Small cell carcinoma of the lung staging

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

Overview

Staging schemes for small cell lung cancer (SCLC) have been developed by the Veterans Administration Lung Study Group (VALG), the American Joint Committee on Cancer (AJCC), and the National Comprehensive Cancer Network (NCCN). The Veterans Administration Lung Study Group (VALG) staging scheme is the oldest among the three staging schemes. Although the AJCC staging scheme is newer than that of the VALG, clinicians commonly use the VALG staging system because it has been referred to in most clinical trials. The NCNN combines the AJCC (TNM) staging scheme with the VALG staging scheme.

VALG Staging

The Veterans Administration Lung Study Group (VALG) staging, also known as VA staging, is an old staging system that has been previously used in most clinical trials. Shown below is a table depicting the VA staging system which classifies SCLC into two stages.

Stage	Characteristics
Limited SCLC	Limited SCLC is characterized by the strict involvement of the ipsilateral lung.
Extensive SCLC	Extensive SCLC extends beyond the ipsilateral lung and may involve the contralateral lung, or can be associated with pleural effusion, pericardial effusion, or hematogenous spread.

AJCC and TNM Staging

Shown below is a table summarizing the staging of lung cancer according to the American Joint Committee on Cancer (AJCC). This staging scheme is the same for both SCLC and non small cell lung cancer.

For more information about the TNM staging, click here.

Stage	T	N	M
Occult carcinoma	TX	N0	M0
Stage 0	Tis	N0	M0
Stage IA	T1	N0	M0
Stage IB	T2	N0	M0
Stage IIA	T1	N1	M0
Stage IIB	T2	N1	M0
	T3	N0	M0
Stage IIIA	T1, T2	N2	M0
	T3	N1, N2	M0
Stage IIIB	Any T	N3	M0
	T4	Any N	M0
Stage IV	Any T	Any N	M1

NCCN Staging

The National Comprehensive Cancer Network (NCCN) staging system combines the staging scheme of the AJCC and that of the VALG. Although the AJCC staging scheme is newer than that of the VALG, clinicians commonly use the VALG staging system because it has been commonly referred to in clinical trials. Shown below is a table depicting the NCNN staging which classifies SCLC into two stages.

Stage	Characteristics
Limited SCLC	Limited SCLC includes lung cancer cases of stage I, II, or III which can be treated with radiation therapy. This stage does not include tumor T3 or T4 with multiple lung nodules, as well as tumor or lymph nodes that are too large to fit in the radiation plan.
Extensive SCLC	Extensive SCLC includes all SCLC categorized as stage IV, or Tumor T3 or T4 with multiple lung nodules, or Tumor or lymph nodes that are too large to fit in the radiation plan

References

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