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Assessment For Management

Assessment For Management
- Staging TNM

It is known by studying the survival of patients with lung cancer that certain combinations of problems with the cancer are associated with similar out comes and so the concept of staging has been developed to incorporate the observations.

In Lung Cancer there are 4 stages - stage 1 to stage 4. which are described in terms of TNM staging. The International medical community uses the TNM staging system to describe these three aspects of cancer, namely the Tumor size and extent, Lymph Node involvement either being no detectable lymphnodes, nodes close to the cancer, nodes in the middle of the chest with cancer in them, or nodes on the opposite side of the body to the main cancer, or above the collar bone, and M status which describes whether metastases are present or not. Metastases are deposits of cancer in a remote site to the main cancer, and in the case of lung cancer these can occur in the liver, bones, adrenal glands, brain or other areas of the body

N Classification has undergone a lot of international discussion, but the Node map below is that used now internationally to describe locations of affected nodes.
CT scanning can indicate a clinical stage. CT of the chest takes in the liver and adrenal glands above the kidneys. Lymph glands in the middle of the chest can be seen as well, but just because the glands may be enlarged does not mean they have cancer cells in them, likewise just because the glands may not be enlarged does not mean they are free of cancer deposits. The only way to tell is to biopsy one of the lymph glands and look at it under the microscope.
Staging of various combinations of TN and M groupings:
Nodal involvement  (N)
N0 No demonstrateable metastasis to regional lymph nodes.
N1 Metastasis to lymph nodes in the peribronchial or the ipsilateral hilar region, or both, including direct extension.
N2 Metastasis to ipsilateral mediastinal lymph nodes and subcarinal lymph nodes.
N3 Metastasis to contra lateral mediastinal lymph nodes, con-tralateral hilar lymph nodes, ipsilateral or constralateral scalene or supraclavicular lymph nodes.

Distant Metastasis - M
M0 No (Known) distant metastasis
M1  Distant metastasis present. Specify site(s) 

Footnote To The TNM Definitions
T1 The uncommon superficial tumor of any size with its invasive component limited to the bronchial wall which may extend proximal to the main bronchus is classified as T1.
T4 Most pleural effusions associated with the lung cancer are due to tumor. There are, however, some few patients in whom cytopathological examination of pleural fluid (on more than one specimen) is negative for tumor, the fluid is non-bloody and is not an exudate. In such cases where these elements and clinical judgment dictate that the effusion is not related to the tumor, the patients should be staged T1, T2 or T3 excluding effusion as a staging element.

Primary Tumor  ( T )
TX Tumor proven by the presence of malignant cells in bronchopulmonary secretions but not visualized roentgen graphically or bronchoscopically, or any tumor that cannot be assessed as in a re-treatment staging.
T0 No evidence of primary tumor.
TIS Carcinoma in situ.
T1 A tumor that is 3.0 cm or less in greatest dimension, surrounded by lung or visceral pleural, and without evidence of invasion proximal to a lobar bronchus at Bronchoscopy.
T2 A tumor more than 3.0 cm in greatest dimension, or a tumor of any size that either invades the visceral pleura or has associated atelectasis or obstructive pneumonoitis extending to the hilar region. At Bronchoscopy, the proximal extent of demonstrateable tumor must be within a lobar bronchus or at least 2.0c cm distal to the carina. Any associated atelectasis or obstructive pneumonitis must involve less than an entire lung. 
T3 A tumor of any size with direct extensions into the chest wall (including superior sulcus tumors), diaphragm, or the mediastinal pleural or pericardium without involving the heart, great vessels, trachea, esophagus or vertebral body, or a tumor in the main bronchus within 2cm of the carina without involving the carina, or associated atelectasis or obstructive pneumonitis of entire lung.
T4 A tumor of any size with invasion of the mediastinum or involving heart, great vessels, trachea, esophagus, vertebral body or carina or presence of malignant pleural effusion.