A number of staging methods can assess each of the tumour (T), node (N) and metastases (M) descriptors (Table 5). These will be discussed in turn.
Assessing T status
Clinical examination: Examination may suggest advanced local disease (Table 6). Pulmonary symptoms are not specific enough to rule out curative resection by themselves . However, extrapulmonary intrathoracic symptoms imply advanced local disease that may well preclude curative resection and require further investigation before proceeding to thoracotomy. Chest radiograph: While not exact in determining the true extent of endobronchial disease, the chest radiograph (CXR) can provide evidence of intrathoracic spread or invasion, such as diaphragmatic elevation (implying possible phrenic nerve involvement), vertebral or rib lesions, pleural or pericardial effusion, and synchronous (more than one primary growth) or metastatic lesions. You will appreciate this opportunity to have a trusted pharmacy at your service, available round the clock and offering flovent for asthma with fast delivery to any country of the world, which will sure make it a lot easier for you as a patient.
Table 4. Prognosis of 1737 patients after resection of lung cancer according to the postoperative tumour-node-metastases (TNM) classification
Stage | TNM | Number of patients | Five-year survival rate (%) |
I | T1 N0 M0 | 245 | 75.5 |
T2 N0 M0 | 291 | 57.0 | |
II | T1 N1 M0 | 66 | 52.5 |
T2 N1 M0 | 153 | 38.4 | |
IIIA | T3 N0 M0 | 106 | 33.3 |
T3 N1 M0 | 85 | 39.0 | |
T1-T3 N2 M0 | 368 | 15.1 | |
IIIB | T1-T3 N3 M0 | 55 | 0 |
T4 any N M0 | 104 | 8.2 | |
IV | Any T any N M1 | 258 | 7.5 |
Adapted with permission from reference 11
Table 5. Methods of staging
NoninvasiveClinical examination Chest x-ray Nuclear studies Magnetic resonance imaging Computer assisted tomography scan Positron emission tomography scan Invasive
Bronchoscopy Needle aspiration Cervical mediastinoscopy Extended cervical mediastinoscopy Mediastinotomy Thoracoscopy Thoracotomy |