Classification of Lung Cancer by Staging and its Localization

 

Classification of Lung Cancer by Staging and its Localization:

Staging

Staging:

According to the domestic classification, lung cancer is divided into the following stages:

Stage I - a tumor from 1 to 3 cm in greatest dimension, located in one segment of the lung or within the segmental bronchus. There are no metastases

Stage II - a tumor up to 6 cm in greatest dimension, located in one segment of the lung or within the segmental bronchus. There are single metastases in the pulmonary and Broncho pulmonary lymph nodes.

Stage III - a tumor larger than 6 cm with a transition to the adjacent lobe of the lung or germination of the adjacent bronchus or main bronchus. Metastases are found in bifurcation, tracheobronchial, and par tracheal lymph nodes.

Stage IV - the tumor extends beyond the lung with spreads to neighboring organs and extensive local and distant metastases, pleurisy, and/or pericarditis join.

According to TNM Staging Tumors are defined by:

T- Primary Tumors:

T x  - insufficient data to assess the primary tumor or tumor cells are found only in sputum or bronchial washings, but not detected by bronchoscopy and/or other methods

T 0 - the primary tumor is not determined

T is - non-invasive cancer (carcinoma in situ)

T l - tumor up to 3 cm in greatest dimension, surrounded by lung tissue or visceral pleura without germination proximal to the lobar bronchus during bronchoscopy (the main bronchus is not affected)

T 2  - a tumor of more than 3 cm in the largest dimension, or a tumor of any size, germinating the visceral pleura, or accompanied by atelectasis, or obstructive pneumonia, which extends to the lung's root but does not completely engulf the lung; Bronchoscopy reveals that the tumor's proximal edge is at least 2 cm from the carina.

T3 - a tumor of any size, passing to the chest wall (including a tumor of the upper groove), diaphragm, mediastinal pleura, pericardium; tumor less than 2 cm short of the carina, but without the involvement of tumor with concurrent atelectasis, a tumor that involves the carina but does not involve the carina, or obstructive pneumonia that affects the entire lung.

T 4 - a tumor of any size directly passing to the mediastinum, heart, large vessels, trachea, esophagus, and vertebral bodies, carina (individual tumor nodes in the same lobe or tumor with malignant pleural effusion).

N- Regional Lymph Nodes:

N x - insufficient data to assess the state of regional lymph nodes

N 0 - no signs of metastatic involvement of regional lymph nodes

N 1 - there is a lesion of per bronchial and/or lymph nodes of the lung root on the side of the lesion, including the direct spread of the tumor to the lymph nodes.

N 2 - there is a lesion of the lymph nodes of the mediastinum on the side of the lesion or bifurcation lymph nodes.

N 3 - damage to the lymph nodes of the mediastinum or the root of the lung on the opposite side: rescaling supraclavicular nodes on the side of the lesion or on the opposite side.

M- Distant Metastasis:

M x - insufficient data to determine distant metastases

M 0 - no signs of distant metastases

M 1 - there are signs of distant metastases, including individual tumor nodes in another lobe

M1a - intrathoracic metastases, individual tumor nodes in the contralateral, opposite lung. The tumor is large but localized in the organs of the chest cavity.

M1c - extra thoracic metastases, metastatic tumors outside the chest cavity - in the brain, liver, bones, kidneys, and adrenal glands.

G- Histopathological Gradation:

G x - the degree of cell differentiation cannot be assessed

G 1 - high degree of differentiation

G 2 - moderate degree of differentiation

G 3 - poorly differentiated tumor

G 4 - undifferentiated tumor

Localization:

Central lung cancer. A tumor originating from the mucous membrane of a large bronchus manifests itself quite early. With its growth, it irritates the bronchial mucosa and causes a violation of bronchial patency and ventilation of the segment, lobe, or entire lung in the form of hypoventilation and atelectasis. In the future, sprouting the nerve trunks and pleura, the tumor causes pain and impaired innervation of the corresponding nerve (diaphragmatic, recurrent, or vagus), as well as a picture of the involvement of the pleura in the tumor process. Joining metastasis leads to the appearance of secondary symptoms from the affected organs and systems.

When the tumor grows into the bronchus, a cough appears, initially dry, then with light sputum, sometimes with an admixture of blood. There is hypoventilation of the lung segment and then its atelectasis. Sputum becomes purulent, which is accompanied by fever, general malaise, and shortness of breath. Cancer pneumonia joins, which is relatively easy to cure but often recurs. Cancerous pleurisy, accompanied by pain syndrome, can join cancer pneumonia.

Hoarseness develops as a result of the paralysis of the vocal muscles if the tumor sprouts the recurrent nerve. Diaphragm paralysis results from phrenic nerve damage. Germination of the pericardium is manifested by pain in the region of the heart.

The defeat of the tumor or its metastases of the superior vena cava causes a violation of the outflow of blood and lymph from the upper half of the trunk, upper limbs, head a, and neck. The patient's face becomes puffy, with a cyanotic tint, and veins swell on the neck, arms, and chest.

Peripheral lung cancer. A peripheral tumor in the initial stage is asymptomatic due to the absence of pain endings in the lung tissue. Later, the tumor node grows, and the bronchi, pleura, and surrounding organs begin to sprout; as a result, the tumor's center may disintegrate and bleed.

Local symptoms of lung cancer include coughing up blood in the sputum, hoarseness, superior vena cava tumor compression syndrome, mediastinal displacement, and signs of tumor growth in nearby organs. Lung apex cancer with Pancoast syndrome has a particularly distinctive clinical picture as a result of localization. With cancerous pleurisy, the syndrome of squeezing the lung with exudate joins.

Common symptoms include a general deterioration in the state of the body, characteristic of the development of malignant tumors: intoxication, shortness of breath, weakness, weight loss and s, and fever. For lung cancer, a violation of calcium metabolism, dermatitis, and deformity of the fingers like “drumsticks " are also added. Advanced stages also include the process of tumor and lung tissue decay, bronchial blockage, atelectasis, and chronic lung bleeding that may result in death.