NCCN Guidelines for Patients® | Lung Cancer - Non-Small Cell Lung Cancer

22 NCCN Guidelines for Patients ® : Lung Cancer – Non-Small Cell, 2018 Cancer staging is a rating by your doctors of how far the cancer has grown and spread. Doctors plan additional tests and treatment based on how much the cancer has grown. In Part 3, the scoring system used for cancer staging is explained. Staging plan Staging is very important for treatment planning. Like diagnosis, there is no single plan for staging that is best for all people. Your plan will depend on the cancer site, your health, and the experience of your doctors. Lung cancer is often staged twice. The first staging is done before treatment and is called the clinical stage. Imaging tests, like CT and PET/CT, may show where the cancer has grown and spread. Blood tests should also be done. Read Part 4 to learn about the procedures used for staging. Your doctors may try to diagnose and stage the cancer at the same time. This can be done by testing the furthest site from the nodule that likely has cancer. Examples of such sites are lymph nodes and adrenal glands. By doing this, you’ll likely have fewer procedures. Some cancers may not be correctly staged until after surgical treatment. For example, all the lymph nodes with cancer might not be found until surgery. On the other hand, some nodes thought to have cancer may be cancer-free. This second staging is called the pathologic stage. It is based on tests of tissue removed during surgery. For some people, lung cancer is diagnosed, staged, and treated during one operation. TNM scores The AJCC ( A merican J oint C ommittee on C ancer) staging system is used to stage lung cancer. In this system, the letters T, N, and M describe different areas of cancer growth. Your doctors will assign a score to each letter. These scores will be combined to assign the cancer a stage. T = Tumor The T score tells how large or where the primary tumor has grown. In medicine, tumors are measured in cm ( c enti m eters). About 0.4 inch equals 1 cm. Figure 6 shows some sites where the tumor might grow. Your doctors will assess the size and growth of tumors. T scores for lung cancer include: † † TX tumors are too small for testing or can’t be found with tests. † † T0 means no primary tumor has been found. † † Tis means there are abnormal or cancer cells in airways that haven’t invaded lung tissue. † † T1 tumors are in the lungs only and are not larger than 3 cm. • T1mi tumors grow only along the surface of lung tissue. Areas of invasion are no deeper than 0.5 cm. • T1a tumors are 1 cm or smaller and have invaded at least 0.5 cm. • T1b tumors are larger than 1 cm but not larger than 2 cm. Areas of invasion are at least 0.5 cm. • T1c tumors are more than 2 cm but not larger than 3 cm. Areas of invasion are at least 0.5 cm. 3 Cancer staging Staging plan | TNM scores