Lung Cancer

Staging

The stage of your cancer describes how far it has spread. Your doctors will determine the extent of your cancer, its location and whether it has spread to nearby organs or to other parts of the body.

Lung cancer may be staged twice. First, your doctor will evaluate the results of your physical exams, biopsies and imaging tests to assign a stage. This stage is called the clinical stage. If you have surgery, your cancer may also be assigned a pathologic stage based on the results from surgery. Staging helps your doctor select the most effective treatment plan for you.

Your doctor and the pathologist will classify the stage of the lung cancer according to the tumor, node, metastasis (TNM) system developed by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC). This system is based on data from around the world collected by the International Association for the Study of Lung Cancer (IASLC) (see Table 2). The system considers the size and location of the tumor (T), whether cancer cells are found in nearby lymph nodes (N) and whether the cancer has metastasized (M), or spread, to other parts of the body. The TNM classifications are then used to determine the overall stage (see Table 1). Lung cancer is staged from Stage 0 (in situ disease, or cancer that has not grown into nearby tissues or spread outside the lung) to Stage IV (cancer that has spread to more than one area in the other lung, the fluid surrounding the lung or heart or distant body parts) (see Staging Illustrations). If lung cancer metastasizes, it is most likely to spread to the adrenal glands, bone, brain, liver or the other lung.

The TNM system is the preferred source for staging the types of non-small cell lung cancer. Limited-stage small cell lung cancer is on only one side of the chest, whereas extensive-stage small cell lung cancer has spread throughout the lung, to the other lung, to lymph nodes on the other side of the chest, or to other parts of the body.

Table 1. Stages of lung cancer

Stage TNM classifications
0 Tis, N0, M0
IA T1a or T1b, N0, M0
IB T2a, N0, M0
IIA
T1a or T1b, N1, M0
T2a, N1, M0
T2b, N0, M0
IIB
T2b, N1, M0
T3, N0, M0
IIIA
T1a or T1b, N2, M0
T2a or T2b, N2, M0
T3, N1 or N2, M0
T4, N0 or N1, M0
IIIB
T4, N2, M0
Any T, N3, M0
IV
Any T, any N, M1a or M1b

 

Table 2. AJCC system for classifying lung cancer

Category Definition
Tumor (T)
Tx Primary tumor cannot be assessed OR there is evidence of cancer according to laboratory studies but no tumor seen on imaging studies or with bronchoscopy
T0 No evidence of primary tumor
Tis Carcinoma in situ (in place)
T1
 
 
 
  T1a
 
  T1b
Tumor is 3 cm (approximately 1 inch) or less in greatest dimension, surrounded by lung or visceral pleura (lining covering the outside of the lung), with no evidence of tumor in the main bronchus (airway)
 
Tumor is 2 cm (approximately 3/4 inch) or less in greatest dimension
 
Tumor is more than 2 cm in greatest dimension but not more than 3 cm in greatest dimension
T2
 
 
 
 
 
 
 
 
  
  T2a
 
  
  T2b
Tumor is more than 3 cm but not more than 7 cm (approximately 2 3/4 inches); or tumor has any of the following features:
 
    • Cancer has invaded the main bronchus, 2 cm or more away from the carina (the ridge
      at the lower end of the trachea)
    • Cancer has invaded the visceral pleura
    • The tumor involves atelectasis (collapse of part of the lung) or obstructive pneumonitis
      (inflammation of lung tissue) that extends to the hilar region but does not involve the
      entire lung
 
Tumor is more than 3 cm but not more than 5 cm (approximately 2 inches) in greatest dimension
 
Tumor is more than 5 cm but not more than 7 cm in greatest dimension
T3 Tumor is more than 7 cm, or directly invades any of the following: parietal pleural (PL3), chest wall, diaphragm, phrenic nerve, mediastinal pleura, parietal pericardium; or the tumor is in the main bronchus less than 2 cm away from the carina but has not invaded the carina; or associated atelectasis or obstructive pneumonitis of the entire lung or separate tumor nodule(s) in the same lobe as the primary
T4 Tumor of any size has invaded any of the following: mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina; OR presence of separate tumor nodule(s) in a different lobe of the lung with the primary tumor
Nodes (N)
Nx Regional lymph nodes cannot be assessed
N0 Cancer has not spread to any regional lymph nodes
N1 Cancer cells are found in the peribronchial and/or hilar lymph nodes and intrapulmonary nodes on the same side as the lung with the primary tumor
N2 Cancer cells are found in the mediastinal and/or subcarinal lymph node(s) on the same side as the lung with the primary tumor
N3 Cancer cells are found in the mediastinal or hilar lymph nodes on the opposite side as the lung with the primary tumor; or cancer cells are found in the scalene or supraclavicular lymph node(s) on the same or opposite side as the lung with the primary tumor
Metastasis (M)
M0 Cancer has not yet spread from the primary tumor
M1
 
  M1a
 
 
  M1b
Cancer has spread from the primary tumor
 
Separate tumor nodule(s) is found in a lobe of the other lung; tumor has pleural nodules or malignant pleural or pericardial effusion
 
Cancer has spread to distant sites in the body

Note: The revisions to the 8th edition of the classification have been proposed and are likely to be adopted in early 2017.

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