Lung cancer (staging - IASLC 8th edition)

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The IASLC (International Association for the Study of Lung Cancer) 8^th edition lung cancer staging system was introduced in 2016 and supersedes the IASLC 7^th edition.

~~It is as follows:~~

TNM system

T: primary tumour

Tx: primary tumour cannot be assessed or tumour proven by the presence of malignant cells in sputum or bronchial washings but not visualised by imaging or bronchoscopy
T0: no evidence of a primary tumour
Tis: carcinoma in situ
T1: tumour under 3 cm in greatest dimension surrounded by lung or visceral pleura without bronchoscopic evidence of invasion more proximal than the lobar bronchus (i.e. not in the main bronchus)
- T1a(mi): minimally invasive adenocarcinoma
- T1a ss: superficial spreading tumour in central airways (spreading tumour of any size but confined to the tracheal or bronchial wall)
- T1a: tumour ≤1 cm in greatest dimension
- T1b: tumour >1 cm but ≤2 cm in greatest dimension
- T1c: tumour >2 cm but ≤3 cm in greatest dimension
T2: tumour >3 cm but ≤5 cm or tumour with any of the following features:
- involves the main bronchus regardless of distance from the carina but without the involvement of the carina
- invades visceral pleura
- associated with atelectasis or obstructive pneumonitis that extends to the hilar region
- involving part or all of the lung
- T2a: tumour >3 cm but ≤4 cm in greatest dimension
- T2b: tumour >4 cm but ≤5 cm in greatest dimension
T3: tumour >5 cm but ≤7 cm in greatest dimension or associated with separate tumour nodule(s) in the same lobe as the primary tumour or directly invades any of the following structures:
- chest wall (including the parietal pleura and superior sulcus)
- phrenic nerve
- parietal pericardium
T4: tumour >7 cm in greatest dimension or associated with separate tumour nodule(s) in a different ipsilateral lobe than that of the primary tumour or invades any of the following structures
- diaphragm
- mediastinum
- heart
- great vessels
- trachea
- recurrent laryngeal nerve
- oesophagus
- vertebral body
- carina

It is recommended that solid and nonsolid lesions should be measured on the image that shows the greatest tumour dimension (on axial, coronal, or sagittal planes). Although those lesions that are part solid should be measured on both their largest average diameter and the largest diameter of the solid component, only the solid component measurement is to be used for staging directions ³. Also, the solid component of subsolid lesions should be performed on a lung or intermediate window rather than mediastinal window ³.

N: regional lymph node involvement

Nx: regional lymph nodes cannot be assessed
N0: no regional lymph node metastasis
N1: metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension
N2: metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s)
N3: metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)

M: distant metastasis

M0: no distant metastasis
M1: distant metastasis present
- M1a: separate tumour nodule(s) in a contralateral lobe; tumour with pleural or pericardial nodule(s) or malignant pleural or pericardial effusions
- M1b: single extrathoracic metastasis
- M1c: multiple extrathoracic metastases in one or more organs

There is a recommendation that the number of metastatic lesions, the larger diameter of individual metastatic deposits, and the number of involved organs should be stated in the radiological report ³.

Stage groupings

stage 0
- TNM equivalent: T_is, N0, M0
stage Ia
- TNM equivalent: T1, N0, M0
- 5-year survival: up to 92%
stage Ib
- TNM equivalent: T2a, N0, M0
- 5-year survival: 68%
stage IIa
- TNM equivalent: T2b, N0, M0
- 5-year survival: 60%
stage IIb
- TNM equivalent: T1/T2, N1, M0 or T3, N0, M0
- 5-year survival: 53%
stage IIIa
- TNM equivalent: T1/T2, N2, M0 or T3/T4, N1, M0 or T4, N0, M0
- 5-year survival: 36%
stage IIIb
- TNM equivalent: T1/T2, N3, M0 or T3/T4, N2, M0
- 5-year survival: 26%
stage IIIc
- TNM equivalent: T3/T4, N3, M0
- 5-year survival: 13%
stage IVa
- TNM equivalent: any T, any N with M1a/M1b
- 5-year survival: 10%
stage IVb
- TNM equivalent: any T, any N with M1c
- 5-year survival: 0%

-The IASLC (International Association for the Study of Lung Cancer) 8th edition lung cancer staging system was introduced in 2016 and supersedes the <a href="/articles/lung-cancer-iaslc-7th-edition-staging">IASLC 7th edition</a>. It is as follows:<h5>TNM system</h5>T: primary tumour<ul>
+The IASLC (International Association for the Study of Lung Cancer) 8th edition lung cancer staging system was introduced in 2016 and supersedes the <a href="/articles/lung-cancer-iaslc-7th-edition-staging">IASLC 7th edition</a>. <h5>TNM system</h5>T: primary tumour<ul>
~~-</ul>N: regional lymph node involvement<ul>~~
+</ul>It is recommended that solid and nonsolid lesions should be measured on the image that shows the greatest tumour dimension (on axial, coronal, or sagittal planes). Although those lesions that are part solid should be measured on both their largest average diameter and the largest diameter of the solid component, only the solid component measurement is to be used for staging directions 3. Also, the solid component of subsolid lesions should be performed on a lung or intermediate window rather than mediastinal window 3. N: regional lymph node involvement<ul>
~~-</ul><h5>Stage groupings</h5><ul>~~
+</ul>There is a recommendation that the number of metastatic lesions, the larger diameter of individual metastatic deposits, and the number of involved organs should be stated in the radiological report 3. <h5>Stage groupings</h5><ul>