Lung cancer diagnostic study of choice: Difference between revisions

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|[[Image:IJRI-25-109-g001.jpg|thumb|300px|Common radiological appearances of lung cancer. Centrally located mass with mediastinal invasion (arrow, A), peripherally situated mass abutting the pleura (arrow, B), mass with smooth, lobulated margins (arrow, C) and with spiculated, irregular margins (arrow, D), via <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F1/><ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]]
|[[Image:IJRI-25-109-g001.jpg|thumb|300px|Common [[radiological]] appearances of lung cancer. Centrally located mass with [[Mediastinum|mediastinal]] [[Invasive (medical)|invasion]] (arrow, A), peripherally situated mass abutting the [[pleura]] (arrow, B), mass with smooth, [[Lobule|lobulated]] margins (arrow, C) and with spiculated, irregular margins (arrow, D), via <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F1/><ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]]
|[[Image:IJRI-25-109-g002.jpg|thumb|300px|Lung cancers with atypical radiological pattern. Squamous cell cancer presenting as a cavitating mass (arrow, A). Adenocarcinoma presenting as dense consolidation (arrow, B). Bronchoalveolar carcinoma (adenocarcinoma in situ) presenting as ground-glass opacity (arrow, C) and mixed density, solid (arrow), and ground-glass nodules (arrowhead) in D via <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F2/><ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]]
|[[Image:IJRI-25-109-g002.jpg|thumb|300px|Lung cancers with atypical [[radiological]] pattern. [[Squamous cell cancer]] presenting as a cavitating mass (arrow, A). [[Adenocarcinoma]] presenting as dense [[Consolidation (medicine)|consolidation]] (arrow, B). [[Bronchoalveolar carcinoma]] (adenocarcinoma in situ) presenting as [[Ground glass opacification on CT|ground-glass opacity]] (arrow, C) and mixed density, solid (arrow), and ground-glass [[Nodule (medicine)|nodules]] (arrowhead) in D via <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F2/><ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]]
|-
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|[[Image:IJRI-25-109-g003.jpg|thumb|300px|Stage T1 and T2 tumors. Stage T1 tumor due to size <3 cm (arrow, A). Stage T2 endobronchial tumor (arrowhead) causing pneumonitis restricted to the upper lobe (arrow) in B. T2a tumor >3 cm but <5 cm (arrow, C). T2b tumor >5 cm but <7 cm (arrow in D) via <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F3/><ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]]
|[[Image:IJRI-25-109-g003.jpg|thumb|300px|[[Cancer staging|Stage]] T1 and T2 [[tumors]]. [[Cancer staging|Stage]] T1 [[tumor]] due to size < 3 cm (arrow, A). [[Cancer staging|Stage]] T2 endobronchial [[tumor]] (arrowhead) causing [[pneumonitis]] restricted to the [[Lobe (anatomy)|upper lobe]] (arrow) in B. T2a [[tumor]] > 3 cm but < 5 cm (arrow, C). T2b [[tumor]] > 5 cm but < 7 cm (arrow in D) via <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F3/><ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]]
|[[Image:IJRI-25-109-g004.jpg|thumb|300px|Stage T3 tumors. T3 tumor due to size >7 cm in size (arrow, A), eroding the ribs (arrow, B), infiltrating the mediastinal pleura but not the vessels (arrow, C), and causing atelectasis of the entire lung (arrowhead, D via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F4/>.<ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]]
|[[Image:IJRI-25-109-g004.jpg|thumb|300px|[[Cancer staging|Stage]] T3 [[Tumor|tumors]]. T3 [[tumor]] due to size > 7 cm in size (arrow, A), eroding the [[Rib|ribs]] (arrow, B), infiltrating the [[mediastinal pleura]] but not the [[Blood vessel|vessels]] (arrow, C), and causing [[atelectasis]] of the entire [[lung]] (arrowhead, D via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F4/>.<ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]]
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|[[Image:IJRI-25-109-g004.jpg|thumb|300px|Stage T4 tumors. T4 tumor due to invasion of pulmonary artery (arrow, A), descending aorta (arrow, B), vertebral body (arrow, C), superior vena cava with thrombus (arrow, D)via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F5/><ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]]
|[[Image:IJRI-25-109-g004.jpg|thumb|300px|[[Cancer staging|Stage]] T4 [[Tumor|tumors]]. T4 [[tumor]] due to [[Invasive (medical)|invasion]] of [[pulmonary artery]] (arrow, A), [[descending aorta]] (arrow, B), [[Body of vertebra|vertebral body]] (arrow, C), [[superior vena cava]] with [[thrombus]] (arrow, D)via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F5/><ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]]
|[[Image:IJRI-25-109-g016.jpg|thumb|300px|
|[[Image:IJRI-25-109-g016.jpg|thumb|300px|


Superior sulcus tumor. Axial (A) and coronal (B) CT scans show a large mass in the apex of the right lung causing destruction of the first and second ribs (arrows) with erosion of the right half of the vertebral body (arrowheads) suggestive of a superior sulcus tumor, via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F16/><ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]]
[[Sulcus (anatomy)|Superior sulcus]] [[tumor]]. Axial (A) and coronal (B) [[Computed tomography|CT scans]] show a large mass in the [[apex]] of the right [[lung]] causing destruction of the first and second [[Rib|ribs]] (arrows) with erosion of the right half of the [[Body of vertebra|vertebral body]] (arrowheads) suggestive of a [[Sulcus (anatomy)|superior sulcus]] [[tumor]], via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F16/><ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]]
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==== Spiral CT perfusion imaging ====
==== Spiral CT Perfusion Imaging ====


