Strange, Weird & Bizarre Medical Cases & Facts

Understanding Staging Lung Cancer

Staging is the process by which once lung cancer is confirmed, the degree to which the cancer has established itself and how it presents in a patient is categorized.  This is essential if an appropriate and effective treatment regime is to be recommended and implemented in a lung cancer patient.
Staging is frequently referred to as “TNM” by oncologists (cancer specialists).

TNM refers to the three main factors used in staging:

•    Primary Tumor (T) – whether there is a tumor or tumors which can be established;
•    Lymph Nodes (N) – whether the cancer has occurred in the lymph nodes; and
•    Metastasis (M) – whether the cancer has spread to or from other parts of the body.

Each of these factors is further assessed to provide more detailed clarification.  For instance, where a tumor cannot be located but it is confirmed by the presence of cancer cells, the assessment will be TX.
A detailed explanation follows:

Primary Tumor (T)
TX – no tumor is located but is confirmed by presence of cancer cells
T0 – no evidence of a primary tumor

T1 – primary tumor of less than 3cm and not in the main bronchus
T2 – primary tumor which is any of the following:

•    Larger than 3cm
•    Is present in the main bronchus or other important parts of the lung

T3 – primary tumor of any size invading surrounding tissue or chest wall
T4 – as T3 but affecting the heart, trachea, great blood vessels – more serious than a T3 tumor
Regional Lymph Nodes (N)

Lymph nodes are small, bean shaped objects which are reservoirs of immune cells and materials vital to protect the body.  Regional lymph nodes refers to those lymph nodes in the surrounding vicinity of the lungs.
NX – no assessment

N0 – no regional lymph node metastasis (i.e. the lung cancer has not spread to the lymph nodes)

N1, N2 and N3 – metastasis has occurred to increasing severity

Distant Metastasis (M)

Metastasis refers to the spreading of the cancer to or from other parts of the body.  This is important because primary cancer (i.e. cancer which has originated at that location in the lung) is susceptible to treatment by surgery whereas metastasized lung cancer usually is not).

MX – no assessment of distant metastasis
M0 – no distant metastasis has occurred

M1 – distant metastasis has occurred and includes separate tumor(s) in other parts of the lung or body
Allocation of a Stage

After assessment of the tumor, lymph nodes and metastases, a stage is allocated which depends on the findings of how many tumors, where they are located and how they have spread?

The stages are allocated as follows:

Occult carcinoma – TX, NO, MO – cancer is present because of the presence of cancer cells but it cannot be located or assessed.  This is not allocated a distinct stage but is classed as an “unknown” or medical wildcard.

Stage 0 – any Tumor, N0 and M0
Stage IA – T1, N0, M0
Stage IB – T2, N0, M0
Stage IIA – T1, N1, M0
Stage IIB – T2, N1, M0 or T3, N0, M0
Stage IIIA – T1-T2, N2, M0 or T3, N1-N2, M0
Stage IIIB – Any T, N3, M0 or T4, any N, M0
Stage IV – Any T, Any N, M1

This is obviously a complicated exercise which may require repeated visits to the hospital and your doctor, but it is vital to effective treatment that this staging process is properly conducted.  How well staging is conducted has a direct bearing on survival rates of patients with lung cancer.

Explaining Medical Terminology Associated with Lung Cancer Treatment

Medical terminology is baffling for any layman and when we are confronted with a condition as serious as lung cancer, it helps to relieve some of the stress if you understand some of the terminology.  Your doctor will help you with understanding what is happening and the treatment regime which is available, but you can also do much to help yourself by learning more about the condition and its cure.

Diagnostic Tools and Techniques

Lung cancer is usually discovered because of a routine chest x-ray or because symptoms occur which send them to the doctor, such as persistent coughing or coughing up blood.  These are not conclusive indicators of lung cancer but prompt further investigation.

Lung cancer can be diagnosed using a combination of the following:

CT Scan – this is a tool using x-rays which provides a detailed picture of the lungs and any abnormality.  The CT stands for Computed Tomography.

PET Scan – PET stands for Positive Emission Tomography and is a non-invasive procedure which highlights the tumor by using an injection of mildly radioactive glucose solution – cancer tumors use a lot of energy and the raw material is glucose sugar – if you have a cancer tumor, it will show up because the radioactive sugars will concentrate around it.

Bronchoscopy – is the insertion of a tube which has a camera and swab or biopsy-taking scalpel on the end of it.  A biopsy is simply a small tissue sample which is taken from the affected area of the lung and sent to the lab for testing for cancer cells.  A bronchoscopy can be mildly discomforting as the tube is inserted through the nose or mouth to reach the major airways so a swab or biopsy can be taken.

