4. STAGING OF BRONCHOGENIC CA

5. NSCLC STAGING TNM CLASSFICATION Adenocarcinoma Squamous cell carcinoma Large cell carcinoma T – Primary tumor N – Regional Lymph nodes M - Metastasis IA - T1N0M0 IB - T2N0M0 IIA - T1N1M0 IIB - T2N1M0 or T3N0M0 IIIA - T1-3N2M0 or T3N1M0 IIIB - Any T4 or any N3M0 IV - Any M1

6. NSCLC STAGING TNM CLASSIFICATION T – PRIMARY TUMOR METHODS OF STAGING CXR – demonstrates peripheral lesions – pleural effusion, direct extension to the ribs, phrenic nerve involvement with elevation of a hemidiaphragm, or mediastinal widening due to lymphadenopathy CT SCAN – contrast enhanced – thorax and abdomen that includes the liver and adrenal glands – Lung window settings: the maximum long axis largest diameter perpendicular to the long axis

7. NSCLC STAGING TNM CLASSIFICATION T – PRIMARY TUMOR METHODS OF STAGING MRI – superior to CT in assessing the pericardium, heart, and great vessels – coronal images are useful in demonstrating the extent of tumor in the subcarinal region, aortopulmonary window & SVC PET SCAN – superior to CT in differentiating between malignant and benign tumors

8. NSCLC STAGING TNM CLASSIFICATION N – REGIONAL LYMPH NODES METHODS OF STAGING CXR – inferior to CT in the detection of mediastinal lymph node metastases, SN of 10-30% only CT SCAN – spiral or multisection CT, thin (5- mm) sections – SN and SP of 40-84% and 52-80% respectively MRI – comparable to those used at CT – distinguish nodes from vessels without IV contrast enhancement PET SCAN – is superior to CT

9. NSCLC STAGING TNM CLASSIFICATION M - METASTASIS METHODS OF STAGING CT SCAN – Liver, adrenal, brain and lung metastases Technetium-99m ( 99m Tc) radionuclide bone scanning – Bone metastases PET SCAN – Adrenal metastases

10. SCLC Staging LIMITED STAGE DISEASE confined to 1 hemithorax – ( includes ipsilateral, contralateral, and/or supraclavicular nodes) CXR; CT of the thorax, liver, and adrenal glands; cranial CT; bone scintigraphy, bone marrow aspiration EXTENSIVE STAGE DISEASE disseminated nature of SCLC makes whole-body survey techniques suitable for its evaluation 99m Tc-labeled monoclonal antibody fragment NR-LU-10 – detect an antigen present in most small cell cancers whole-body FDG-PET – Detects nodal disease. combined MRI of the brain, spine, abdomen, and pelvis enables comprehensive staging with a single modality