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Staging of Lung cancer

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TNM definition

Primary tumor (T)

TX: Primary tumor cannot be assessed, or tumor proven by the presence of malignant cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy

T0: No evidence of primary tumor

Tis: Carcinoma in situ

T1: A tumor that is 3 cm or less in greatest dimension, surrounded by lung or visceral pleura, and without bronchoscopic evidence of invasion more proximal than the lobar bronchus (i.e., not in the main bronchus).

T2: A tumor with any of the following features of size or extent:

• More than 3 cm in greatest dimension
• Involves the main bronchus, 2 cm or more distal to the carina
• Invades the visceral pleura
• Associated with atelectasis or obstructive pneumonitis that extends to the hilar region but does not involve the entire lung

T3: A tumor of any size that directly invades any of the following: chestwall (including superior sulcus tumors), diaphragm, mediastinal pleura, parietal pericardium; or tumor in the main bronchus less than 2 cm distal to the carina but without involvement of the carina; or associated atelectasis or obstructive pneumonitis of the entire lung

T4: A tumor of any size that invades any of the following: mediastinum, heart, great vessels, trachea, esophagus, vertebral body, carina; or separate tumor nodules in the same lobe; or tumor with a malignant pleural effusion.

Regional lymph nodes (N)

• NX: Regional lymph nodes cannot be assessed
• N0: No regional lymph node metastasis
• N1: Metastasis to ipsilateral peribronchial and/or ipsilateral hilar lymph nodes, and intrapulmonary nodes including involvement by direct extension of the primary tumor
• N2: Metastasis to ipsilateral mediastinal and/or subcarinal lymph node(s)
• N3: Metastasis to contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)

Distant metastasis (M)

• MX: Distant metastasis cannot be assessed
• M0: No distant metastasis
• M1: Distant metastasis present.

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Stage grouping

Occult carcinoma

• TX, N0, M0

Stage 0

• Tis, N0, M0

Stage IA

• T1, N0, M0

Stage IB

• T2, N0, M0

Stage IIA

• T1, N1, M0

Stage IIB

• T2, N1, M0
• T3, N0, M0

Stage IIIA

• T1, N2, M0
• T2, N2, M0
• T3, N1, M0
• T3, N2, M0

Stage IIIB

• Any T, N3, M0
• T4, any N, M0

Stage IV

• Any T, any N, M1

References

1. Lung. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 167-181. 

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