Lung Cancer Staging

Question 1

Define T1?

Answer 1

Size ≤ 3 cm

Question 2

Define the subdivisions of T1?

Answer 2

T1 mi: Minimally invasive adenocarcinoma (≤ 5 mm invasion in greatest dimension)
T1a: ≤ 1 OR superficial, spreading tumor of any size, invading only the bronchial wall, which may extend to the main bronchus
T1b: ≤ 2
T1c: ≤ 3

Question 3

Define T2?

Answer 3

3 ≤ size ≤ 5
OR
Tumor involving mainstem bronchus (NOT carina);
A/w atelectasis or obstructive pneumonitis;
Invades visceral pleura

Question 4

Define T3?

Answer 4

5 ≤ size ≤ 7
OR
Tumor involving parietal pleura;
Chest wall;
Phrenic nerve;
Parietal pericardium;
Separate tumor in same ipsilateral lobe

Question 5

Define T4?

Answer 5

≥ 7
OR
Tumor invading diaphragm;
Mediastinum;
Heart;
Great Vessels;
Trachea;
Carina;
Recurrent laryngeal nerve;
Esophagus;
Vertebral body;
Carina;
Separate tumor in different ipsilateral lobe

Question 6

Define M1 subdivisions?

Answer 6

M0: No distant mets
M1a: Separate nodule in contralateral lobe, tumor w/ pleural or pericardial nodules, malignant pleural or pericardial effusion
M1b: Single extra-thoracic metastasis, including single nonregional node
M1c: Multiple metastasis in a single or multiple organs

Question 7

Define N1 subdivisions?

Answer 7

NX: Cannot be assessed
N0: No LNs involved
N1: LNs up to and including hilar noted (double digits)
N2: Ipsilateral mediastinal and subcarinal
N3: Contralateral mediastinal and subcarinal

Question 8

Define LN level 2?

Answer 8

Upper paratracheal

Question 9

Define LN level 3?

Answer 9

Prevascular and Retrotracheal

Question 10

Define LN level 4?

Answer 10

Lower paratracheal

Question 11

Define LN level 5?

Answer 11

AP Window

Question 12

Define LN level 6?

Answer 12

Para-aortic (ascending aorta or phrenic)

Question 13

Define LN level 7?

Answer 13

Subcarinal

Question 14

Define LN level 8?

Answer 14

Esophageal

Question 15

Define LN level 9?

Answer 15

Pulmonary Ligament

Question 16

Define LN level 10?

Answer 16

Hilar

Question 17

Define LN level 11?

Answer 17

Interlobar

Question 18

Define LN level 12?

Answer 18

Lobar

Question 19

Define LN level 13?

Answer 19

Segmental

Question 20

Define LN level 14?

Answer 20

Sub-segmental

Question 21

Define LN level 1?

Answer 21

Low cervical, supraclavicular, sternal notch

Question 22

Define Stage 1 subdivisions?

Answer 22

1A1: T1a
1A2: T1b
1A3: T1c
1B: T2a

Question 23

Define Stage 2 subdivisions?

Answer 23

2A: T2b
2B: T3; N1; Sp: T3 N0

Question 24

Define Stage 3 subdivisions?

Answer 24

3A: T4; N2; Sp: T3 N1, T4 N0/1
3B: N3; Sp: T3/4, N2
3C: T3/4, N3

Question 25

Define Stage 4 subdivisions?

Answer 25

4A: M1a/b
4B: M1c