Lung cancer classification: Difference between revisions

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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=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 | T0 ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |There is no evidence of primary tumor.
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|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 |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 |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 characteristic<br>
|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
The greatest dimension is >3cm
<br> OR <br>
<br> OR <br>
The tumor involves the main bronchus, 2 cm or more distal to the carina.
The tumor involves the main bronchus, 2 cm or more distal to the [[carina]].
<br> OR <br>
<br> OR <br>
The tumor invades the visceral pleura.
The tumor invades the [[visceral pleura]].
<br> OR <br>
<br> OR <br>
There is evidence of atelectasis or obstructive pneumonitis that extends to the hilar region without the involvement of the entire lung.
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.
|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>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.
<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, oesophagus, vertebral body, carina<br> OR <br>There is/are separate tumor nodule(s) in the same lobe. <br> OR <br>
|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.
The tumor is associated with malignant [[pleural effusion]].
|}
|}


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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 |NX ||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |the regional lymph nodes cannot be assessed.
| 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 |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 |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 |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).
|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).
|}
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|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 |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 |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 as demonstrated by the presence of separate tumour nodule(s) in a different lobe (ipsilateral or contralateral).
|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).
|}
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Revision as of 17:16, 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]

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 classified by their histopathological findings, and they are 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

  • Primary lung cancer can be classified into two main categories: small cell lung cancer (~15%) and non small cell lung cancer (~85%).
  • There are three main sub-types of non small cell lung cancer , which are grouped together because their prognosis and management are similar:
  • A subtype of adenocarcinoma, the bronchioloalveolar carcinoma, is more common in female never-smokers, and may have different responses to treatment.[2]

WHO Histological Classification of Tumors of the Lung [1]

Malignant Epithelial Tumors

  • Squamous cell carcinoma
  • Papillary
  • Clear cell
  • Small cell
  • Basaloid
  • Small cell carcinoma
  • Combined small cell carcinoma
  • Adenocarcinoma
  • 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 carcinoma
  • Large cell neuroendocrine carcinoma
  • Combined large cell neuroendocrine carcinoma
  • Basaloid carcinoma
  • Lymphoepithelioma-like carcinoma
  • Clear cell carcinoma
  • Large cell carcinoma with rhabdoid phenotype
  • Adenosquamous carcinoma
  • Sarcomatoid carcinoma
  • Pleomorphic carcinoma
  • Spindle cell carcinoma
  • Giant cell carcinoma
  • Carcinosarcoma
  • Pulmonary blastoma
  • Carcinoid tumor
  • Typical carcinoid
  • Atypical carcinoid
  • Salivary gland tumors
  • 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

TNM Classification of Carcinomas of the Lung

T: Primary Tumor

T Description
TX Primary tumor cannot be assessed.
OR
Tumor is demonstrated by the presence of malignant cells in bronchial washings or sputum, but is not visualized by imaging or bronchoscopy.
T0 There is no evidence of primary tumor.
Tis Carcinoma in situ
T1 The tumor has the following characteristics:
The greatest dimension is <3 cm
AND
The tumor is surrounded by lung or visceral pleura
AND
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.
T2 The tumor has the following characteristics:

The greatest dimension is >3cm
OR
The tumor involves the main bronchus, 2 cm or more distal to the carina.
OR
The tumor invades the visceral pleura.
OR
There is evidence of atelectasis or obstructive pneumonitis that extends to the hilar region without the involvement of the entire lung.

T3 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.


OR
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.
OR
There is evidence of associated atelectasis or obstructive pneumonitis of the entire lung.

T4 The tumor is of any size that invades any of the following: mediastinum, heart, great vessels, trachea, esophagus, vertebral body, carina
OR
There is/are separate tumor nodule(s) in the same lobe.
OR

The tumor is associated with malignant pleural effusion.

N:Regional Lymph Nodes

T Description
NX the regional lymph nodes cannot be assessed.
N0 There is no evidence of regional lymph node metastasis.
N1 There is metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension.
N2 There is metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s).
N3 There is metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s).

M: Distant Metastasis

T Description
MX Distant metastasis cannot be assessed.
M0 There is no evidence of distant metastasis.
M1 There is evidence of distant metastasis which includes the presence of separate tumor nodule(s) in a different lobe (ipsilateral or contralateral).

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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