Non-small Cell Lung Cancer
Disease Staging/Prognosis
TNM Systems
In patients with lung cancer, clinical staging based on chest radiography, CT of the chest and upper abdomen and evaluation of the patient’s performance status is effective for treatment planning. 1
Staging is done by assessing the amount and the size of tumours (T), the amount of nodal involvement (N) and the degree of metastasis (M). In general: 1
- Hidden stage: cancer is too small to be seen, but cancer cells are detected in sputum
-
Stage 0: cancer is only found in the original tumour
-
Stage I: cancer is confined to one part of the lung
-
Stage II: cancer has spread to nearby lymph nodes or tissues
-
Stage III: cancer has spread more extensively within the chest and usually to the major lymph nodes
-
Stage IV: cancer has spread to other organs
Table 1: TNM descriptors*1
| Primary tumour(T) | |
| TX | tumour cannot be assessed, or tumour is detected by the presence of malignant cells in sputum or bronchial washings. Cancer cells are not visualized by imaging or bronchoscopy |
| T0 | No evidence of tumour |
| Tis | Carcinoma in situ |
| T1 | ≤3 cm; surrounded by lung/visceral pleura. No bronchoscopic evidence of invasion more proximal than the lobar bronchus (not in the main bronchus). Invasive component of uncommon superficial tumour is limited to bronchial wall, but may extend proximal to the main bronchus |
| T2 | >3 cm; involves main bronchus, ≥2 cm distal to the carina. Invades the visceral pleura; associated with atelectasis or obstructive pneumonitis extending to hilar region. Entire lung is not involved |
| T3 | Any-sized tumour that directly invades chest wall, diaphragm, mediastinal pleura, parietal pericardium; or, tumour in main bronchus (<2 cm distal to carina), but no involvement of carina; or, tumour associated with atelectasis or obstructive pneumonitis of entire lung |
| T4 | Any-sized tumour that invades mediastinum, heart, great vessels, trachea, esophagus, vertebral body, carina; or, separate tumour nodules in same lobe; or, tumour has malignant pleural effusion† |
| Regional lymph nodes (N) | |
| NX | Cannot be assessed |
| N0 | No node metastasis |
| N1 | Metastasis to ipsilateral peribronchial and/or ipsilateral hilar lymph nodes; intrapulmonary nodes involved, including by direct extension of the primary tumour |
| N2 | Metastasis to ipsilateral mediastinal/subcarinal lymph node(s) |
| N3 | Metastasis to either contralateral mediastinal, contralateral hilar, ipsilateral, contralateral scalene, or supraclavicular lymph node(s) |
| Distant metastasis (M) | |
| MX | Cannot be assessed |
| M0 | No distant metastasis |
| M1 | Distant metastasis present, including involvement of separate tumour nodule(s) in a different lobe (ipsilateral or contralateral) |
* Adapted from the American Joint Committee on Cancer, 2002.
† In patients in whom pleural fluid was negative for tumour on multiple cytopathologic examinations, fluid is not bloody and is not an exudate. These patients should be further evaluated by video-assisted thoracoscopy and direct pleural biopsies. If the effusion is not related to the tumour, effusion should not be considered a staging element. The patient should be staged T1, T2 or T3.
References:
1. Putnam JB, Fossella FV, Komaki R, eds. Implementation of multidisciplinary care in the treatment of patients with lung cancer. In: Fossella FV, Komaki R, Putnam JB, eds. Lung Cancer. New York, NY: Springer-Verlag; 2003:1-24.
