Mediastinal staging for NSCLC

Question 1

Lung ca (T-stage)

Answer 1

T1: < 3 cm (T1a: < 2cm, T1b 2-3 cm)

• surrounded by visceral pleura
• involvment of lobar (not main) bronchus

T2: 3-5cm

• involvement of main bronchus (> 2cm from carina)
• invasion of visceral pleura
• atelectaiss or obstructive pneumonitis (< entire lung)

T3: 5- 7 cm

• invasion of CW, diaphragm, phrenic n, mediastinal pleura, parietal pleura
• involvement of main bronchus (< 2cm from carina, not involving carina itself)
• atelectasis or obstructive pneumonitis (entire lung)
• separate tumor nodules in same lobe

T4: >7cm

• invasion of mediastinum, heart, great vessels, trachea, RLN, esophagus, vertebral body
• involvement of carina
• separate tumor nodules in different, ipsilateral lobes

Question 2

Lung ca (N-stage)

Answer 2

N1: Ipsilateral peribronchial, hilar, intrapulmonary LN

N2: Ipsilateral mediastinal/subcarinal LN

N3:

• Contralateral mediastinal/hilar LN
• Ipsilateral/contraleral scalene or supraclavicluar LN

Question 3

Lung ca (M-stage)

Answer 3

M1: Distant mets

M1a:

• Separate tumor nodule in contralateral lobe
• Tumor with pleural nodules
• Malignant pleural or pericardial effusion

M1b: distant mets (liver, bone, brain, adrenal)

Question 4

AJCC lung cancer staging

Answer 4

Stage I: T1-T2a, N0, M0. ; tumors < 4cm

Stage II:

• T1-2 with N1 disease (MO)
• T2b or T3 alone (NO, MO)

Stage III:

• N2 or N3 disease
• T3 with LN (N1-3)
• T4 alone

Stage IV: M1 disease (M1a or M1b)

Question 5

Answer 5

Question 6

Answer 6

Question 7

Answer 7

Question 8

N3 positive disease

Answer 8

Chemotherapy + radiation

Question 9

N2 Negative

Answer 9

Question 10

Treatment of single-station N2 disease?

Answer 10

Question 11

Treatment of Multistation N2 Disease?

Answer 11

Chemotherapy +/- radiation treatment