THORACIC Section 5: Lung Cancer Staging

Question 1

Lung Cancer Staging (8th Edition)

Tumor is <3 cm

Answer 1

T1

Question 2

Lung Cancer Staging (8th Edition)

Tumor is 3-5 cm

Irregardless of size the tumor
* Invades the visceral pleura
* Invades the main bronchus w/o involvement of carina
* Causes obstruction (atelectasis or pneumonia) that extends to the hilum

Answer 2

T2

Question 3

Lung Cancer Staging (8th Edition)

Tumor is 5-7 cm

Irregardless of size the tumor
* Invades the chest wall
* Invades the pericardium
* Invades the phrenic nerve (diaphragm paralysis)
* Has one or more satellite nodule in the same lung lobe

Answer 3

T3

Question 4

Lung Cancer Staging (8th Edition)

Pancoast (Superior Sulcus) Tumor that is limited to involvement of T1 and T2 nerve roots

Answer 4

T3

Question 5

Lung Cancer Staging (8th Edition)

Tumor is >7cm

Irregardless of size the tumor
* Invades the mediastinal fat or great vessels
* Invades the diaphragm
* Involves the carina
* Has 1 or more satellite nodule in another lobe but the same lung

Answer 5

T4

Question 6

Pancoast (Superior
Sulcus) Tumor that
involves level C8 or
higher

Answer 6

T4

Question 7

Pulmonary Vein Anatomy Trivia:

intrapericardial portions of the superior and inferior
right and left pulmonary veins, is classified as?

Answer 7

T4

The key is to draw a line from the pericardium (arrow) through
the pulmonary vein (dotted black line). Anything deep to that
(checkered in the drawing) is considered T4.

Question 8

Two or more
primary
carcinomas which
coexist at the time
of diagnosis.

Answer 8

Synchronus

Question 9

A cancer that
develops
consequently
(some time
interval) after the
first primary

Answer 9

Metachronus

Question 10

Stage?

Answer 10

T3 (Two in Same lobe)

Question 11

Stage?

Answer 11

T4 (Two in different lobes, but still the same lung)

Question 12

Stage?

Answer 12

M1a (Two in different lungs)

Question 13

Nodes Staging

Ipsilateral within the lung
up to the hilar nodes.

Answer 13

N1

Question 14

Nodes Staging

Ipsilateral mediastinal or subcarinal nodes

Answer 14

N2

Question 15

Nodes Staging

Contralateral mediastinal or contralateral hilum

Or

Scalene or Supraclavicular nodes

Answer 15

N3

Question 16

Most reliable modality for nodal Staging

Answer 16

PET-CT

Question 17

The most important boundary to consider in nodal staging?

What are the borders?

Answer 17

Is the distinction between level 1 nodes (which are N3) and level 2 nodes (which are
N2).

The lower level of the clavicles and the upper border of the manubrium (above this is level 1)

Question 18

What are the Typical Contraindications to Lobectomy/Resection?

Answer 18

The big issues (things that make lobectomy impossible) are going to be:
* Growth of the tumor through a fissure
* Invasion of the Pulmonary Vasculature
* Invasion of the main bronchus
* Invasion of both the upper and lower lobe bronchi.

Other findings that will make the tumor NOT resectable:
* N 2*(if the tum or is > 5cm) or N3 Nodal Disease — corresponding to a Stage 3B cancer
* Multi-lobar Disease
* Malignant Pleural Effusion