Staging lung cancer: METHODS OF STAGING (1)

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

Table 6. Clinical symptoms of lung cancer