When are tumours classified as T3 althouh they are less than 5cm?
Invades any of:
or has seperate tumour nodules in the same lobe as primary
What is T4?
More than 7cm
When is a tumour T4 although it is less than 7cm?
Invades any of:
Recurrent laryngeal nerve
or seperate tumour nodules in a different ipsilateral lobe
What does N staging range from?
N0 to N3
What is N0?
No regional lymph node involvement
What is N1?
Ipsilateral peribronchial, hilar or intrapulmonary nodes including by direct extension
What is N2?
Ipsilateral mediastinal, subcarinal
What is N3?
Contralateral mediastinal, contralateral hilar, scalene or supraclavicular
How does the number of lymph nodes change with size?
There are many small lymph nodes and few large ones
How does the prevalence of metastasis change with the size of lymph nodes?
Large lymph nodes are more likely to have metastasis
What percentage of patients present with metastasis?
What are common metastasis?
What does M staging range from?
M0 to M1
What is M0?
No distant metastasis
What is M1?
What are the different classes of M1?
What is M1a?
Seperate tumour nodes in a contralateral lobe, tumour with pleural or pericardial nodules or malignant pleural or pericardial effusion
What is M1b?
Single distant metastasis
What is M1c?
Multiple distant metastasis
What are some of the advantages of PET/CT scanning in staging?
Performs whole body staging in single study excluding cerebral disease
Discloses metastasis and other pathology no detected by other means
Excludes metastasis where structural imaging abnormal
What are some limitations of CT/PET?
All tests have false positives and false negatives
How does 5 year survival change with staging?
As staging increases survival decreases
What are some examples of tissue diagnosis methods?
Bronchoscopy with endobronchial ultrasound
Percutaneous image guided biopsy, flouroscopy/CT/US guided
Mediastinoscopy (sample mediastinal nodes)
Mediastinotomy (anterior mediastinal nodes)
Video assisted thoracoscopic surgery (VATS)