Clinical staging of lung cancer
Clinical stage of lung cancer treatment options and prognosis of the main basis. The treatment of different, non-small cell lung cancer and small cell lung cancer staging criteria are different.
First, non-small cell lung cancer
Treatment of non-small cell lung cancer should strive for surgery. Depends on tumor stage: tumor size and location; have hilar and (or) mediastinal lymph nodes; pleura, chest wall or mediastinal structures are invaded; chest metastasis. In recent years, treatment and technology continue to improve, increasing the scope of surgical resection. Chest wall invasion were as long as no distant metastasis, can be used for bulk removal; whether or not combined radiotherapy, still 30% _40% of patients survive heart and great vessels and tumor invasion differ. Bronchoplasty (sleeve resection) to less than 2cm from the carina not yet crossed the center line of the tumor will also be radical resection. Surgical mediastinal lymph node metastasis is not contraindication. 1989 International TNM classification used in the further period is divided into A and B, the former stage a late stage cancer, surgery can still win, but the prognosis is poor; the latter is not the indications for surgery, which can be more targeted to a treatment plan, easy to compare the efficacy and prognosis.
(A) TNM classification (1989)
lT – primary tumor
TX: bronchial secretions found in malignant cells, but the X-ray examination or bronchoscopy negative; or any other cancer treatment of re-evaluation of the other failed to find tumors.
TO: primary tumor was not found.
Tis: carcinoma in situ.
T1: maximum tumor diameter 3cm, surrounded by lung or visceral pleura. Bronchoscopy no tumor of the proximal lobar bronchus violations. Superficial tumor of any size confined to the bronchial wall, even though invading the main bronchus, it is still Tl.
T2: maximum tumor diameter> 3cm, tumor invasion of the visceral pleura or the patient had obstructive pneumonia or atelectasis, and hilar but has been extended and the whole lung were. Bronchoscopy, the tumor more than 2cm from the carina.
T3: tumor of any size have violated the chest wall (including superior sulcus tumors), diaphragm, mediastinal pleura or pericardium, but not violations of the heart, great vessels, trachea, esophagus, or subject to the body. Tumor and the bulge distance <2cm, but the bulge is not invaded.
T4: tumor of any size or mediastinal invasion of heart and great vessels, trachea, esophagus, vertebral body or carina. Or a malignant pleural effusion (cytology positive). There pleural effusion, pleural effusion examination more than once, were not detected in tumor cells based upon the original T1_T3 stage.
2.N– the regional lymph nodes
NO: No regional lymph node metastasis.
Nl: bronchi and (or) ipsilateral hilar lymph node metastasis or direct spread of involvement.
N2: ipsilateral mediastinal and subcarinal lymph node metastasis.
N3: contralateral mediastinal or hilar lymph nodes, ipsilateral or contralateral scalene or supraclavicular fossa lymph node group metastasis.
3.M – distant metastasis
MO: no known distant metastases.
M1: distant metastasis.
Lung cancer stage (II) phases
Recessive cancer (TX NO MO): bronchial secretions of malignant cells, not found in the primary tumor or metastasis.
O period (Tis NO MO): carcinoma in situ.
Phase (T1 NO MO; T2 NO MO): the primary tumor as T1 or T2, without any lymph node or distant metastasis.
stage (T1 Nl MO; T2 Nl MO): the primary tumor as T1 or T2, transferred to the bronchi and (or) ipsilateral hilar lymph nodes.
A period (T3 NO MO; T3 N1 MO; Tl '~ 3 N2 MO): primary tumors greater than T2, but it did not infringe the vital organs, or any T3 tumors following ipsilateral or subcarinal mediastinal lymph node metastasis.
B, (Any T, N3, MO; T4, any N, MO): mediastinal tumor invasion within the heart and other important organs, can not be removed or transferred to the lymph nodes, but did not spread outside the chest.
of (any T, any N, M1): tumor metastasis.
Clinical staging of lung cancer (c) lymph node area partition
American Thoracic Society (ATS) Committee to consider lung cancer to the original partition TNM classification criteria not detailed enough lymph nodes, intrathoracic lymph nodes further distinguished by anatomic site in order to obtain more detailed and consistent records, comparative efficacy. Glazer and CT scan image displayed on the corresponding lymph nodes in each group. However, group 4 and 10 is more difficult distinction. Fried-man suggested lOR lymph nodes as Nl, 10L lymph nodes as N2, 8 and 9 group should be merged group, and increased diaphragmatic lymph nodes, ipsilateral who is N2.