Lung Cancer Staging and Resectability

UPDATED based on the 7th edition of the Tumor, Node, and Metastasis (TNM) staging manual of non–small cell lung cancer.

Early-stage disease (stage I, II, and, in some cases, IIIA) is considered surgically resectable with or without neoadjuvant or adjuvant chemotherapy and radiation therapy.

Stage IIIB and IV tumors are considered unresectable. Under the 7th edition TNM classification, stage IIIB is defined as 1) T4, N2, M0 OR 2) T1-T4, N3, M0. Presence of M1 disease bumps the stage to IV.

• T4: Tumor (size is irrelevant) that invades the mediastinum, trachea/carina, heart, great vessels, esophagus, or vertebral body.
• N2: Ipsilateral mediastinal or subcarinal nodes.
• N3: Contralateral hilar and mediastinal and contra- or ipsilateral scalene and supraclavicular nodes.
• M1: Thoracic (M1a): Malignant pleural effusions, pleural dissemination, pericardial disease, and pulmonary nodules in the contralateral lung. Extrathoracic (M1b): Spread to locations away from the chest (liver, adrenal gland, brain, etc.).

In semi-plain English: 1) Any tumor size that involves contralateral, scalene, or supraclavicular nodes is unresectable, 2) T4 tumor is unresectable once nodes other than ipsilateral hilar are involved, and 3) Any metastatic disease is considered unresectable.

T4 tumor with ipsilateral hilar nodes (N1) is now considered stage IIIA and resectable.

Quick Links

• Descriptors from the 7th edition.
• Stage groupings in the 6th and 7th editions.
• Nodal stations.

References

UyBico SJ, Wu CC, Suh RD, Le NH, Brown K, Krishnam MS. Lung cancer staging essentials: the new TNM staging system and potential imaging pitfalls. Radiographics. 2010 Sep;30(5):1163-81.