STAGING OF BRONCHOGENIC CA

NSCLC STAGING

TNM CLASSFICATION• Adenocarcinoma• Squamous cell carcinoma• Large cell carcinoma

• T – Primary tumor• N – Regional Lymph nodes• M - Metastasis

IA - T1N0M0 IB - T2N0M0 IIA - T1N1M0 IIB - T2N1M0 or T3N0M0 IIIA - T1-3N2M0 or T3N1M0 IIIB - Any T4 or any N3M0 IV - Any M1

NSCLC STAGINGTNM CLASSIFICATION

T – PRIMARY TUMOR METHODS OF STAGING•CXR – demonstrates peripheral lesions

–pleural effusion, direct extension to the ribs, phrenic nerve involvement with elevation of a hemidiaphragm, or mediastinal widening due to lymphadenopathy

•CT SCAN – contrast enhanced–thorax and abdomen that includes

the liver and adrenal glands–Lung window settings:

• the maximum long axis • largest diameter perpendicular to

the long axis

NSCLC STAGINGTNM CLASSIFICATION

T – PRIMARY TUMOR METHODS OF STAGING•MRI

–superior to CT in assessing the pericardium, heart, and great vessels–coronal images are useful in

demonstrating the extent of tumor in the subcarinal region, aortopulmonary window & SVC

•PET SCAN–superior to CT in differentiating

between malignant and benign tumors

NSCLC STAGINGTNM CLASSIFICATION

N – REGIONAL LYMPH NODES METHODS OF STAGING• CXR

– inferior to CT in the detection of mediastinal lymph node metastases, SN of 10-30% only

• CT SCAN– spiral or multisection CT, thin (5-mm)

sections– SN and SP of 40-84% and 52-80%

respectively• MRI

– comparable to those used at CT– distinguish nodes from vessels without IV

contrast enhancement• PET SCAN

– is superior to CT

NSCLC STAGINGTNM CLASSIFICATION

M - METASTASIS METHODS OF STAGING• CT SCAN

– Liver, adrenal, brain and lung metastases

• Technetium-99m (99m Tc) radionuclide bone scanning – Bone metastases

• PET SCAN– Adrenal metastases

SCLC Staging

LIMITED STAGE DISEASE• confined to 1 hemithorax

– ( includes ipsilateral, contralateral, and/or supraclavicular nodes)

• CXR; CT of the thorax, liver, and adrenal glands; cranial CT; bone scintigraphy, bone marrow aspiration

EXTENSIVE STAGE DISEASE• disseminated nature of SCLC makes

whole-body survey techniques suitable for its evaluation

• 99m Tc-labeled monoclonal antibody fragment NR-LU-10– detect an antigen present in

most small cell cancers• whole-body FDG-PET

– Detects nodal disease. • combined MRI of the brain, spine,

abdomen, and pelvis enables comprehensive staging with a single modality