IS Case 60: Stage IV lung cancer with cerebral metastases

Nate Johnson, MD

Imaging Sciences URMC 2008
Publication Date: 2009-05-19


A 67-year-old male presents to the emergency department with complaint of confusion and cough.


Stage IV lung cancer with cerebral metastases


It is important not only to detect but also to accurately stage bronchogenic carcinoma in order to correctly determine treatment and prognosis. While lung cancer can have a dim prognosis, there is a large spread of five-year mortality based on staging. A patient diagnosed with Stage 1A lung cancer has a 75% five-year survival. However a patient with Stage IV disease (as does our patient) has less than a 5% chance of survival at five years. A patient is considered to have unresectable disease if their stage is either IIIB or IV.

The staging of lung cancer is based on the familiar TNM system which relies on grading the 1) primary tumor, 2) lymph node involvement, and 3) metastases.

  • M1 - denotes the presence of metastatic disease.
  • M0 - designates absence of metastases

Nodal staging is as follows:

  • N0 - No lymph nodes involved
  • N1 - Ipsilateral hilar or bronchopulmonary nodes involved
  • N2 - Mediastinal nodes involved
  • N3 - Contralateral lymph nodes or scalene/supraclavicular nodal involvement

Primary tumor grading (T) is as follows:


  1. Mountain CF. Revisions in the International System for Staging Lung Cancer. Chest. 1997 Jun;111(6):1710-7. [PMID: 9187198]
  2. Mountain CF. A new international staging system for lung cancer. Chest. 1986 Apr;89(4 Suppl):225S-233S. [PMID: 3514171]
  3. Mountain CF. Expanded possibilities for surgical treatment of lung cancer. Survival in stage IIIa disease. Chest. 1990 May;97(5):1045-51. [PMID: 2158877]

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