*Spiral CT perfusion study can be used as a diagnostic method for peripheral pulmonary nodules.
*[[Spiral CT scan|Spiral CT]] [[perfusion]] study can be used as a [[Diagnosis|diagnostic]] method for peripheral [[Pulmonary nodule|pulmonary nodules]].
*Spiral CT perfusion study provides non-invasive method of quantitative assessment about the blood flow patterns of peripheral pulmonary nodules.
*[[Spiral CT scan|Spiral CT]] [[perfusion]] study provides non-[[Invasive (medical)|invasive]] method for the quantitative assessment of [[blood flow]] patterns of peripheral [[Pulmonary nodule|pulmonary nodules]].
*Spiral CT perfusion imaging is analyzed and evaluated for:.<ref name="MaLe2008">{{cite journal|last1=Ma|first1=Shu-Hua|last2=Le|first2=Hong-Bo|last3=Jia|first3=Bao-hui|last4=Wang|first4=Zhao-Xin|last5=Xiao|first5=Zhuang-Wei|last6=Cheng|first6=Xiao-Ling|last7=Mei|first7=Wei|last8=Wu|first8=Min|last9=Hu|first9=Zhi-Guo|last10=Li|first10=Yu-Guang|title=Peripheral pulmonary nodules: Relationship between multi-slice spiral CT perfusion imaging and tumor angiogenesis and VEGF expression|journal=BMC Cancer|volume=8|issue=1|year=2008|issn=1471-2407|doi=10.1186/1471-2407-8-186}}</ref>]]
*[[Spiral CT scan|Spiral CT]] [[perfusion]] [[imaging]] is analyzed and evaluated for:<ref name="MaLe2008">{{cite journal|last1=Ma|first1=Shu-Hua|last2=Le|first2=Hong-Bo|last3=Jia|first3=Bao-hui|last4=Wang|first4=Zhao-Xin|last5=Xiao|first5=Zhuang-Wei|last6=Cheng|first6=Xiao-Ling|last7=Mei|first7=Wei|last8=Wu|first8=Min|last9=Hu|first9=Zhi-Guo|last10=Li|first10=Yu-Guang|title=Peripheral pulmonary nodules: Relationship between multi-slice spiral CT perfusion imaging and tumor angiogenesis and VEGF expression|journal=BMC Cancer|volume=8|issue=1|year=2008|issn=1471-2407|doi=10.1186/1471-2407-8-186}}</ref>
**TDC (time density curve)
**TDC (time density curve)
**Perfusion parametric maps
**[[Perfusion]] parametric maps
**The respective perfusion parameters.
**The respective [[perfusion]] parameters
**Immunohistochemical findings of microvessel density (MVD) measurement
**[[Immunohistochemistry|Immunohistochemical]] findings of [[microvessel]] [[density]] (MVD) measurement
**VEGF expression
**[[Vascular endothelial growth factor|VEGF]] [[expression]]


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==== CT Findings of Metastatic disease ====
==== CT Findings of Metastatic disease ====


*CT scans help stage the lung cancer. A CT scan of the abdomen and brain can help visualize the common sights of metastases: adrenal glands, liver, and brain.
*[[Computed tomography|CT scans]] help [[Cancer staging|stage]] the lung cancer. A [[Computed tomography|CT scan]] of the [[abdomen]] and [[brain]] can help visualize the common sights of [[metastases]] such as [[adrenal glands]], [[liver]], and [[brain]].
*The benefits of CT Scans in lung cancer patients are the following:<ref name="Silvestri">Gerard A. Silvestri, Lynn T. Tanoue, Mitchell L. Margolis, John Barker, Frank Detterbeck.11/30/11.The Noninvasive Staging of Non Small-cell Lung Cancer. Chestpubs. http://chestjournal.chestpubs.org/content/123/1_suppl/147S.full/</ref>
*The benefits of [[Computed tomography|CT scan]] in lung cancer [[Patient|patients]] are the following:<ref name="Silvestri">Gerard A. Silvestri, Lynn T. Tanoue, Mitchell L. Margolis, John Barker, Frank Detterbeck.11/30/11.The Noninvasive Staging of Non Small-cell Lung Cancer. Chestpubs. http://chestjournal.chestpubs.org/content/123/1_suppl/147S.full/</ref>
**Provides anatomical detail to locate the [[tumor]]
**Provides [[Anatomy|anatomical]] detail to locate the [[tumor]]
**Demonstrates proximity to nearby structures
**Demonstrates proximity to nearby structures
**Deciphers whether [[lymph nodes]] are enlarged in the [[mediastinum]]
**Deciphers whether [[lymph nodes]] are enlarged in the [[mediastinum]]


