| Ch 6 | Example of Cancer Classification | |
| Cancer Classification |
Lung cancer | |
The classification of lung (or bronchial) carcinoma is based on TNM or more surgical stages derived from TNM.
The following drawings illustrate these stages:
| T | Description |
TX |
Primary tumour cannot be assessed, or tumour is proven by the presence of malignant cells in sputum or bronchial washings but is not visualised by imaging or bronchoscopy. |
T0 |
No evidence of primary tumour |
Tis |
Carcinoma in situ |
T1 |
A tumour measuring less than 3 cm at its largest point, surrounded by lung or visceral pleura, and without bronchoscopic evidence of more proximal invasion than the lobar bronchus (i.e., not in the main bronchus). |
T2 |
A tumour with any of the following features of size or extension: >3 cm at its largest point, involving the main bronchus and >=2 cm distal to the carina invading the visceral pleura, associated with atelectasis or obstructive pneumonitis extending to the hilar region but not involving the entire lung |
T3 |
A tumour of any size directly invading any of the following: chest wall (including superior sulcus tumours), diaphragm, mediastinal pleura, parietal pericardium, or, tumour in the main bronchus <2 cm distal to the carina but without involvement of the carina, or, associated atelectasis or obstructive pneumonitis of the entire lung |
T4 |
A tumour of any size invading any of the following: mediastinum, heart, great vessels, trachea, oesophagus, vertebral body, carina, or, separate tumour nodules in the same lobe, or, tumour with a malignant pleural effusion. |
| N | Description |
| NX | Regional lymph nodes cannot be assessed |
N0 |
No regional lymph node metastasis |
N1 |
Metastasis to ipsilateral peribronchial and/or ipsilateral hilar lymph nodes, and intrapulmonary nodes including involvement by direct extension of the primary tumour |
N2 |
Metastasis to ipsilateral mediastinal and/or subcarinal lymph node(s) |
N3 |
Metastasis to contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s) |
| Stages |
Description |
| Stade 0 |
Tis, N0, M0 |
| T1 N0 M0 or T2 N0 M0 |
|
| T1 N1 M0 or T2 N1 M0 |
|
| Extra-pulmonary invasion (T3 N0 M0 or T3 N1 M0, T3 N2 M0, T2 N2 M0) |
|
| T1-4 N3 M0, T4 and N1-3 M0 |
|
| Stade 4 |
Remote metastases |
 |
| Stages |
Description |
5 year survival |
| Stage 1a |
T1 N0 M0 |
> 70% |
| Stage 1b |
T2 N0 M0 |
60% |
| Stage 2a |
T1 N1 M0 |
50% |
| Stage 2b |
T2 N1 M0 |
30-40% |
| Stage 2b |
T3, N0-N1,M0 |
30-40% |
| Stage 3a |
T3 N0 M0 or T3 N1 M0, T3 N2 M0, T2 N2 M0 |
10-30% |
| Stage 3b |
T1-4 N3 M0, T4 and N1-3 M0 |
< 10% |
| Stage 4 |
Remote metastases |
< 5% |
Small cell lung cancer is a specific histological entity. The website of the Lorraine Cancer Network, Oncolor describes decision trees for this pathology.
Another interesting page for lung pathology is the website Webpath from Florida University.
Of course, the NCI has published two interesting series of pages : for non-small cell lung cancer and for small-cell lung cancer.
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