THORACIC Section 5: Lung Cancer Staging Flashcards
Lung Cancer Staging (8th Edition)
Tumor is <3 cm
T1
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
T2
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
T3
Lung Cancer Staging (8th Edition)
Pancoast (Superior Sulcus) Tumor that is limited to involvement of T1 and T2 nerve roots
T3
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
T4
Pancoast (Superior
Sulcus) Tumor that
involves level C8 or
higher
T4
Pulmonary Vein Anatomy Trivia:
intrapericardial portions of the superior and inferior
right and left pulmonary veins, is classified as?
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.
Two or more
primary
carcinomas which
coexist at the time
of diagnosis.
Synchronus
A cancer that
develops
consequently
(some time
interval) after the
first primary
Metachronus
Stage?
T3 (Two in Same lobe)
Stage?
T4 (Two in different lobes, but still the same lung)
Stage?
M1a (Two in different lungs)
Nodes Staging
Ipsilateral within the lung
up to the hilar nodes.
N1
Nodes Staging
Ipsilateral mediastinal or subcarinal nodes
N2
Nodes Staging
Contralateral mediastinal or contralateral hilum
Or
Scalene or Supraclavicular nodes
N3
Most reliable modality for nodal Staging
PET-CT
The most important boundary to consider in nodal staging?
What are the borders?
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)
What are the Typical Contraindications to Lobectomy/Resection?
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