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|[[Image:IJRI-25-109-g010.jpg|thumb|300px|Metastatic disease. Bilateral pleural effusions-M1a (arrow, A), lung metastases-M1a (arrows, B), adrenal metastasis-M1b (arrow, C), vertebral metastasis-M1b (arrow, D), brain metastasis-M1b (arrow, E), liver metastases-M1b (arrows, F)via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F10/>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.<ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]]
|[[Image:IJRI-25-109-g010.jpg|thumb|300px|[[Metastatic disease]]. Bilateral [[Pleural effusion|pleural effusions]]-M1a (arrow, A), [[lung]] [[Metastasis|metastases]]-M1a (arrows, B), [[Adrenal gland|adrenal]] [[metastasis]]-M1b (arrow, C), [[Vertebra|vertebral]] [[metastasis]]-M1b (arrow, D), [[brain metastasis]]-M1b (arrow, E), [[liver]] [[Metastasis|metastases]]-M1b (arrows, F)via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F10/>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.<ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]]
|[[Image:IJRI-25-109-g011.jpg|thumb|300px|Adrenal adenoma versus metastasis. Enhancing solid adrenal nodule on CT scan in a case of lung cancer (arrow, A) suggestive of metastatic deposit. Unenhanced CT scan shows fatty attenuation within the nodule with an HU value of 0 suggesting the possibility of an adenoma (arrow, B). FDG PET/CT shows no tracer concentration in the nodule, confirming the diagnosis of adenoma. Enhancing solid adrenal nodule on CT scan in another patient of lung cancer (arrow, D), which is indeterminate in nature. FDG PET/CT shows abnormal focal tracer concentration in the nodule (arrow, E) highly suggestive of a metastatic deposit via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F11/><ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]]
|[[Image:IJRI-25-109-g011.jpg|thumb|300px|[[Adrenal adenoma]] versus [[metastasis]]. Enhancing solid [[Adrenal gland|adrenal]] [[Nodule (medicine)|nodule]] on [[Computed tomography|CT scan]] in a case of lung cancer (arrow, A) suggestive of [[Metastasis|metastatic]] deposit. Unenhanced [[Computed tomography|CT scan]] shows [[Fat|fatty]] attenuation within the [[Nodule (medicine)|nodule]] with an HU value of 0 suggesting the possibility of an [[adenoma]] (arrow, B). [[FDG-PET]]/[[Computed tomography|CT]] shows no tracer concentration in the [[Nodule (medicine)|nodule]], confirming the [[diagnosis]] of [[adenoma]]. Enhancing solid [[Adrenal gland|adrenal]] [[Nodule (medicine)|nodule]] on [[Computed tomography|CT scan]] in another [[patient]] of lung cancer (arrow, D), which is indeterminate in nature. [[FDG-PET]]/[[Computed tomography|CT]] shows abnormal focal tracer concentration in the [[Nodule (medicine)|nodule]] (arrow, E) highly suggestive of a [[Metastasis|metastatic]] deposit via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F11/><ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]]
|[[Image:IJRI-25-109-g012.jpg|thumb|300px|Brain metastases in asymptomatic patient, CT scan versus MRI. MRI brain in a patient of lung cancer shows multiple tiny enhancing foci scattered in the parenchyma bilaterally (arrows in A and B) suggestive of metastatic lesions. Corresponding contrast CT scan sections of the brain show no obvious lesions (C and D). Note the beam hardening effects due to bone, leading to a loss of resolution on the CT images (C and D)|thumb|Brain metastases in asymptomatic patient, CT scan versus MRI. MRI brain in a patient of lung cancer shows multiple tiny enhancing foci scattered in the parenchyma bilaterally (arrows in A and B) suggestive of metastatic lesions. Corresponding contrast CT scan sections of the brain show no obvious lesions (C and D). Note the beam hardening effects due to bone, leading to a loss of resolution on the CT images (C and D)via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F12/><ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]]
|[[Image:IJRI-25-109-g012.jpg|thumb|300px|Brain metastases in asymptomatic patient, CT scan versus MRI. MRI brain in a patient of lung cancer shows multiple tiny enhancing foci scattered in the parenchyma bilaterally (arrows in A and B) suggestive of metastatic lesions. Corresponding contrast CT scan sections of the brain show no obvious lesions (C and D). Note the beam hardening effects due to bone, leading to a loss of resolution on the CT images (C and D)|thumb|Brain metastases in asymptomatic patient, CT scan versus MRI. MRI brain in a patient of lung cancer shows multiple tiny enhancing foci scattered in the parenchyma bilaterally (arrows in A and B) suggestive of metastatic lesions. Corresponding contrast CT scan sections of the brain show no obvious lesions (C and D). Note the beam hardening effects due to bone, leading to a loss of resolution on the CT images (C and D)via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F12/><ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]]
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*Unfortunately, research has shown that there are a number of false positives associated with CT scanning because a CT scan on its own cannot determine [[malignancy]].  
*Unfortunately, [[research]] has shown that there are a number of [[False positive|false positives]] associated with [[Computed tomography|CT scanning]] because [[Computed tomography|CT scan]] alone cannot determine [[malignancy]].
*A positive result for a tumor using a CT scan is typically followed up with a [[biopsy]] for confirmation.
*A positive result for a [[tumor]] using [[Computed tomography|CT scan]] is typically followed up with a [[biopsy]] for confirmation.


