|
ตารางที่ 2
แสดงการแบ่งระยะของโรคแบบ
TNM Staging system
โดย American
Joint Committee on Cancer
(AJCC 1997) 5th
edition
LUNG
 DEFINITIONS
Primary Tumor (T)
TX
Primary tumor cannot be assessed, or tumor proven by presence of
malignant cells in sputum
or
bronchial washings but not visualized by imaging or bronchoscopy
TO
No evidence of primary tumor
Tis
Carcinoma in situ
T1
Tumor 3 cm or less in greatest dimension, surrounded by lung or visceral
pleura, without bronchoscopic evidence of invasion more proximal than the lobar
bronchus* (i.e., not in main bronchus)
T2
Tumor with any of the following features of size or extent:
More than 3 cm in greatest dimension
Involves main bronchus, 2 cm or more distal to the carina
Invades the visceral pleura
Associated with atelectasis or obstructive pneumonitis that extends to
the hilar region
but does not involve the entire lung
T3
Tumor of any size that directly invades any of the following: chest wall
(including superior sulcus tumors), diaphragm, mediastinal pleura, parietal
pericardium; or tumor in the main bronchus less than 2 cm distal to the carina
but without involvement of the carina; or associated atelectasis or obstructive
pneumonitis of the entire lung
T4
Tumor of any size that invades any of the following: mediastinum,heart,
great vessels, trachea, esophagus, vertebral body, carina; separate tumor nodule
(s) in the same lobe; or tumor with a malignant pleural effusion**
* The uncommon
superficial tumor of any size with its invasive component limited to the
bronchial
wall, which may
extend proximal to the main bronchus, is also classified T1.
** Most pleural
effusions associated with lung cancer are due to tumor.
However, there are a few parients in whom multiple cytopathologic
examinations of pleural fluid are negative for tumor.
In these cases, fluid is nonbloody and is not an exudate.
When these elements and clinical judgment dictate that the effusion is
not related to the tumor, the effusion should be excluded as a staging element
and the patient should be staged T1, T2 or T3.
Regional Lymph
Nodes (N)
NX
Regional lymph nodes cannot be assessed
NO
No regional lymph node metastasis
N1
Metastasis to ipsilateral peribronchial and/or ipsilateral hilar lymph
nodes and intrapulmonary nodes involved by direct extension of the primary tumor
N2
Metastasis to ipsilateral mediastinal and/or subcarinal lymph node (s)
N3
Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral
or contralateral scalene or
supraclavicular
lymph node (s)
Distant
Metastasis (M)
MX
Distant metastasis cannot be assessed
MO
No distant metastasis
M1
Distant metastasis present (includes synchronous separate nodule (s) in a
different lobe)
Stage Grouping
Occult
TX
NO
MO
O
Tis
NO
MO
IA
T1
NO
MO
IB
T2
NO
MO
IIA
T1
N1
MO
IIB
T2
N1
MO
T3
NO
MO
IIIA
T1
N2
MO
T2
N2
MO
T3
N1
MO
T3
N2
MO
T3
N2
MO
IIIB
Any T N3
MO
T4
Any N MO
IV
Any T Any N
M1
| 
