So staging of lung cancer is a little
complex. This is a simplified table and there
are three components to this. The first is
the tumour size and simply enough the bigger
the tumour the higher the stage and the higher
stage is the ones which are less treatable.
So for example tumours that is less than 3cm
diameter is stage 1 on the tumour size staging,
the T-staging, if it's 3-7 cm it is stage 2
T2. If it is above 7cms it's T3. However
any of these tumours which are invading sites
which you cannot resects such as the trachea
large blood vessels of the spine and medially
the tumour becomes stage T4. Nodal involvement
is described either as none as in N-0,
ipsilateral hilar nodes N1, ipsilateral
mediastinal nodes N2, contralateral or extrathoracic
nodes which means cervical lymph nodes, lymph
nodes down in the gut, axillary lymph nodes
and if they are involved it's an N3 disease.
Metastases is very simple. Either the patient
has an extra pulmonary metastases or it doesn’t.
So M0- no metastases, M1- any metastases anywhere
and it doesn't matter what size it is. It could be half
a centimeter in the liver if that was metastases
then that patient has M1 disease. This staging
process is simplified a little to this and
the reason for this simplification is that
essentially, surgery is offered to patients
with stages 1 & 2 but to not stage 3 or 4.
So if somebody is presenting with mediastinal
lymph nodes on the other side then they are
not surgically operable. Anybody presenting
with metastases is not operable. Ipsilateral
mediastinal nodes it’s difficult.
They can be operated on some times but in
general that probably means that’s not going
to be operated on. Ipsilateral hilar nodes
or just the mass in the lung can be operated