=== Staging ===
=== Staging ===
The following is 2017 TNM classification of lung cancer.<ref>{{cite book | last =Mountain | first =CF | authorlink = | coauthors =Libshitz HI, Hermes KE | title =A Handbook for Staging, Imaging, and Lymph Node Classification | publisher =Charles P Young Company | date =2003 | url =http://www.ctsnet.org/book/mountain/index.html | accessdate =2007-09-01 }}</ref><ref name="Collins">{{cite journal | last = Collins | first = LG | coauthors = Haines C, Perkel R, Enck RE | title = Lung cancer: diagnosis and management | journal = American Family Physician | volume = 75 | issue = 1 | pages = 56–63 | publisher = American Academy of Family Physicians | date = Jan 2007 | url= http://www.aafp.org/afp/20070101/56.html | pmid =17225705 | accessdate =2007-08-10 }}</ref><ref name="HarmsKriegsmann2017">{{cite journal|last1=Harms|first1=A.|last2=Kriegsmann|first2=M.|last3=Fink|first3=L.|last4=Länger|first4=F.|last5=Warth|first5=A.|title=Die neue TNM-Klassifikation für Lungentumoren|journal=Der Pathologe|volume=38|issue=1|year=2017|pages=11–20|issn=0172-8113|doi=10.1007/s00292-017-0268-y}}</ref>
The following is 2017 [[TNM classification]] of lung cancer.<ref>{{cite book | last =Mountain | first =CF | authorlink = | coauthors =Libshitz HI, Hermes KE | title =A Handbook for Staging, Imaging, and Lymph Node Classification | publisher =Charles P Young Company | date =2003 | url =http://www.ctsnet.org/book/mountain/index.html | accessdate =2007-09-01 }}</ref><ref name="Collins">{{cite journal | last = Collins | first = LG | coauthors = Haines C, Perkel R, Enck RE | title = Lung cancer: diagnosis and management | journal = American Family Physician | volume = 75 | issue = 1 | pages = 56–63 | publisher = American Academy of Family Physicians | date = Jan 2007 | url= http://www.aafp.org/afp/20070101/56.html | pmid =17225705 | accessdate =2007-08-10 }}</ref><ref name="HarmsKriegsmann2017">{{cite journal|last1=Harms|first1=A.|last2=Kriegsmann|first2=M.|last3=Fink|first3=L.|last4=Länger|first4=F.|last5=Warth|first5=A.|title=Die neue TNM-Klassifikation für Lungentumoren|journal=Der Pathologe|volume=38|issue=1|year=2017|pages=11–20|issn=0172-8113|doi=10.1007/s00292-017-0268-y}}</ref>


====T: Primary Tumor====
====T: Primary Tumor====
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| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''T'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''Description'''
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''T'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''Description'''
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |TX || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Primary tumor cannot be assessed.<br> OR <br>Tumor is demonstrated by the presence of malignant cells in bronchial washings or [[sputum]], but is not visualized by imaging or [[bronchoscopy]].
! style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |TX  
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="left" |
* Primary [[tumor]] cannot be assessed.<br> OR  
* [[Tumor]] is demonstrated by the presence of [[Cancer cell|malignant cells]] in [[bronchial]] washings or [[sputum]], but is not visualized by [[imaging]] or [[bronchoscopy]].
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | T0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |There is no evidence of primary tumor.
! style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" | T0  
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="left" |
* There is no evidence of primary [[tumor]].
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Tis || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Carcinoma in situ
! style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |Tis  
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="left" |
* [[Carcinoma in situ]]
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |The tumor has the following characteristics:  
! style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |T1  
* T1a: tumor ≤1 cm in the largest diameter.
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="left" |
* The [[tumor]] has the following characteristics:


* T1b: tumor> 1 cm, but ≤2 cm in the largest diameter.
**'''T1a''': [[Tumor]] ≤ 1 cm in the largest [[diameter]].
* T1c: tumor> 2 cm, but ≤3 cm in the largest diameter.<br> AND <br>The tumor is surrounded by lung or [[visceral pleura]]<br> AND <br>The tumor does not extend to the main bronchus as demonstrated by the absence of bronchoscopic evidence of invasion more proximal than the lobar bronchus.
 
**'''T1b''': [[Tumor]] > 1 cm, but ≤ 2 cm in the largest [[diameter]].
**'''T1c''': [[Tumor]] > 2 cm, but ≤ 3 cm in the largest [[diameter]].<br> AND  
*The [[tumor]] is surrounded by [[lung]] or [[visceral pleura]]<br> AND  
*The [[tumor]] does not extend to the [[main bronchus]] as demonstrated by the absence of [[Bronchoscopy|bronchoscopic]] evidence of [[Invasive (medical)|invasion]] more [[Anatomical terms of location|proximal]] than the [[Lobe (anatomy)|lobar]] [[bronchus]].
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |The tumor has the following characteristics:
! style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |T2  
* T2a: tumor> 3 cm, but ≤4 cm in the largest diameter.
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="left" |
* T2b: Tumor> 4 cm, but ≤5 cm in the largest diameter.<br>The tumor involves the main bronchus, 2 cm or more distal to the [[carina]]. <br> OR <br>The tumor invades the [[visceral pleura]]. <br> OR <br>There is evidence of [[atelectasis]] or obstructive [[pneumonitis]] that extends to the hilar region without the involvement of the entire lung.
* The [[tumor]] has the following characteristics:
 
**'''T2a''': [[Tumor]] > 3 cm, but ≤ 4 cm in the largest [[diameter]].
**'''T2b''': [[Tumor]] > 4 cm, but ≤ 5 cm in the largest [[diameter]].
*The [[tumor]] involves the [[main bronchus]], 2 cm or more [[Anatomical terms of location|distal]] to the [[carina]]. <br> OR  
*The [[tumor]] [[Invasive (medical)|invades]] the [[visceral pleura]]. <br> OR  
*There is evidence of [[atelectasis]] or [[Obstruction|obstructive]] [[pneumonitis]] that extends to the [[Hilum of lung|hilar region]] without the involvement of the entire [[lung]].
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Tumor > 5 cm, but ≤ 7 cm in size.
! style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |T3  
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="left" |
* [[Tumor]] > 5 cm, but ≤ 7 cm in size.
 
