)
 * TTNA (transthoracic needle aspiration)
 * VATS staging (video assisted thoracic surgery) aka thoracoscopy.
 * Extended cervical mediastinoscopy
 * Chamberlain procedure

The minimally invasive procedures are:


 * EBUS-FNA (endobronchial ultrasound guided fine needle aspiration).
 * EUS-FNA (esophogeal endoscopic ultrasound guided fine needle aspiration).

Primary tumor

 * Tis - Carcinoma in situ
 * TX - Positive malignant cytologic findings, no lesion observed
 * T1 - Diameter of 3 cm or smaller and surrounded by lung or visceral pleura or endobronchial tumor distal to the lobar bronchus
 * T2 - Diameter greater than 3 cm ; extension to the visceral pleura, atelectasis, or obstructive pneumopathy involving less than 1 lung; lobar endobronchial tumor; or tumor of a main bronchus more than 2 cm from the carina
 * T3 - Tumor at the apex; total atelectasis of 1 lung; endobronchial tumor of main bronchus within 2 cm of the carina but not invading it; or tumor of any size with direct extension to the adjacent structures (i.e. chest wall mediastinal pleura, diaphragm, pericardium parietal layer).
 * T4 - Invasion of the mediastinal organs (i.e esophagus, trachea, carina, great vessels, heart), obstruction of the superior vena cava; involvement of a vertebral body; recurrent nerve involvement; malignant pleural effusion, malignant pericardial effusion; or satellite pulmonary nodules within the same lobe as the primary tumor

Regional lymph node involvement

 * N0 - No lymph nodes involved
 * N1 - Ipsilateral hilar nodal involvement
 * N2 - Ipsilateral mediastinal involvement
 * N3 - Contralateral mediastinal or hilar nodal involvement or any scalene or supraclavicular nodal involvement

Metastatic involvement

 * M0 - No metastases
 * M1 - Metastases present

Stage groupings of Lung Cancer

 * IA - T1N0M0
 * IB - T2N0M0
 * IIA - T1N1M0
 * IIB - T2N1M0 or T3N0M0
 * IIIA - T1-3N2M0 or T3N1M0
 * IIIB - Any T4 or any N3M0
 * IV - Any M1