Lung Cancer TNM Staging System Explained In Detail

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Lung cancer staging helps to determine the disease prognosis and to select an appropriate treatment strategy.

TNM is the most commonly used staging system for lung cancer. It uses mainly 3 parameters: “T” stands for “Tumor”; “N” for “Lymph Nodes”; and “M” for “Metastasis”.

Numbers and/or letters after T (0, is, 1, 2, 3, and 4), N (0, 1, 2, and 3), and M (0 and 1) provide more details about each of these parameters. Once T, N, and M are determined, it is used to assign an overall stage (from 0 to IV).

Tis – Pre-cancerous changes or carcinoma in situ. No spread to nearby lymph nodes or distant body parts.

T1mi– Cancer is minimally invasive adenocarcinoma </=3 cm in greatest dimension and invasion </=5 mm in greatest dimension. No spread to nearby lymph nodes or distant body parts.

T1a – A tumor </=1 cm in the greatest dimension without invasion of the pleural membrane or main bronchus. No spread to nearby lymph nodes or distant body parts.

T1b – A tumor >1 cm but </=2 cm in the greatest dimension without invasion of the pleural membrane or main bronchus. No spread to nearby lymph nodes or distant body parts.

T1c – A tumor >2 cm but </=3 cm in the greatest dimension without invasion of the pleural membrane or main bronchus. No spread to nearby lymph nodes or distant body parts.

T2a – A tumor >3 cm but </=4 cm in the greatest dimension that:
· has invaded into the main bronchus but has not affected the carina (the point where the trachea divides into the 2 bronchi), or
· invades the visceral pleura, or
· is partially choking the airway

T2b – A tumor >4 cm but </=5 cm in the greatest dimension that:
· has invaded into the main bronchus but has not affected the carina (the point where the trachea divides into the 2 bronchi)
· has grown into the visceral pleura
· is partially choking the airway

T3 – A tumor >5 cm but </=7 cm in the greatest dimension that has invaded into the parietal pleura, chest wall, phrenic nerve, or the membranes surrounding the heart (parietal pericardium); or
There are 2 separate primary tumor nodules within the same lobe.

T4 – A tumor >7 cm in the greatest dimension that has invaded into the diaphragm, mediastinum, heart, large blood vessels, trachea, recurrent laryngeal nerve, esophagus, backbone, or carina; or
there is another tumor nodule in the adjacent lobe of the same lung. 

Lung Cancer TNM Staging System

lung cancer tnm staging
Lung Cancer T Staging

N0 – No spread of cancer to nearby lymph nodes 

N1 – Cancer has spread to nearby lymph nodes within the lung or along the bronchus or around the area where the bronchus enters the lung

N2 – Cancer has spread to subcarinal or ipsilateral mediastinal lymph nodes

N3 – Cancer has spread to mediastinal lymph nodes on the other side of the primary tumor, or nodes near the collarbone (supraclavicular nodes)

Lung Cancer N Staging

M0 – Cancer has not spread to distant body parts

M1a – Spread of cancer cells into the pleura or pleural fluid (malignant pleural effusion) or into the pericardium or pericardial fluid (malignant pericardial effusion).

M1b – Single tumor deposit in a single distant organ (for example, liver, bones, brain, etc) or to a non-regional lymph node.

M1c – Multiple tumor deposits in single or multiple distant organs.

Lung Cancer M Staging

Lung Cancer TNM Staging

STAGETNM
0Tis N0 M0
IA1T1mi N0 M0
T1a N0 M0
IA2T1b N0 M0
IA3T1c N0 M0
IBT2a N0 M0
IIAT2b N0 M0
IIBT1a-2b N1 M0
T3 N0 M0
IIIAT1a-2b N2 M0
T3 N1 M0
T4 N0-1 M0
IIIBT1a-2b N3 M0
T3-4 N2 M0
IIICT3-4 N3 M0
IVAAny T Any N M1a
Any T Any N M1b
IVBAny T Any N M1c

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Additionally, SCLC is divided into following 2 stages based on the extent of disease spread and type of treatment approach to be followed:

Limited-Stage: This means that cancer is only on one side of the chest and might have spread to lymph nodes (including lymph nodes above the collarbone) on the same side.

This type of SCLC is generally confined to a specific small region of the lung that can be treated with a single radiation field.

Extensive-Stage: This means that cancer has extensively spread throughout the lung, to other lung, lymph nodes on the other side of the chest, pleural membrane, distant lymph nodes, or distant organ.

This type of SCLC cannot be treated with a single radiation therapy and require chemotherapy for their management.

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