AND
AND


It directly invades any of the following: [[chest wall]] (including superior sulcus tumors), [[diaphragm]], mediastinal pleura, parietal [[pericardium]].<br> OR <br>The tumor is localized in the main bronchus at a distance less than 2 cm distal to the [[carina]] but without the involvement of the [[carina]].<br> OR <br>There is evidence of associated [[atelectasis]] or obstructive [[pneumonitis]] of the entire lung.
* It directly [[Invasive (medical)|invades]] any of the following: [[Chest wall]] (including [[Sulcus (anatomy)|superior sulcus]] [[Tumor|tumors]]), [[diaphragm]], [[mediastinal pleura]], [[parietal pericardium]].<br> OR  
* The [[tumor]] is localized in the [[main bronchus]] at a distance less than 2 cm [[Anatomical terms of location|distal]] to the [[carina]] but without the involvement of the [[carina]].<br> OR  
* There is evidence of associated [[atelectasis]] or [[Obstruction|obstructive]] [[pneumonitis]] of the entire [[lung]].
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T4 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Tumor > 7 cm in size.
! style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |T4  
The tumor invades any of the following: [[mediastinum]], [[heart]], great vessels, [[trachea]], [[esophagus]], [[vertebral body]], [[carina]]<br> OR <br>There is/are separate tumor nodule(s) in the same lobe. <br> OR  
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="left" |
The tumor is associated with malignant [[pleural effusion]].
* [[Tumor]] > 7 cm in size.
* The [[tumor]] [[Invasive (medical)|invades]] any of the following: [[Mediastinum]], [[heart]], [[great vessels]], [[trachea]], [[esophagus]], [[vertebral body]], and [[carina]]<br> OR  
* There is/are separate [[tumor]] [[Nodule (medicine)|nodule(s)]] in the same [[Lobe (anatomy)|lobe]]. <br> OR  
* The [[tumor]] is associated with [[malignant]] [[pleural effusion]].
|}
|}


====N:Regional Lymph Nodes====
====N: Regional Lymph Nodes====
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''T'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''Description'''
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''T'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''Description'''
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |NX || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |the regional [[lymph node]]s cannot be assessed.
! style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |NX  
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="left" |
* Regional [[lymph node]]s cannot be assessed.
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |There is no evidence of regional lymph node metastasis.
! style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |N0  
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="left" |
* There is no evidence of regional [[lymph node]] [[metastasis]].
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |[[Metastasis]] in [[Anatomical terms of location|ipsilateral]] peribronchial and/or [[Anatomical terms of location|ipsilateral]] [[Hilar lymphadenopathy|hilum]] or intrapulmonary [[Lymph node|lymph nodes]]  
! style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |N1  
N1a - A [[lymph node]] invasion.
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="left" |
 
* [[Metastasis]] in [[Anatomical terms of location|ipsilateral]] peribronchial and/or [[Anatomical terms of location|ipsilateral]] [[Hilar lymphadenopathy|hilum]] or intrapulmonary [[Lymph node|lymph nodes]]
N1b - > 1 [[lymph node]] affected.
* '''N1a:''' Invasion of 1 [[lymph node]].
* '''N1b:''' > 1 [[lymph node]] affected.
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |There is [[metastasis]] in ipsilateral [[Mediastinum|mediastinal]] and/or subcarinal [[Lymph node|lymph node(s).]]
! style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |N2  
N2a1 - One lymph node infested without lymph node involvement of an N1-defined lymph node station.
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="left" |
 
* There is [[metastasis]] in the [[Anatomical terms of location|ipsilateral]] [[Mediastinum|mediastinal]] and/or [[Carina of trachea|subcarinal]] [[Lymph node|lymph node(s).]]
N2a2 - One lymph node infested with a lymph node of an N1-defined lymph node station
* '''N2a1:''' One [[lymph node]] affected without [[lymph node]] involvement of an N1-defined [[lymph node]] station.
 
* '''N2a2:''' One [[lymph node]] affected with a [[lymph node]] of an N1-defined [[lymph node]] station
N2b - > 1 lymph node affected
* '''N2b:''' > 1 [[lymph node]] affected
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |There is [[metastasis]] in [[Anatomical terms of location|contralateral]] [[Mediastinum|mediastinal]], contralateral [[Hilum|hilar]], [[Anatomical terms of location|ipsilateral]] or [[Anatomical terms of location|contralateral]] scalene, or supraclavicular [[Lymph node|lymph node(s).]]
! style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |N3  
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="left" |
* There is [[metastasis]] in the [[Anatomical terms of location|contralateral]] [[Mediastinum|mediastinal]], [[Anatomical terms of location|contralateral]] [[Hilum|hilar]], [[Anatomical terms of location|ipsilateral]] or [[Anatomical terms of location|contralateral]] [[scalene]], or [[supraclavicular]] [[Lymph node|lymph node(s).]]
|}
|}


