Sunday, February 8, 2009

77 - NIMS MEDICINE february 2009 paper - 2

2q: a non small cell cancer of lung with malignant pleural effusion is graded as ?

a. T3
b. T2
c. T4
d. M1

answer: c . T 4 . see the staging of non small cell lung cancer below .

TX
Primary tumour cannot be assessed, or tumour proven by the presence of malignant cells in sputum or
bronchial washings but not visualised by imaging or bronchoscopy

T0
No evidence of primary tumour

T1
Tumour 3 cm or less in greatest dimension, surrounded by lung or visceral pleura, without
bronchoscopic evidence of invasion more proximal than lobar bronchus (i.e., not in the main bronchus)

T2
Tumour with any of the following features of size or extent.
• More than 3 cm in greatest dimension
• Involving main bronchus, 2 cm or more distal to the carina.
• Invading the visceral pleura.
• Associated with atliectasis or obstructive pneumonitis that extends to the hilar region but does not
involve the whole lung

T3
• Tumour of any size that directly invades the chest wall (including superior sulcus tumours),
diaphragm, mediastinal pleura, phrenic nerve or parietal pericardium
• Tumours in the main bronchus less than 2 cm distal to the carina but without involvement of carina.
• Associated ateliectasis or obstructive pneumonitis of the entire lung

T4
• Tumour of any size, which invades the mediastinum, heart, great vessels, trachea, oesophagus,
vertebral body or carina
• Tumour with a MALIGNANT PLEURAL EFFUSION
• Secondary nodules in the same lobe of the lung

Regional Lymph Nodes

NX
Regional nodes cannot be assessed

N0
No regional node metastasis

N1
Ipsilateral peribronchial and/or ipsilateral hilar nodes including direct extension

N2
Ipsilateral mediastinal and/or subcarinal nodes

N3
Ipsilateral scalene, contralateral mediastinal, hilar, scalene or supraclavicular nodes
Distant Metastasis

MX
Presence of metastasis cannot be assessed

M0
No distant metastasis

M1
Distant metastasis present; secondary nodules in a different lobe of the lung other than that of primary

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