Non small cell lung cancer staging

Non-small cell lung cancer (NSCLC) staging can be accomplished both by the TNM system.

system, or by the AJCC staging

TNM system
The current 7th edition NSCLC staging is as follows 4
Primary tumour (T)

o o o o o o o o

Tx - malignant cells on cytology but no tumour found on bronchoscopy or imaging. Tis - carcinoma in situ T1 T1a - smaller than 2cm in longest dimension T1b - larger than 2cm but smaller or equal to 3cm T2 - > 3cm in size and > 2cm from carina ; visceral pleura involvement ; lobar atelectasis T2a - larger than 3cm but smaller than 5cm T2b - larger than 5cm but smaller than 7cm T3 - < 2cm from carina but not involving trachea or carina ; involvement of chest wall, diaphragm, mediastinal pleura or parietal pericardium T4 involvement of the trachea, oesophagus, vertebra, great vessels or heart separate tumour nodules in the same lung but not in the same lobe

Nodal status (N)

Nx - regional nodes cannot be assessed N0 - no regional nodal metastases N1 - ipsilateral peribronchial, hilar or intrapulmonary nodes N2 - ipsilateral mediastinal or subcarinal nodes N3 - contralateral nodal involvement ; ipsilateral or contralateral scalene or supraclavicular nodal involvement
Distant metastasis (M)

Mx - distant metastases cannot be assessed M0 - no distant metastases M1 - distant metastases present M1a - presence of a malignant pleural effusion, pleural dissemination, or pericardial disease, intra thoracic matastases M1b - extra-thoracic matastases

AJCC staging system

o o o o o o o o o o o o o o o o o o

stage 0 TNM equivalent : carcinoma in stiu resectable : yes stage I TNM equivalent : T1 or T2, N0, M0 resectable : yes 5 year survival : 47% stage IIa TNM equivalent : T1, N1, M0 resectable : yes stage IIb TNM equivalent : T2, N1, M0 or T3, N0, M0 resectable : yes 5 year survival : 26% stage IIIa TNM equivalent : T1 or 2, N2, M0 or T3, N1 or 2, M0 resectable : yes stage IIIb TNM equivalent : T1, 2 or 3, N3, M0 or T4, N0, 1, 2 or 3, M0 resectable : no 5 year survival : 8% stage IV TNM equivalent : Any T, Any N with M1 resectable : no 5 year survival : 2%

Histological grade

grade 1 : well differentiated grade 2 : moderately differentiated grade 3 : poorly differentiated grade 4 : undifferentiated