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| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''T'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''Description'''
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''T'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''Description'''
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |MX || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Distant metastasis cannot be assessed.
! style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |MX  
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="left" |
* Distant [[metastasis]] cannot be assessed.
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |There is no evidence of distant [[metastasis]].
! style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |M0  
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="left" |
* There is no evidence of distant [[metastasis]].
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |There is evidence of [[distant]] metastasis which includes the presence of separate tumor nodule(s) in a different lobe (ipsilateral or contralateral).
! style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |M1  
M1a - Tumor foci separated from the primary tumor in a contralateral lung lobe; Tumor with pleural metastases or malignant pleural or pericardial effusion
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="left" |
 
* There is evidence of [[distant]] [[metastasis]] which includes the presence of separate [[tumor]] [[Nodule (medicine)|nodule(s)]] in a different [[Lobe (anatomy)|lobe]] ([[Anatomical terms of location|ipsilateral]] or [[Anatomical terms of location|contralateral]]).
M1b - Simple metastases in an organ
* '''M1a:''' [[Tumor]] foci separated from the primary [[tumor]] in a [[Anatomical terms of location|contralateral]] [[Lung|lung lobe]]; [[tumor]] with [[pleural]] [[Metastasis|metastases]] or [[malignant]] [[Pleural effusion|pleural]] or [[pericardial effusion]]
 
* '''M1b:''' Single [[Metastasis|metastatic lesion]] in an [[Organ (anatomy)|organ]]
M1c - Multiple metastases in one organ or one or more metastases in more than one organ
* '''M1c:''' Multiple [[Metastasis|metastases]] in one [[Organ (anatomy)|organ]] or one or more [[Metastasis|metastases]] in more than one [[Organ-limited amyloidosis|organ]]


|}
|}
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| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''Stage'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''T'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''N'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''M'''
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''Stage'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''T'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''N'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align="center" |'''M'''
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Occult carcinoma''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |TX|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N0|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |'''Occult carcinoma''' || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |TX|| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N0|| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Stage 0''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Tis || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |'''Stage 0''' || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |Tis || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" | N0 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Stage IA1''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1(mi)/T1a || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |'''Stage IA1''' || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T1(mi)/T1a || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N0 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Stage IA2''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1b || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | M0
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |'''Stage IA2''' || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T1b || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N0 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" | M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | '''Stage IA3'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1c || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | M0
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" | '''Stage IA3'''|| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T1c || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N0 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" | M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Stage IB''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2a || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | M0
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |'''Stage IB''' || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T2a || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N0 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" | M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Stage IIA''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2b || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |'''Stage IIA''' || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T2b || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N0 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| rowspan="5" style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Stage IIB''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1a || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | M0
| rowspan="5" style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |'''Stage IIB''' || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T1a || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N1 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" | M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1c || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T1c || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N1 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2a || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T2a || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N1 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2b || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T2b || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N1 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T3 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N0 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| rowspan="13" style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Stage IIIA''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1a
| rowspan="13" style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |'''Stage IIIA''' || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T1a
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N2 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1b || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T1b || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N2 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1c || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T1c || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N2 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2a || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T2a || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N2 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2b || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T2b || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N2 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1a || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T1a || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N2 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1b || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T1b || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N2 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1c || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T1c || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N2 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2a || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T2a || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N2 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2b || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T2b || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N2 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T3 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N1 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T4 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N0 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T4 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N0 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T4|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N1 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T4|| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N1 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| rowspan="12" style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Stage IIIB''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1a|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| rowspan="12" style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |'''Stage IIIB''' || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T1a|| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N3 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1b || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T1b || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N3 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1c || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T1c || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N3 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2a || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T2a || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N3 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2b || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T2b || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N3 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1a || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T1a || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N3 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
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| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1b || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T1b || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N3 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T1c || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T1c || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N3 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2a || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T2a || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N3 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T2b || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T2b || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N3 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T3 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N2 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
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|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T4 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T4 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N2 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| rowspan="2"  style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Stage IIIC'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| rowspan="2"  style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |'''Stage IIIC'''|| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T3 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N3 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |T4 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |N3 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M0
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |T4 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |N3 || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M0
|-
|-
| rowspan="2" style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Stage IVA'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Any T || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Any N || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M1a
| rowspan="2" style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |'''Stage IVA'''|| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |Any T || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |Any N || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M1a
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Any T || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Any N || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M1b  
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |Any T || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |Any N || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M1b  
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Stage IVB'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Any T || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |Any N || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |M1c
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="center" |'''Stage IVB'''|| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |Any T || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |Any N || style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |M1c
|}
|}


===Procedures for Staging Lung Cancer===
===Procedures for Staging Lung Cancer===
There are currently multiple different procedures available to stage lung cancer.  
 
