Criteria for TNM Clinical Staging

Physical examination and history; pathologic examination of primary tumor or other tissue to establish a diagnosis of cancer, imaging, endoscopy, and studies to determine presence or absence of positive nodes and distant metastases.

Criteria for TNM Pathologic Staging

All information from clinical staging and thoracotomy, plus pathologic examination of the resected specimen and lymph nodes.

Clinical staging tends to underestimate the extent of disease and therefore may distort survival rates.

The Veterans Administration Lung Cancer Study Group used a two-stage system for describing small cell lung cancers:

Limited stage

Confined to the hemithorax of origin, the mediastinum and the supraclavicular nodes, the region which can be encompassed by a radiotherapy port.

Extensive stage

Tumor too widespread to be included in the definition for limited stage disease.

Note: patients with pleural effusion, contralateral supraclavicular nodes, or multiple ipsilateral lung tumors may be included in either stage because the size of the radiotherapy port has not been defined.

Collaborative Stage Elements

For more details on Collaborative Stage, see the Intro to Collaborative Staging module.