lung cancer lecture 3 deck 3 Flashcards
how do you determine staging of lung cancer?
- clinical history/ examination
- performance status
- pulmonary function
- TNM international system for staging lung cancer
what does the T in the TNM international system account for?
size and position of the tumour
what does the N in the TNM international system account for?
whether cancer cells have spread into the lymph node
what does the M in the TNM international system account for?
whether the tumour has spread anywhere else in the body i.e. metastases
what imaging is used to determine T stage? what for?
CT, PET-CT, bronchoscopy, assessing size position and chest wall/ mediastinal invasion
what imaging is used to determine N stage?
CT, PET-CT, EBUS/EUS, mediastinoscopy
what imaging is used to determine M stage?
CT, PET-CT, bone scan
what does TX account for?
primary tumour cannot be assessed
what does T0 account for?
no evidence of primary tumour
what does Tis stand for?
carcinoma in situ (neoplasia)
what does T1 account for? what are T1’s subdivisions?
tumour < 3 cm in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of involvement of the main bronchus. Subdivisions include a (minimally invasive adenocarcinoma tumour <=1 cm in greatest dimension), b (<= 2 cm), c (<= 3 cm)
what does T2 account for? what are T2’s subdivisions?
(a) tumour 3-4 cm, (b) 4-5 cm or any of the following: involves main bronchus but not carina, invades visceral pleura, associated with atelectasis or obstructive pneumonitis that extends to the hilar region involving part or all the lung
what does T3 account for? what are T3’s subdivisions?
5-7 cm, or one that directly invades any of the following:
- chest wall (including sulcus tumours)
- phrenic nerve
- parietal pericardium
or separate tumour nodules int the same lobe as the primary
what does T4 stand for? what are T4’s subdivisions?
>7cm, or invades any of the following: - diaphragm - mediastinum - heart - great vessels - trachea - recurrent laryngeal nerve - oesophagus - vertebral body - carina separate tumour nodules in a different ipsilateral lobe
what does N0 account for?
no regional lymph node metastases
what does N1 account for?
ipsilateral peribronchial, hilar or intrapulmonary nodes including by direct extension
what does N2 account for?
ipsilateral mediastinal, subcarinal
what does N3 account for?
contralateral mediastinal, contralateral hilar, scalene or supraclavicular
how many lymph nodes are <1 cm? what metastases % do they represent?
336, 13%
how many lymph nodes are 1-1,9 cm? what metastases % do they represent?
57, 25%
how many lymph nodes are 2-2,9 cm? what metastases % do they represent?
13, 62%
how many lymph nodes are 3-3,9 cm? what metastases % do they represent?
6, 67%
how many lymph nodes are >4 cm? what metastases % do they represent?
2, 100%
what does M0 account for?
no distant metastasis
what does M1 account for? what are M1’s subdivisions?
distant metastasis, a (separate tumour nodule in a contralateral lobe or tumour with pleural or pericardial nodules or malignant pleural/ pericardial effusion), b (single distant metastasis), c (multiple distant metastasis)
what are the commonest metastases after a primary lung cancer?
brain, skeleton, adrenal, liver
what % 5YS for stage 4 on TNM scale?
1% 5YS
what does a T4 mean for the TNM stage? what is the % 5YS?
stage 3B, 5% 5YS
