Clinical Staging

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Once the diagnosis of lung cancer is confirmed through visualization and biopsy, the extent of disease must be determined. NSCLC is staged using the American Joint Committee on Cancer tumor, node, and metastasis (TNM) staging system. SCLC is typically staged using the Veterans Administration Lung Cancer Study Group method. Clinical staging serves two primary purposes: predicting prognosis and guiding therapy.

Nonsmall Cell Lung Cancer

Clinical staging of NSCLC with the TNM system evaluates the size of the tumor (T), extent of nodal involvement (N), and presence of metastatic sites (M). The combination of these three evaluations determines the stage. Clinical stages and associated survival rates are outlined in Table 90-3. Local disease includes tumors that are confined to a single hemithorax and those cancers that have spread to the ipsalateral hilar lymph nodes. Once malignancy invades the mediastinal lymph nodes or contralateral hilar nodes, the disease becomes locally advanced. When signs of cancer are detected outside the pleural cavity, it is classified as advanced disease. Local disease is associated with the highest cure and survival rates, whereas those with advanced disease have a 5-year survival rate of less than 10%.

Table 90-3 Clinical Stage and Prognosis

Small Cell Lung Cancer

The most common system for staging SCLC was developed originally by the Veterans Administration Lung Cancer Study Group. This system categorizes SCLC into two classifications: limited and extensive disease14:

• Limited disease: Evidence of the tumor is confined to a single hemithorax and can be encompassed by a single radiation port

• Extensive disease: Any progression beyond limited disease

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