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Definition and staging of NSCLC

Lung cancer refers to tumors originating in the lung parenchyma or within the bronchi.1 Non-small-cell lung cancer (NSCLC) is the most common type of lung cancer, making up approximately 85% of lung cancers, and is defined as any type of epithelial lung cancer other than small cell lung cancer (SCLC).2,3

NSCLC can be further subdivided on the basis of histological features into several categories, the most common of which are adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.4 Large cell carcinoma has been defined in the past as a tumor that lacks morphologic evidence of either glandular or squamous differentiation.5 Figure 1 shows some of the more common histological subtypes of tumors found in NSCLC.3

About NSCLC

However, increasing evidence shows that a large proportion of these tumors can be subtyped further using modern immunohistochemical and molecular methods.5 These molecular subtypes are discussed in more detail in the section “Molecular subtypes of NSCLC”.

In high-risk groups, such as those with tobacco exposure, one of the screening methods shown to reduce mortality is low-dose computed tomography (CT).7,8 Lung cancer may present with symptoms, such as cough or chest pain, or be found on chest imaging, with additional investigations aiming to confirm the diagnosis and determine the extent of the disease.9 Factors such as stage, histology, presence and type of mutation, and the presence of comorbidities will define the prognosis and treatment options available to a patient.10–13

Determination of stage has important prognostic and treatment implications.10 Procedures used to establish stage include a physical examination and radiological assessment.14,15 The disease is staged according to the 8th edition of the American Joint Committee on Cancer (AJCC) TNM system, which is based on:16

  • Size and extent of main tumor (T)
  • Spread to nearby lymph nodes (N)
  • Metastasis (M) to distant sites
NSCLC stages 1–4 are outlined in Figure 2.16
Figure 2a - NSCLC stage 1, as defined by the size and extent of the main tumor, its spread to nearby lymph nodes and metastasis to distant sites.16 Some stages of NSCLC have more than one possible combination of T, N, and M.Figure 2b - NSCLC stage 2, as defined by the size and extent of the main tumor, its spread to nearby lymph nodes and metastasis to distant sites.16 Some stages of NSCLC have more than one possible combination of T, N, and M.Figure 2c - NSCLC stage 3, as defined by the size and extent of the main tumor, its spread to nearby lymph nodes and metastasis to distant sites.16 Some stages of NSCLC have more than one possible combination of T, N, and M.Figure 2d - NSCLC stage 4, as defined by the size and extent of the main tumor, its spread to nearby lymph nodes and metastasis to distant sites.16 

Lung cancer refers to tumors originating in the lung parenchyma or within the bronchi.1 Non-small-cell lung cancer (NSCLC) is the most common type of lung cancer, making up approximately 85% of lung cancers, and is defined as any type of epithelial lung cancer other than small cell lung cancer (SCLC).2,3

NSCLC can be further subdivided on the basis of histological features into several categories, the most common of which are adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.4 Large cell carcinoma has been defined in the past as a tumor that lacks morphologic evidence of either glandular or squamous differentiation.5 Figure 1 shows some of the more common histological subtypes of tumors found in NSCLC.3

Lung cancer refers to tumors originating in the lung parenchyma or within the bronchi.1 Non-small-cell lung cancer (NSCLC) is the most common type of lung cancer, making up approximately 85% of lung cancers, and is defined as any type of epithelial lung cancer other than small cell lung cancer (SCLC).2,3

NSCLC can be further subdivided on the basis of histological features into several categories, the most common of which are adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.4 Large cell carcinoma has been defined in the past as a tumor that lacks morphologic evidence of either glandular or squamous differentiation.5 Figure 1 shows some of the more common histological subtypes of tumors found in NSCLC.3

Prevalence and incidence of NSCLC Learn more Molecular subtypes of NSCLC Learn more H3 (Mobile)

Abbreviations
AJCC, American Joint Committee on Cancer; CT, computed tomography; NSCLC, non-small-cell lung cancer; SCLC, small-cell lung carcinoma.

ReferencesSiddiqui F, Siddiqui AH. Lung Cancer. Available here (accessed July 2022).Cancer.gov. Available here (accessed July 2022).Schabath MB and Cote ML. Cancer Epidemiol Biomarkers Prev 2019;28(10):1563–79.Zheng M. Surg Oncol Clin N Am 2016;25(3):447–68.Weissferdt A. Semin Diagn Pathol 2014;31(4):278–88.Chan BA, Hughes BGM. Transl Lung Cancer Res 2015;4(1):36–54.Aberle DR, et al. N Engl J Med 2011;365(5):395–409.Balata H, et al. J Thorac Oncol 2019;14(9):1513–27.Xing P, et al. Cancer Med 2019;8(8):4055–69.Liam C, et al. Respirology 2015;20(4):526–34.SEER. Available here (accessed July 2022).Gutierrez ME, et al. Clin Lung Cancer 2017;18(6):651–9.Leduc C, et al. Eur Respir J 2017;49:1601721.Rami-Porta R, et al. Eur Respir J 2018;51(5):1800190.Ost DE, et al. Chest 2013;143(5 Suppl):e121S–e141S.Lababede O, Meziane MA. Oncologist 2018;23(7):844–8.
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