Confused about staging

Surgery vs. chemo
Dear CGC,

I am a survivor of both breast and lung cancer, both stage 1. I read research from both areas since they both pertain to me. I have noticed research in the last few years in the area of breast cancer that surgery for the primary tumor extends life even when the patient is in stage 4 cancer where it has spread from the original area to distant spots. Surgery on the lung is tricky of course, because it affects our breathing. When doctors know that the cancer has spread outside the lung and that surgery won't do much good,currently they don't bother. If the tumor is confined to the lung, there is a chance that surgery will be curative. Sometimes you need both surgery and chemo to get the best results.

I found the following information on staging athttp://www.health-alliance.com/Cancer/Lung/staging.html so you can stage your mom's cancer yourself. Look through her path reports and test reports for the needed information.

Staging of Non-Small Cell Lung Cancer (NSCLC)

The system most often used to describe the growth and spread of non-small cell lung cancer (NSCLC) is the TNM staging system, also known as the American Joint Committee on Cancer (AJCC) system. T stands for tumor (its size and how far it has spread within the lung and to nearby organs), N stands for spread to lymph nodes and M is for metastasis (spread to distant organs). In TNM staging, information about the tumor, lymph nodes, and metastasis is combined and a stage is assigned to specific TNM groupings. The grouped stages are described using Roman numerals from 0 to IV.

Non-small cell lung cancer T stages

Tis: Cancer is found only in the layer of cells lining the air passages. It has not invaded other lung tissues. This stage is also known as carcinoma in situ.

T1: The cancer is no larger than 3 centimeters (slightly less than 1¼ inches), has not spread to the visceral pleura (membranes that surround the lungs) and does not affect the main branches of the bronchi.

T2: The cancer has one or more of the following features:

it is larger than 3 cm
it involves a main bronchus, but is not closer than 2 cm (about ¾ inch) to the point where the trachea (windpipe) branches into the left and right main bronchi
it has spread to the visceral pleura
the cancer may partially clog the airways, but this has not caused the entire lung to collapse or develop pneumonia
T3: The cancer has one or more of the following features:

it has spread to the chest wall, the diaphragm (breathing muscle that separates the chest from the abdomen), the mediastinal pleura (membranes surrounding the space between the two lungs), or parietal pericardium (membranes of the sac surrounding the heart).
it involves a main bronchus and is closer than 2 cm (about ¾ inch) to the point where the trachea (windpipe) branches into the left and right main bronchi, but does not involve this area
it has grown into the airways enough to cause one lung to entirely collapse or to cause pneumonia of the entire lung
T4: The cancer has one or more of the following features:

it has spread to the mediastinum (space behind the chest bone and in front of the heart), the heart, the trachea (windpipe), the esophagus (tube connecting the throat to the stomach), the backbone or the point where the windpipe branches into the left and right main bronchi
two or more separate tumor nodules are present in the same lobe
there is a malignant pleural effusion (fluid containing cancer cells in the space surrounding the lung)
Non-small cell lung cancer N stages

N0: No spread to lymph nodes

N1: Spread to lymph nodes within the lung, hilar lymph nodes (located around the area where the bronchus enters the lung). Metastases affect lymph nodes only on the same sides as the cancerous lung.

N2: Spread to lymph nodes around the point where the windpipe branches into the left and right bronchi or to lymph nodes in the medistinum (space behind the chest bone and in front of the heart). Affected lymph nodes are on the same side of the cancerous lung.

N3: Spread to lymph nodes near the collarbone on either side, to hilar or mediastinal lymph nodes on the side opposite the cancerous lung.

Non-small cell lung cancer M stages

M0: No distant spread

M1: Distant spread is present. Sites considered distant include other lobes of the lungs, lymph nodes further than those mentioned in N stages, and other organs or tissues such as the liver, bones, or brain.

Stage grouping for non-small cell lung cancer

Once the T, N and M categories have been assigned, this information is combined (stage grouping) to assign an overall stage of 0, I, II, III or IV.

Overall Stage T Stage N Stage M Stage Treatment
Stage 0 Tis (In situ) N0 M0 treatment
Stage IA T1 N0 M0 treatment
Stage IB T2 N0 M0 treatment
Stage IIA T1 N1 M0 treatment
Stage IIB T2 N1 M0 treatment
T3 N0 M0
Stage IIIA T1 N2 M0 treatment
T2 N2 M0
T3 N1 M0
T3 N2 M0
Stage IIIB Any T N3 M0 treatment
T4 Any N M0
Stage IV Any T Any N M1 treatment


The website gives treatment plans under the buttons above marked "treatment", but of course those plans didn't copy above. You might try the American Cancer Society website information on stage too to see how it compares with the above site. If what the oncologist is telling you doesn't make sense, you need to get your mom's tests and reports to another oncologist for a second opinion. It will help you know what is going on and what you should do next.

As for chemo, some kinds of chemo are bummers on your quality of life and some aren't. If my cancer comes back for example, I've been told I'm a candidate for a pill that will probably give me a bad case of acne-like rash. That's not exactly something to look forward too, but if it gives me several more years on this planet it is not so bad either. Knowing what treatment the doctors think will work best with your mom's cancer and how many months that treatment might buy helps make those tough decisions a lot easier. A second opinion with a clinic that specializes in lung cancer treatment can help you get the information you need.
Good luck!

C. Abbott