What changes the TNM staging?

[Oak]

A 77 year old female with a long history of cigarette smoking is found to have a small tumor at the periphery of her right upper lobe. Initially, the tumor was believed to be a Stage I carcinoma (T1 NO MO), but after surgery it is found to be Stage II (T1 N1 MO). What is found at surgery that changed the staging?

A. Involvement of the chest wall
B. Positive bronchial lymph nodes
C. Small cell histology
D. Tumor at the carina
E. Tumor size greater than 3 cm

[Hero]

(B) Positive bronchial Lymph nodes

[Oak]

Thats right the correct answer is B. Although it is nearly impossible to memorize the staging rules for all the different kinds of tumors, there are several basic principles common to all. The TNM stage of a tumor is determined by the tumor size and extent (T for tumor), lymph node involvement (N for nodes), and metastasis (M for metastasis). N0 always means no lymph nodes are involved. An NI lesion has positive nodes, and only choice B, positive bronchial lymph nodes, changes the patient's nodal status.

Involvement of the chest wall is a feature of tumor size and extent-thus, it is a component of the T in TNM-staging. T2 lesions involve the chest wall (choice A).

Histological features of the tumor, such as small cell morphology (choice C), are not considered in tumor stage, but rather in tumor grade. Small cell tumors are considered high-grade carcinomas.

Tumor extending to the carina reflects the tumor size and extent-thus, it is a component of the T in TNM-staging: T3 lesions involve the carina (choice D).

Tumor size is a consideration in the T of TNM-staging. Tumors greater than 3 cm (choice E) are at least T2 lesions.