Σταδιοποίηση σε Ca Πνεύμονα

 

Ca Πνεύμονα

AJCC Stages

Stages

T

N

M

Occult carcinoma

TX

N0

M0

0

Tis

N0

M0

IA

T1a

N0

M0

T1b

N0

M0

IB

T2a

N0

M0

IIA

T2b

N0

M0

T1a

N1

M0

T1b

N1

M0

T2a

N1

M0

IIB

T2b

N1

M0

T3

N0

M0

IIIA

T1a

N2

M0

T1b

N2

M0

T2a

N2

M0

T2b

N2

M0

T3

N1

M0

T3

N2

M0

T4

N0

M0

T4

N1

M0

IIIB

T1a

N3

M0

T1b

N3

M0

T2a

N3

M0

T2b

N3

M0

T3

N3

M0

T4

N2

M0

T4

N3

M0

IV

Any T

Any N

M1a

Any T

Any N

M1b

(T) Primary Tumor

TX

Primary tumor cannot be assessed or tumor proven by presence of malignant cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy

T0

No evidence of primary tumor

Tis

Carcinoma in situ

T1

Tumor ≤ 3 cm in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus (i.e., not in the main bronchus)¹

T1a

Tumor ≤ 2 cm in greatest dimension

T1b

Tumor > 2 cm but ≤ 3 cm in greatest dimension

T2

Tumor > 3 cm but ≤ 7 cm or tumor with any of the following features: Involves main bronchus, ≥ 2 cm distal to the carina; invades visceral pleura (PL1 or PL2); associated with atelectasis or obstructive pneumonitis that extends to hilar region but does not involve the entire lung

T2a

Tumor > 3 cm but ≤ 5 cm in greatest dimension

T2b

Tumor > 5 cm but ≤ 7 cm in greatest dimension

T3

Tumor > 7 cm or tumor that directly invades any of the following: Parietal pleural (PL3) chest wall (including superior sulcus tumors), diaphragm, phrenic nerve, mediastinal pleura, parietal pericardium; or tumor in the main bronchus (≤ 2 cm distal to the carina¹ but without involvement of the carina); or associated atelectasis or obstructive pneumonitis of the entire lung or separate tumor nodule(s) in the same lobe

T4

Tumor of any size that invades any of the following: Mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina, separate tumor nodule(s) in a different ipsilateral lobe

¹The uncommon superficial spreading tumor of any size with its invasive component limited to bronchial wall, which may extend proximally to the main bronchus, is also classified as T1a.

(N) Regional Lymph Nodes

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastases

N1

Metastasis in ipsilateral peribronchial &/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension

N2

Metastasis in ipsilateral mediastinal &/or subcarinal lymph node(s)

N3

Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)

(M) Distant Metastasis

M0

No distant metastasis

M1

Distant metastasis

M1a

Separate tumor nodule(s) in a contralateral lobe tumor with pleural nodules or malignant pleural (or pericardial) effusion²

M1b

Distant metastasis

²Most pleural (and pericardial) effusions with lung cancer are due to tumor. In a few patients, however, multiple cytopathologic examinations of pleural (pericardial) fluid are negative for tumor, and the fluid is not bloody and is not an exudate. Where these elements and clinical judgment dictate that the effusion is not related to the tumor, the effusion should be excluded as a staging element and the patient's disease should be classified as M0.

Χαρακτηριστικά Επέκτασης

Local extension

  • Direct extension to surrounding tissues
  • Not frequently encountered
  • Most commonly involves
    • Pleural extension
      • Most frequently results in pleural metastases in caudal and posterior parts of pleural cavities
    • Thyroid
    • Esophagus
    • Thymus
    • Chest wall
  • Spread into airways is rare

Lymphatic spread

  • Through lymphatic system to neighboring or distant lymph nodes
  • Lymphangitic spread can be associated with hematogenous dissemination
    • Followed by invasion of adjacent interstitium and lymphatics
    • Subsequent tumor spread toward hila or lung periphery

Distant metastases

  • Pulmonary veins are common route for metastases
    • Rich vascular supply draining directly into systemic venous system
  • Spread via bronchial arteries may be responsible for some endobronchial metastases

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

  • Non-small cell lung cancer (NSCLC)
    • Adenocarcinoma, including bronchioloalveolar cell carcinoma (BAC)
    • Squamous cell
    • Large cell
  • Small cell
  • Carcinoid