DIAGNOSIS & STAGING
Stages of Lung Cancer
What is lung cancer staging and why is it important?
Lung cancer staging is a way to describe the extent of the disease, whether it is localized to the lungs, has spread to local or distant lymph nodes, and if it has affected other organs of the body. There are treatment options for all stages of lung cancer, so precise staging is crucial because it helps us:
- Understand how advanced the disease is
- Plan the most suitable treatments for each patient, which may include a combination of surgery, drug therapy, and radiation
- Evaluate the response to treatment and modify the initial treatment plan with a more effective one.
When should lung cancer staging be done?
Staging can be done once or multiple times.
The initial staging is mandatory for all patients at the time of the initial diagnosis and should be completed before any therapeutic intervention begins. The initial staging is often referred to as clinical staging.
Clinical staging is based on results obtained from various tests recommended by the attending physician, including imaging tests (CT scans, PET scans) as well as biopsies and specific blood tests. The initial clinical stage not only forms the basis for selecting the most appropriate treatment but also allows us to evaluate the success of treatment during its administration.
The second type of staging, which is the most accurate, is pathological or surgical staging.
This staging is not based on images but on results from surgery. All specimens surgically removed are examined by the pathologist who offers an accurate staging. If the pathological stage differs from the clinical stage (indicating that the disease may be more or sometimes less advanced than initially estimated), then we can adjust treatment.
TNM Staging System for Lung Cancer
The TNM staging system is practically used for Non-Small Cell Lung Cancer (NSCLC), including adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. The same system could be applied to Small Cell Lung Cancer, although patients are usually classified into only two stages: limited and extensive.
The various stages of cancer according to the TNM classification system are derived from three elements:
T (stands for tumor): refers to the size of the primary tumor and whether it is single or multiple.
N (stands for nodes): refers to the presence of positive or negative lymph nodes and in which region, such as within the lung, near the root of the lung, , or distant sites from the lung. Regional lymph nodes are those located around a tumor. Imagine them as drainage points for the lung and, of course, points where cancer can spread from the primary tumor.
M (stands for metastasis): refers to metastasis, which is the spread of cancer cells from the original site to other organs, such as the adrenal glands, bones, brain, other lung, or liver.
Therefore, the combination of the numbers for T, N, and M elements determines the stage of the disease. Stages based on the TNM system are classified from zero to four. Specifically, Roman numerals I, II, III, and IV are used. The lower the number, the less advanced the stage, and the better the prognosis. Stages I-IV are further subdivided into other sub-stages (e.g., IIIA or IIIB).
Is this important and why was it created?
It is an International language for all physicians dealing with lung cancer. It allows us to place each patient in a specific group, allowing us to design best suitable treatments for each stage, based on scientific evidence.
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