Non-small cell lung carcinoma staging

Non-small cell lung carcinoma staging is an important part of the assessment of patients with non-small cell lung carcinoma (a type of lung cancer). These patients undergo staging as part of the process of considering prognosis and treatment. The American Joint Committee on Cancer (AJCC) recommends TNM staging followed by further grouping.

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TNM staging

The first part of the staging classification is the TNM system.

Primary tumour (T)

• TX: The primary tumour cannot be assessed, or there are malignant cells in the sputum or bronchoalveolar lavage but not seen on imaging or bronchoscopy.
• Tis: Carcinoma in situ.
• T0: No evidence of primary tumour.
• T1: Tumour less than 3 cm in its greatest dimension, surrounded by lung or visceral pleura and without bronchoscopic invasion into the main bronchus.
• T2: A tumour with any of: -
  • More than 3 cm in greatest dimension.
  • Extending into the main bronchus, but more than 2 cm distal to the carina.
  • Obstructive pneumonitis, but not involving the entire lung.
• T3: A tumour with any of: -
  • Invasion of the chest wall, diaphragm, mediastinal pleura, or parietal pericardium.
  • Extending into the main bronchus, within 2 cm of the carina, but not involving the carina.
  • Obstructive pneumonitis of the entire lung.
• T4: A tumour with any of: -
  • Invasion of the mediastinum, heart, great vessels, trachea, oesophagus, vertebra, or carina.
  • Separate tumour nodules in the same lobe.
  • Malignant pleural effusion.

Lymph nodes (N)

• NX: Lymph nodes cannot be assessed.
• N0: No lymph nodes involved.
• N1: Metastasis to ipsilateral peribronchial or ipsilateral hilar lymph nodes.
• N2: Metastasis to ipsilateral mediastinal or subcarinal lymph nodes.
• N3: Metastasis to any of: -
  • Ipsilateral supraclavicular lymph nodes.
  • Ipsilateral scalene lymph nodes.
  • Contralateral lymph nodes.

Distant metastasis (M)

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

Mountain classification

Clifton Mountain, a surgeon in Texas, assigned further categories of staging on the basis of similarities in treatment and prognosis.^[1]

Prognosis

References

1. ^ Mountain, Clifton F; Herman I Libshitz, Kay E Hermes. A Handbook for Staging, Imaging, and Lymph Node Classification. Charles P Young Company. 
2. ^ Mountain, CF (1997). "Revisions in the international system for staging lung cancer". Chest 111: 1710-1717. American College of Chest Physicians.