IS Case 60: Stage IV lung cancer with cerebral metastases
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.
- 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:
- Tis - Carcinoma in situ.
- TX - Positive malignant cytologic findings without identifiable lesion.
- T1 - Lesion <3cm surrounded by lung or visceral pleura -or- endobronchial variety distal to lobar bronchi.
- T2 - Lesion >3cm - or - extends to the visceral pleura -or- causes atelectasis/obstruction - or - main bronchi tumors more than 2cm from the carina.
- T3 - Direct extension into structures such as the diaphragm, pericardium parietal layer, mediastinal pleura or chest wall - or - endobronchial tumors within 2cm of the carina, without invasion - or - complete atelectasis of an entire lung - or - apical tumors.
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