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===Metastatic Tumors===
===Metastatic Tumors===
==TNM Classification of Lung Cancer==
===T: Primary Tumor===
{| 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="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=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=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=left |T1 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |The tumor has the following characteristics: <br> The greatest dimension is <3 cm <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.
|-
|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:<br>
The greatest dimension is >3cm
<br> OR <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.
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T3 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |The tumor is of any size 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.
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |T4 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |The tumor is of any size that 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 <br>
The tumor is associated with malignant [[pleural effusion]].
|}
===N:Regional Lymph Nodes===
{| 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="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=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=left |N1 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |There is [[metastasis]] in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension.
|-
|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 mediastinal and/or subcarinal lymph node(s).
|-
|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 contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s).
|}
===M: Distant Metastasis===
{| 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="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=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=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).
|}


==Classification of Lung Cancer by Staging==
==Classification of Lung Cancer by Staging==

Revision as of 19:51, 9 June 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Kim-Son H. Nguyen, M.D., M.P.A., Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA; Cafer Zorkun, M.D., Ph.D. [2]; Rim Halaby, M.D. [3]

Overview

Primary lung cancer can be classified into two main categories: small cell lung cancer (~15%) and non small cell lung cancer (~85%). Non small cell lung cancer includes several subtypes grouped together because their prognosis and management are similar. The 2004 WHO histological classification of tumors of the lung categorized lung tumors into malignant epithelial tumors, benign epithelial tumors, lymphoproliferative tumors, miscellaneous tumors, and metastatic tumors.[1]

Classification

WHO Histological Classification of Tumors of the Lung [1]

Malignant Epithelial Tumors

  • Papillary
  • Clear cell
  • Small cell
  • Basaloid
  • Combined small cell carcinoma
  • Adenocarcinoma, mixed subtype
  • Acinar adenocarcinoma
  • Papillary adenocarcinoma
  • Bronchioloalveolar carcinoma
  • Nonmucinous
  • Mucinous
  • Mixed nonmucinous and mucinous or indeterminate
  • Solid adenocarcinoma with mucin production
  • Fetal adenocarcinoma
  • Mucinous (“colloid”) carcinoma
  • Mucinous cystadenocarcinoma
  • Signet ring adenocarcinoma
  • Clear cell adenocarcinoma
  • Large cell neuroendocrine carcinoma
  • Combined large cell neuroendocrine carcinoma
  • Basaloid carcinoma
  • Lymphoepithelioma-like carcinoma
  • Clear cell carcinoma
  • Large cell carcinoma with rhabdoid phenotype
  • Pleomorphic carcinoma
  • Spindle cell carcinoma
  • Giant cell carcinoma
  • Carcinosarcoma
  • Pulmonary blastoma
  • Typical carcinoid
  • Atypical carcinoid
  • Mucoepidermoid carcinoma
  • Adenoid cystic carcinoma
  • Epithelial-myoepithelial carcinoma
  • Preinvasive lesions
  • Squamous carcinoma in situ
  • Atypical adenomatous hyperplasia
  • Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia
  • Mesenchymal tumors
  • Epithelioid haemangioendothelioma
  • Angiosarcoma
  • Pleuropulmonary blastoma
  • Chondroma
  • Congenial peribronchial myofibroblastic tumor
  • Diffuse pulmonary lymphangiomatosis
  • Inflammatory myofibroblastic tumor
  • Lymphangioleiomyomatosis
  • Synovial sarcoma
  • Monophasic
  • Biphasic
  • Pulmonary artery sarcoma
  • Pulmonary vein sarcoma

Benign Epithelial Tumors

  • Papillomas
  • Squamous cell papilloma
  • Exophytic
  • Inverted
  • Glandular papilloma
  • Mixed squamous cell and glandular papilloma
  • Adenomas
  • Alveolar adenoma
  • Papillary adenoma
  • Adenomas of the salivary gland type
  • Mucous gland adenoma
  • Pleomorphic adenoma
  • Others
  • Mucinous cystadenoma

Lymphoproliferative Tumors

  • Marginal zone B-cell lymphoma of the MALT type
  • Diffuse large B-cell lymphoma
  • Lymphomatoid granulomatosis
  • Langerhans cell histiocytosis

Miscellaneous Tumors

  • Harmatoma
  • Sclerosing hemangioma
  • Clear cell tumor
  • Germ cell tumors
  • Teratoma, mature
  • Immature
  • Other germ cell tumors
  • Intrapulmonary thymoma
  • Melanoma

Metastatic Tumors

Classification of Lung Cancer by Staging

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
Stage IIB T3 N0 M0
Stage IIIA T1, T2 N2 M0
Stage IIIA T3 N1, N2 M0
Stage IIIB Any T N3 M0
Stage IIIB T4 Any N M0
Stage IV Any T Any N M1

References

  1. ↑ 1.0 1.1 Travis, William (2004). Pathology and genetics of tumours of the lung, pleura, thymus, and heart. Lyon: IARC Press. ISBN 9283224183.
  2. ↑ Raz, DJ (Mar 2006). "Bronchioloalveolar carcinoma: a review". Clinical Lung Cancer. Cancer Information Group. 7 (5): 313–322. PMID 16640802. Unknown parameter |coauthors= ignored (help)

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