* They can be broken down into two overarching categories, [[invasive]] and minimally invasive.
* There are currently multiple different [[Procedure|procedures]] available to [[Cancer staging|stage]] lung cancer.  
** The [[Invasive (medical)|invasive procedures]] are:
 
*** [[EUS-NA]] ([[esophageal]] [[endoscopic]] [[ultrasound]] with needle [[aspiration]])
* They can be broken down into two overarching categories, [[invasive]] and minimally [[Invasive (medical)|invasive]].
*** [[TBNA]] ([[TBNA|transbronchial needle aspiration]])
 
*** [[EBUS-NA|EBUS-NA (endobronchial ultrasound with needle aspiration)]]
===== Invasive =====
*** [[TTNA]] ([[transthoracic needle aspiration]])
 
*** [[Thoracoscopy|VATS staging (video assisted thoracic surgery)]] ''aka'' [[thoracoscopy]]
*[[EUS-NA]] ([[esophageal]] [[endoscopic]] [[ultrasound]] with [[Needle aspiration biopsy|needle aspiration]])
*** [[Mediastinoscopy|Extended cervical mediastinoscopy]]
*[[TBNA]] ([[TBNA|transbronchial needle aspiration]])
*** [[Chamberlain procedure]]
*[[EBUS-NA|EBUS-NA (endobronchial ultrasound with needle aspiration)]]
** The [[Minimally invasive procedure|minimally invasive procedures]] are:
*[[TTNA]] ([[transthoracic needle aspiration]])
*** [[EBUS-NA|EBUS-FNA]] ([[Endoscopic ultrasound|endobronchial ultrasound]] guided [[Needle aspiration biopsy|fine needle aspiration)]]
*[[Thoracoscopy|VATS staging (video assisted thoracic surgery)]] ''aka'' [[thoracoscopy]]
*** [[EUS-NA|EUS-FNA]] ([[esophageal endoscopic ultrasound]] guided [[Needle aspiration biopsy|fine needle aspiration)]]
*[[Mediastinoscopy|Extended cervical mediastinoscopy]]
*[[Chamberlain procedure]]
 
===== Minimally Invasive =====
 
*[[EBUS-NA|EBUS-FNA]] ([[Endoscopic ultrasound|endobronchial ultrasound]] guided [[Needle aspiration biopsy|fine needle aspiration)]]
*[[EUS-NA|EUS-FNA]] ([[esophageal endoscopic ultrasound]] guided [[Needle aspiration biopsy|fine needle aspiration)]]




Latest revision as of 17:41, 8 July 2019

Lung cancer Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]Kim-Son H. Nguyen M.D., Cafer Zorkun, M.D., Ph.D. [3]. Rim Halaby, M.D. [4], Michael Maddaleni, B.S.

Overview

Chest CT scan is the modality of choice in the diagnosis of lung cancer. Findings on CT scan suggestive of lung cancer include a solitary pulmonary nodule, centrally located masses, mediastinal invasion CT scans help stage the lung cancer. A CT scan of the abdomen and brain can help visualize the common sights of metastases such as adrenal glands, liver, and brain. CT scans diagnose lung cancer by providing anatomical detail to locate the tumor, demonstrating proximity to the nearby structures, and deciphering whether lymph nodes are enlarged in the mediastinum.

Diagnostic Study of Choice

Study of Choice

Chest CT scan is the modality of choice in the diagnosis of lung cancer. Findings on CT scan suggestive of lung cancer include:[1]

Common radiological appearances of lung cancer. Centrally located mass with mediastinal invasion (arrow, A), peripherally situated mass abutting the pleura (arrow, B), mass with smooth, lobulated margins (arrow, C) and with spiculated, irregular margins (arrow, D), via <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F1/>[1]
Lung cancers with atypical radiological pattern. Squamous cell cancer presenting as a cavitating mass (arrow, A). Adenocarcinoma presenting as dense consolidation (arrow, B). Bronchoalveolar carcinoma (adenocarcinoma in situ) presenting as ground-glass opacity (arrow, C) and mixed density, solid (arrow), and ground-glass nodules (arrowhead) in D via <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F2/>[1]
Stage T1 and T2 tumors. Stage T1 tumor due to size < 3 cm (arrow, A). Stage T2 endobronchial tumor (arrowhead) causing pneumonitis restricted to the upper lobe (arrow) in B. T2a tumor > 3 cm but < 5 cm (arrow, C). T2b tumor > 5 cm but < 7 cm (arrow in D) via <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F3/>[1]
Stage T3 tumors. T3 tumor due to size > 7 cm in size (arrow, A), eroding the ribs (arrow, B), infiltrating the mediastinal pleura but not the vessels (arrow, C), and causing atelectasis of the entire lung (arrowhead, D via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F4/>.[1]
Stage T4 tumors. T4 tumor due to invasion of pulmonary artery (arrow, A), descending aorta (arrow, B), vertebral body (arrow, C), superior vena cava with thrombus (arrow, D)via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F5/>[1]
Superior sulcus tumor. Axial (A) and coronal (B) CT scans show a large mass in the apex of the right lung causing destruction of the first and second ribs (arrows) with erosion of the right half of the vertebral body (arrowheads) suggestive of a superior sulcus tumor, via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F16/>[1]

Spiral CT Perfusion Imaging

(A-H) Poorly differentiated adenocarcinoma found in the apicoposterior segment of superior lobe of the left lung of a 56 year-old male. (A) Time density curve. (B-F) (original image, BF, BV, MTT, PS) typeI parametric maps, PS value is higher (30.883). (G) CD34 staining shows many immature tumor microvessels (× 200). (H) VEGF expression is strong positive (× 400) via, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2474637/figure/F6/.[2]
(A-H) (A-H) Well differentiated squamous cell carcinoma found in the posterior basal segment of inferior lobe of the right lung of a 61-year-old male. (A) Time density curve. (B-F) (original image, BF, BV, MTT, PS) TypeII parametric maps, PS value is higher (27.051). (G) CD34 staining shows many immature tumor microvessels (× 200). (H) VEGF expression is strong positive (× 400). via, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2474637/figure/F3/.[2]