Needle Biopsy – the doctor will use the results of a CT Scan to guide a needle into the affected area of the lung so a tissue sample can be taken for testing.

Surgical Biopsy – if the abnormality is in a difficult to access part of the lung or is too small for a needle to accurately find it, then a small incision is made through which the surgeon is able to remove part of the lung containing the affected tissue.  The tissue is then tested for cancer cells in the pathology lab.

Staging or TNM

Staging – the process by which a cancer is categorized based on a number of factors; the result is used to determine an effective and appropriate treatment regime.

TNM – staging is frequently referred to as “TNM” which stands for the three main factors – the presence of a Tumor, the cancer being present in the Lymph Nodes, and the spreading of the cancer to or from other parts of the body, referred to as Metastasizing.

Primary Cancer – this refers to a cancer which has originated at that spot and has not occurred because it has spread from another part of the body.  Surgery is frequently used to treat early forms of primary lung cancer backed by chemotherapy or radiation treatment.
Metastasized Cancer – this refers to a cancer tumor which has originated elsewhere in the body and has spread to the lungs.  It is not usually treated by surgery unless the cancer is non-aggressive and not too large.

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The Role and Importance of Non-Invasive Imaging and Diagnostics in the Detection and Treatment of Lung Cancer:

One of the advents of modern medicine has been the development of several novel techniques used for diagnosing, staging, and evaluating lung cancer for treatment.  Many of these studies are non-invasive imaging techniques; others require some degree of physical exertion or effort to determine the patient’s level of risk for surgery.  The aim of diagnostic testing seems so esoteric to patients they are often reluctant or apathetic to have them done.   The outcomes of these exams can significantly alter patient care strategy and warrant explanation to the patient in a way they can understand.  The following measures are necessary steps in the continuum of patient care, and with cooperation between the medical provider and the patient; levels of patient care thought previously unattainable seem within reach.

Non-invasive imaging techniques, such as PET Scans, CT Scans, and MRI’s are typically the way lung cancer is detected.  Patients with shortness of breath, cough, non-cardiac chest pain, and discomfort are typically sent for some kind of imaging of the chest.  In many cases these scans give rise to suspicious looking lesions or masses which warrant involvement from an oncologist or thoracic surgeon. In other situations a lung mass or lesion may be detected incidentally, that is, it is discovered while investigating another illness.  Each one of these studies is useful for detecting different characteristics of lung cancer.

-PET (positron emission tomography) imagery works when a patient is injected with a radioactive sugar based solution which is taken up and metabolized by highly active cells.  This radioactive element is able to be detected by a machine which is able to render a series of 2-D or 3-D images of the patient.  PET scans are important in detecting cancer as the hallmark of many forms of cancer is that the cells divide rapidly and cause destruction of surrounding tissue. This prolonged cell division is a process called metastasis.

-CT (computerized tomography) or CAT (Computerized Axial Tomography) is a method of imaging that compiles a series of x-rays to construct an image.  CT scans function to help identify masses of densely packed cells that are nestled among less dense tissue, such as that found in the lungs.  CT scans are also useful in detecting the shape of a mass.  Determining the shape of a mass is an important step in staging and prospective treatment of lung cancer.

-MRI (Magnetic Resonance Imaging) is an imaging technique that uses magnetic fields to resonate the water molecules within the patient’s body.  The importance of this technique is that it allows a distinction to be made between tissues of similar density, allowing the physician to determine if there is a mass and if it is malignant.  MRIs can also be useful in detecting vasculature (blood vessels) in and around a lung mass prior to a prospective surgery.

-PFT’s (pulmonary function tests) allow the physician to evaluate the level of pulmonary health a patient has and may precipitate the use of pre-operative therapies involving steroids or bronchodilators.  This set of tests also acts as one of the best predictors of post-operative pulmonary complications by indicating whether the patient can survive with the lung resected.

-Cardiac Stress Tests are either conducted as exercise (treadmill) stress or nuclear stress test that can help determine how a patient will function as they undergo surgery.  During this test the patient is placed on a treadmill and their heart rate, electrical activity, and blood flow are measured continuously to demonstrate whether a patient will tolerate surgery with appropriate risks for morbidity and mortality.  Another variation of this test uses chemicals that mimic the stress the body endures during physical exertion if it is unsafe for the patient to exercise.

Each one of the respective tests is beneficial for different reasons.  The advent of these new diagnostics coupled with novel methods of treatment are allowing patients to be more effectively identified and treated for lung cancer.  With some 215,000 new cases of lung cancer diagnosed in 2008, the news of effective treatment can’t come soon enough, especially considering that over 20,000 patients per year who are diagnosed with lung cancer have never smoked.

Click to find out more information about Lung Cancer Treatement

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