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Confused about staging


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I'm confused about staging lc. Don't know if anyone can shed light?

My friend has nsclc adenocarcinom but the tumour is under 18mm max diameter - which is pretty small isn't it?

But it has metastacised to patches in the spine. In all the stuff I've been reading that makes it stage 4. Is it though when you consider how small the primary is?

Does it make any difference how big the lung cancer is, to affect the spine?

I'm confused!


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Staging does not depend on the size of the original tumor. It depends on the distance the cancer has traveled from the original site.

Stage I is for tumors that are well contained within the host. No metastasis.

Stage II is for tumors that are contained within the host but exist along the margins where possibly it could espace. No metastasis seen.

Stage III is for tumors that have left the host or original tumor (escaped) but are still in the general vicinity of the host.

Stage IV is for tumors that have traveled beyond the original site and the immediate area, wherever in the body that is.


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Don pretty much hit the nail on the head.

My doctor told me that once it spreads from the original site it has entered the blood stream and there fore it is considered late stage.

I'm sorry to read this about your friend.


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Hi -

Sorry you had to find us. John C. Ruckdeschel, M.D., Prof of Oncology & Medicine & Director of H Lee Moffitt Cancer Center & Research Institute at the University of South Florida in Tampa published a booklet that explains LC and Staging/Treatment very well. He has some articles out but try and go to "Treatment of Stage IIIA Non-Small LC"..and just look around. You will have to sign in at some point, so you become a "resident" LOL...Good Luck


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Size does matter sometimes, but any metastasis makes it stage IV. One thing your friend should find out for sure is that the spine is truly a metastasis and not a false positive. This would change the treatment drastically, since surgery likely would be done if it is stage I.

I belive from the research it is uncertain how the size of a tumor is related to the tumor's ability to metastasize.

T - size, location

N - lymph node involvement

M - distant metastasis

In the TNM systems, 4 stages are further subdivided into I-III and A or B subtypes. These stages have important therapeutic and prognostic implications. The stages are as follows:

Primary tumor

Tis - Carcinoma in situ

TX - Positive malignant cytologic findings, no lesion observed

T1 - Diameter of 3 cm or smaller and surrounded by lung or visceral pleura (see Image 1) or endobronchial tumor distal to the lobar bronchus

T2 -Diameter greater than 3 cm (see Images 2-3); extension to the visceral pleura, atelectasis, or obstructive pneumopathy involving less than 1 lung; lobar endobronchial tumor; or tumor of a main bronchus more than 2 cm from the carina

T3 - Tumor at the apex (see Image 5); total atelectasis of 1 lung; endobronchial tumor of main bronchus within 2 cm of the carina but not invading it; or tumor of any size with direct extension to the adjacent structures such as the chest wall mediastinal pleura (see Image 8), diaphragm, pericardium parietal layer, or mediastinal fat of the phrenic nerve

T4 - Invasion of the mediastinal organs, including the esophagus trachea, carina (see Image 11), great vessels (see Image 13), and/or heart; obstruction of the superior vena cava; involvement of a vertebral body; recurrent nerve involvement; malignant pleural or pericardial effusion; or satellite pulmonary nodules within the same lobe as the primary tumor

Regional lymph node involvement

N0 - No lymph nodes involved

N1 - Ipsilateral bronchopulmonary or hilar nodes involved

N2 - Ipsilateral mediastinal nodes or ligament involved

Upper paratracheal lower paratracheal nodes

Pretracheal (see Image 4, Image 7, Image 10) and retrotracheal nodes

Aortic and aortic window nodes

Para-aortic nodes

Para-esophageal nodes

Pulmonary ligament

Subcarinal nodes (see Images 12-17)

N3 - contralateral mediastinal or hilar nodes involved (see Image 19) or any scalene or supraclavicular nodes involved

Metastatic involvement

M0 - No metastases

M1 - Metastases present (see Images 20-27)

Stage groupings are as follows:

IA - T1N0M0

IB - T2N0M0

IIA - T1N1M0

IIB - T2N1M0 or T3N0M0

IIIA - T1-3N2M0 or T3N1M0

IIIB - Any T4 or any N3M0

IV - Any M1

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Looks like everyone answered your question -- it is definitely stage IV -- my mom's primary spot was tiny, yet they did find it in her spine as well. I am so sorry that you friend received this news. I'll be thinking about you both.

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  • 2 weeks later...

Hi, thank you for all of your posts. Will have to accept stage 4 by sounds of things.

Just one thing - mention of a false positive. What's that and does it happen often? I didn't know they don't operate if it has metastacsed - is there a reason for that as surely it doesn't affect the lung itself?



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you are asking some of the very best questions. This is the time to gather precise information for correct staging and treatment planning.

False positives.

That is a word that I have heard often. That is a very important word. John's post was brilliant as far as bringing this issue up with you. There is a possibility that the evidence of spine mets are false positives. What evidence do you have? Did they show on CT AND PET AND bone scan? You mentioned multiple mets. For sure? And where are they?

The docs will not remove the tumor if there are distant mets (outside the lung or immediate area) because the tumor cells are "floating around" looking for a place to set up another nest. Too small to see and destroy.

If it were me, I would double check to see if the spine mets diagnosis is accurate. For sure. If it is a "false positive", easier treatment and success of treatment would be much more favorable.

Great luck.

Cindi o'h

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