CT Findings of Metastatic disease

Metastatic disease. Bilateral pleural effusions-M1a (arrow, A), lung metastases-M1a (arrows, B), adrenal metastasis-M1b (arrow, C), vertebral metastasis-M1b (arrow, D), brain metastasis-M1b (arrow, E), liver metastases-M1b (arrows, F)via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F10/>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.[1]
Adrenal adenoma versus metastasis. Enhancing solid adrenal nodule on CT scan in a case of lung cancer (arrow, A) suggestive of metastatic deposit. Unenhanced CT scan shows fatty attenuation within the nodule with an HU value of 0 suggesting the possibility of an adenoma (arrow, B). FDG-PET/CT shows no tracer concentration in the nodule, confirming the diagnosis of adenoma. Enhancing solid adrenal nodule on CT scan in another patient of lung cancer (arrow, D), which is indeterminate in nature. FDG-PET/CT shows abnormal focal tracer concentration in the nodule (arrow, E) highly suggestive of a metastatic deposit via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F11/>[1]
Brain metastases in asymptomatic patient, CT scan versus MRI. MRI brain in a patient of lung cancer shows multiple tiny enhancing foci scattered in the parenchyma bilaterally (arrows in A and B) suggestive of metastatic lesions. Corresponding contrast CT scan sections of the brain show no obvious lesions (C and D). Note the beam hardening effects due to bone, leading to a loss of resolution on the CT images (C and D)via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F12/>[1]

Staging

The following is 2017 TNM classification of lung cancer.[4][5][6]

T: Primary Tumor

T Description
TX
T0
  • There is no evidence of primary tumor.
Tis
T1
  • The tumor has the following characteristics:
T2
  • The tumor has the following characteristics:
T3
  • Tumor > 5 cm, but ≤ 7 cm in size.

AND

T4

N: Regional Lymph Nodes

T Description
NX
N0
N1
N2
N3

M: Distant Metastasis

T Description
MX
M0
M1

Classification of Lung Cancer by Staging

Stage T N M
Occult carcinoma TX N0 M0
Stage 0 Tis N0 M0
Stage IA1 T1(mi)/T1a N0 M0
Stage IA2 T1b N0 M0
Stage IA3 T1c N0 M0
Stage IB T2a N0 M0
Stage IIA T2b N0 M0
Stage IIB T1a N1 M0
T1c N1 M0
T2a N1 M0
T2b N1 M0
T3 N0 M0
Stage IIIA T1a N2 M0
T1b N2 M0
T1c N2 M0
T2a N2 M0
T2b N2 M0
T1a N2 M0
T1b N2 M0
T1c N2 M0
T2a N2 M0
T2b N2 M0
T3 N1 M0
T4 N0 M0
T4 N1 M0
Stage IIIB T1a N3 M0
T1b N3 M0
T1c N3 M0
T2a N3 M0
T2b N3 M0
T1a N3 M0
T1b N3 M0
T1c N3 M0
T2a N3 M0
T2b N3 M0
T3 N2 M0
T4 N2 M0
Stage IIIC T3 N3 M0
T4 N3 M0
Stage IVA Any T Any N M1a
Any T Any N M1b
Stage IVB Any T Any N M1c

Procedures for Staging Lung Cancer

  • There are currently multiple different procedures available to stage lung cancer.
  • They can be broken down into two overarching categories, invasive and minimally invasive.
Invasive
Minimally Invasive


References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 Purandare, NilenduC; Rangarajan, Venkatesh (2015). "Imaging of lung cancer: Implications on staging and management". Indian Journal of Radiology and Imaging. 25 (2): 109. doi:10.4103/0971-3026.155831. ISSN 0971-3026.
  2. ↑ 2.0 2.1 2.2 Ma, Shu-Hua; Le, Hong-Bo; Jia, Bao-hui; Wang, Zhao-Xin; Xiao, Zhuang-Wei; Cheng, Xiao-Ling; Mei, Wei; Wu, Min; Hu, Zhi-Guo; Li, Yu-Guang (2008). "Peripheral pulmonary nodules: Relationship between multi-slice spiral CT perfusion imaging and tumor angiogenesis and VEGF expression". BMC Cancer. 8 (1). doi:10.1186/1471-2407-8-186. ISSN 1471-2407.
  3. ↑ Gerard A. Silvestri, Lynn T. Tanoue, Mitchell L. Margolis, John Barker, Frank Detterbeck.11/30/11.The Noninvasive Staging of Non Small-cell Lung Cancer. Chestpubs. http://chestjournal.chestpubs.org/content/123/1_suppl/147S.full/
  4. ↑ Mountain, CF (2003). A Handbook for Staging, Imaging, and Lymph Node Classification. Charles P Young Company. Retrieved 2007-09-01. Unknown parameter |coauthors= ignored (help)
  5. ↑ Collins, LG (Jan 2007). "Lung cancer: diagnosis and management". American Family Physician. American Academy of Family Physicians. 75 (1): 56–63. PMID 17225705. Retrieved 2007-08-10. Unknown parameter |coauthors= ignored (help)
  6. ↑ Harms, A.; Kriegsmann, M.; Fink, L.; Länger, F.; Warth, A. (2017). "Die neue TNM-Klassifikation für Lungentumoren". Der Pathologe. 38 (1): 11–20. doi:10.1007/s00292-017-0268-y. ISSN 0172-8113.

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