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Lung tumor



Reviewer: Deepali Jain, M.D. (see Reviewers page)
Revised: 17 January 2013, last major update September 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

Primary tumor (T)

TX: Primary tumor cannot be assessed, or tumor proven by the presence of malignant cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy
T0: No evidence of primary tumor
Tis: Carcinoma in situ
T1: Tumor 3 cm or less in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus (i.e. not in the main bronchus); also includes the uncommon, superficial tumor of any size with its invasive component limited to the bronchial wall, which may extend proximally to the main bronchus
T1a: Tumor 2 cm or less in greatest dimension
T1b: Tumor more than 2 cm but 3 cm or less in greatest dimension
T2: Tumor more than 3 cm but 7 cm or less or tumor with any of the following features (T2 tumors with these features are classified T2a if 5 cm or less):
- Involves main bronchus
- 2 cm or more distal to the carina
- Invades visceral pleura (PL1 or PL2)
- Associated with atelectasis or obstructive pneumonitis that extends to the hilar region but does not involve the entire lung
T2a: Tumor more than 3 cm but 5 cm or less in greatest dimension
T2b: Tumor more than 5 cm but 7 cm or less in greatest dimension
T3: Tumor more than 7 cm or one that directly invades any of the following: parietal pleura (PL3), chest wall (including superior sulcus tumors), diaphragm, phrenic nerve, mediastinal pleura, parietal pericardium; or tumor in the main bronchus (less than 2 cm distal to the carina but without involvement of the carina); or associated atelectasis or obstructive pneumonitis of the entire lung or separate tumor nodule(s) in the same lobe
T4: Tumor of any size that invades any of the following: mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina; separate tumor nodule(s) in a different ipsilateral lobe

Regional lymph nodes (N)

NX: Regional lymph nodes cannot be assessed
N0: No regional lymph node metastasis
N1: Metastasis in ipsilateral peribronchial or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension
N2: Metastasis in ipsilateral mediastinal or subcarinal lymph node(s)
N3: Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)

Distant metastasis (M)

M0: No distant metastasis
M1: Distant metastasis
M1a: Separate tumor nodule(s) in a contralateral lobe tumor with pleural nodules or malignant pleural (or pericardial) effusion
M1b: Distant metastasis

● Most pleural (and pericardial) effusions are due to tumor
● In a few patients, however, multiple cytopathologic examinations of pleural (pericardial) fluid are negative for tumor, and the fluid is nonblood and is not an exudate
● Where these elements and clinical judgment dictate that the effusion is not related to the tumor, the effusion should be excluded as a staging element and the patient should be classified as M0

Stage grouping

Occult carcinoma: TX N0 M0
Stage 0: Tis N0 M0
Stage IA: T1a-b N0 M0
Stage IB: T2a N0 M0
Stage IIA: T2b N0 M0 or T1a-T2a N1 M0
Stage IIB: T2b N1 M0 or T3 N0 M0
Stage IIIA: T1a-T2b N2 M0 or T3 N1-N2 M0 or T4 N0-N1 M0
Stage IIIB: Any T N3 M0 or T4 N2-N3 M0
Stage IV: Any T any N M1a-b

Additional references

AJCC Cancer Staging Manual (7th ed)

End of Lung tumor > Other > Staging

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