The Diagnosis and Staging of Lung Cancer
Tze-Ming Chen, MD, FCCP
Staging is an assessment of the extent of spread of the tumor, including spread to lymph
nodes and metastasis to other parts of the body. Determination of the stage involves
obtaining information about tumor sites from tests that may include combined positron
emission tomography (PET) and computed tomography (CT), endobronchial
ultrasonography guided fine needle aspiration, endoscopic ultrasonography guided fine
needle aspiration, electromagnetic navigational bronchoscopy, mediastinoscopy,
thoracentesis, video-assisted thoracoscopic surgery, and CT or ultrasonography guided fine
needle aspiration.
The current system for staging non-small cell lung cancer is the tumor-node-metastasis
(TNM) classification, which includes assessment of the tumor (size and effect of the tumor
on the surrounding lung tissue or interaction with non-lung tissue) (T) (Table 1), the extent
of spread of lung cancer to lymph nodes (N) (Table 2 and Figure 1), and the presence or
absence of metastatic spread of lung cancer outside of lung tissue (M) (Table 3). The tumor
stage of non-small cell lung cancer ranges from localized disease (IA) to widespread disease
(IV) and provides information about expected prognosis and survival (Table 4).
See pages 7-9 for tables and figures.
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