Chapter 085. Neoplasms of the Lung (Part 7)

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Table 85-2 Tumor, Node, Metastasis International Staging System for Lung Cancer 5-Year Survival Rate, % Stage TNM Descriptors Stage Clinical SurgicalPathologic Stage IA T1 N0 M0 61 67 IB T2 N0 M0 38 57 IIA T1 N1 M0 34 55 IIB T2 N1 M0 24 39 IIB T3 N0 M0 22 38 IIIA T3 N1 M0 9 25 T1–2–3 M0 N2 13 23 IIIB M0 T4 N0–1–2 7

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Chapter 085. Neoplasms of the Lung (Part 7) Table 85-2 Tumor, Node, Metastasis International Staging System for Lung Cancer 5-Year Survival Rate, % Stage TNM Clinical Surgical- Descriptors Stage Pathologic Stage IA T1 N0 M0 61 67 IB T2 N0 M0 38 57 IIA T1 N1 M0 34 55 IIB T2 N1 M0 24 39
IIB T3 N0 M0 22 38 IIIA T3 N1 M0 9 25 T1–2–3 N2 13 23 M0 IIIB T4 N0–1–2 7
TX Primary tumor cannot be assessed, or tumor proven by the presence of malignant cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy TIS Carcinoma in situ T1 Tumor 3 cm in greatest dimension; involves main bronchus, ≥2 cm distal to the carina; invades visceral pleura; associated with atelectasis or obstructive pneumonitis extending to hilum but does not involve entire lung T3 Tumor of any size that directly invades any of the following: chest wall (including superior sulcus tumors), diaphragm, mediastinal pleura, parietal pericardium; or tumor in main bronchus
T4 Tumor of any size that invades any of the following: mediastinum, heart, great vessels, trachea, esophagus, vertebral body, carina; or tumor with a malignant pleural or pericardial effusion,a or with satellite tumor nodule(s) within the ipsilateral primary-tumor lobe of the lung. Lymph Node (N) Involvement Descriptor 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 involved by direct extension of the primary tumor 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) Distant Metastasis (M) Descriptor MX Presence of distant metastasis cannot be assessed M0 No distant metastasis M1 Distant metastasis presentb a Most pleural effusions associated with lung cancer are due to tumor. However, in a few patients with multiple negative cytopathologic exams of a non- bloody, non-exudative pleural or pericardial effusion that clinical judgment dictates is not related to the tumor, the effusion should be excluded as a staging element and the patient's disease staged as T1, T2, or T3. b Separate metastatic pulmonary tumor nodule(s) in the ipsilateral nonprimary tumor lobe(s) of the lung are classified as M1. Source: Adapted from CF Mountain. Revisions in the International System
for Staging of Lung Cancer. Chest 111:1710, 1997; with permission.