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What staging means in lung cancer?

When lung cancer is diagnosed, the pathologist will assign a type (non-small cell lung cancer or small cell lung cancer) and a stage to the cancer. The stage is a formal classification that signifies the extent of the cancer and will determine the type of treatment your oncologist recommends.
Lung cancer staging is based on a pathology (disease) report from tissue obtained during bronchoscopy, needle (or other) biopsy, blood tests, and imaging studies to rule out distant metastasis.
Lung cancer staging usually is described in terms of the TNM system—a classification system developed and recently revised by the American Joint Committee on Cancer (AJCC) and the Union Internationale Contre le Cancer (UICC; International Union Against Cancer). According to this system:
T = tumor size
N = node involvement
M = metastasis status

Staging of non-small cell lung cancer

The primary tumor (T) is classified according to the following categories:
TX: Tumor cannot be evaluated or tumor is proven by the presence of cancer cells in the sputum or bronchial washings, but it cannot be seen during imaging or bronchoscopy (“occult” tumor)
T0: No evidence of primary tumor.
Tis: Carcinoma in situ.
T1:Tumor 3 centimeters (< 3 cm) or less in greatest dimension, surrounded by lung or pleura, and not located in the main stem bronchus. T2: Tumor more than 3 centimeters (> 3 cm) in greatest dimension, or tumor involving the main stem bronchus, 2 cm or more from the carina, or tumor invading the visceral pleura, or tumor with incomplete lung expansion or obstructive lung infection that does not involve the entire lung.
T3: Tumor of any size that directly invades the chest wall, diaphragm, pleura, or pericardium, or tumor that involves the main stem bronchus less than 2 centimeters (< 2 cm) from the carina (ridge between the right and left main stem bronchi), or tumor that is associated with complete lung collapse or obstructive lung infection involving the entire lung. T4: Tumor of any size that invades the heart, great vessels (aorta, superior or inferior vena cava, pulmonary artery, or pulmonary vein), trachea, esophagus, vertebral body, or carina, or separate tumor nodules in the same lung lobe, or tumor associated with a malignant pleural effusion.

The regional lymph nodes (N) are clinically divided into the following categories:
NX: Regional lymph nodes cannot be assessed.
N0: Regional lymph nodes contain no metastases.
N1: Metastasis to same-side peribronchial (around the bronchi) and/or hilar (pit in the lungs where vessels enter and exit) lymph nodes and nodes within the lungs that are involved by direct spread of the primary tumor.
N2: Metastasis to same-side mediastinal and/or subcarinal (under the carina, or tracheal ridge) lymph nodes.
N3: Metastasis to opposite-side mediastinal or hilar nodes or to same- or opposite-side scalene (neck/upper rib) or supracalvicular (above collarbone) lymph nodes.

The state of metastasis (M) is defined as follows:
MX: Distant metastases cannot be assessed.
M0: No distant metastases are found.
M1: Distant metastases are present (this also includes separate tumor nodules in a different lobe of lung on either side).

The TNM system—which includes the overall features of the tumor, lymph nodes, and metastatic status—places lung cancer growth at a particular stage.
Stage Ia: T1, N0, M0
Stage Ib: T2, N0, M0
Stage IIa: N1, M0
Stage IIb: T2, N1, M0 or T3, N0, M0
Stage IIIa: T1-2, N2, M0 or T3, N1-2, M0
Stage IIIb: T(any), N3, M0 or T4, N(any), M0
Stage IV: T(any), N(any), M1

Staging of small cell lung cancer

Small cell lung cancer is classified as either limited stage or extensive stage.
– Limited stage: the tumor is found in one lung and in nearby lymph nodes.
– Extensive: the tumor has spread beyond one lung or to other organs.

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