Pancoast tumor classification

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

Classification

• The staging of pancoast tumor is based on the TNM system.
• Pancoast tumors staging starts at T3  always, as there is invasion of chest wall. Invasion of vertebral body or the subclavian vessels is regarded as T4.

Stage	T	N	M
IIB	T3	N0	M0
IIIA	T3	N1-2	M0
IIIB	T4	Any N	M0
IIIB	Any T	N3	M0
IV	Any T	Any N	M1

TNM-8th Edition
T	T1	Tumor size ≤3cm in greatest dimension
	T2	Tumor size >3cm to ≤5cm Tumor of any size that invades the visceral pleura involves main bronchus, irrespective of distance to the carina shows an atelectasis or obstructive pneumonitis that extends to the hilum
	T3	Tumor size >5cm to 7cm Pancoast that involves thoracic nerve roots T1 and T2 only. Tumor of any size that invades the chest wall invades the pericardium invades the phrenic nerve involves main bronchus, irrespective of distance to the carina shows one or more satellite nodules in the same lung lobe
	T4	Tumor size >7cm Involvement of C8 or higher nerve roots, brachial plexus, subclavian vessels or spine Tumor of any size that invades mediastinal fat or mediastinal structures invades the diaphragm involves the carina shows one or more satellite nodules in another lobe on the ipsilateral side
N	N0	No regional lymph node metastasis
	N1	Nodes are ipsilateral nodes within the lung up to hilar nodes.
	N2	Nodes represent ipsilateral mediastinal or subcarinal lymphadenopathy.
	N3	Nodes represent contralateral mediastinal or contralateral hilar lymphadenopathy or any scalene or supraclavicular nodes.
M	M0	No distant metastasis
	M1	Distant metastasis