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Lung Cancer in Wales, a detailed analysis of population trends of incidence and stage at diagnosis up to and including 2012 About lung cancer staging The stage of a cancer is usually determined by X-rays, scans or histology. Clinicians will always consider the stage of a cancer when considering appropriate treatment. The stage describes “the status” of the cancer at the time of diagnosis. An international classification is used to assess this status. It is called the TNM (currently 7th Edition). TNM stands for: Tumour (size and extent of invasion) - records the size of the tumour at diagnosis Nodes (presence/absence of tumour - records the local spread of the tumour into the lymphatic system (also described as involvement) Metastases (tumour spread to other organs) records whether the tumour has metastasized, via the blood stream or lymphatic system other part of the body (this is known as secondary or metastatic cancer) These 3 components are then aggregated into an overall Stage 1–4 (which may be subclassified i.e. 1A, 1B etc.). The Stage Groupings are generally as follows: Stage 1 - the cancer is small and localised in one area. Stage 2 - the cancer is larger and may have grown into surrounding tissues and there may be cancer cells in the regional lymph nodes (those lymph nodes local to the organ in which the tumour is sited). Stage 3 - the cancer may be larger, has directly spread to other structures, or there is involvement of lymph nodes. Stage 4 – the cancer has spread to another organ. In summary, the lower the stage number recorded, the better the prognosis is. The higher the stage of the cancer, the worst the prognosis is. Welsh Cancer Intelligence and Surveillance Unit 1 Lung Cancer in Wales, a detailed analysis of population trends of incidence and stage at diagnosis up to and including 2012 The Lung cancer stage groupings are as follows:Stage 1A - the tumour is small (up to 3cm). Stage 1B - the cancer is between 3 and 5cm. It may have spread into nearby structures. Stage 2A - the cancer is between 5 and 7cm but there are no cancer cells in any lymph nodes. Or it is 5cm or less and there are cancer cells in the lymph nodes close to the affected lung. In either case it may have spread into nearby structures such as the bronchus) or the pleura. Or the lung may have partly collapsed. Stage 2B - the cancer is between 5 and 7cm and there are cancer cells in the lymph nodes close to the affected lung Or, it is larger than 7cm but there are no cancer cells in any lymph nodes Or, it is not in any lymph nodes but has spread into one or more of the following areas – the chest wall, diaphragm, the phrenic nerve, or the layers that cover the outer layers of the heart Or, it is In the bronchus close to where it divides to go into each lung Or, it is making part of the lung collapse Or, it is any size but there is more than one tumour in the same lobe of the lung. Stage 3A the cancer is in the lymph nodes close to the lung and the cancer is bigger than 7cm or there are 2 tumours Or, is smaller and growing into one of the following areas – the chest wall, the diaphragm, or the layers that cover the heart or the phrenic nerve Or, the cancer is more than 7 cm and there are cancer cells in lymph nodes and in mediastinum Or , the cancer is any size but has grown into another major structure in your chest, such as the heart, the trachea, the oesophagus, the nerve that goes to the larynx, a spinal bone, or a main blood vessel There may also be cancer cells in lymph nodes close to the affected lung, Or, the cancer is in more than one lobe of the same lung and may have spread into lymph nodes close to the affected lung. Welsh Cancer Intelligence and Surveillance Unit 2 Lung Cancer in Wales, a detailed analysis of population trends of incidence and stage at diagnosis up to and including 2012 Stage 3B the cancer has spread into lymph nodes on the opposite side of the chest from the affected lung. Stage 4 this means that the cancer is in both lungs. Or, has spread to another part of the body, for example, the liver or bones Or, has caused a malignant pleural effusion) or pericardial effusion Welsh Cancer Intelligence and Surveillance Unit 3