TNM sistema – tarptautiniu mastu taikomas standartas plaučių vėžiui apibūdinti. Kiekviena raidė atspindi skirtingą ligos aspektą: T – pirminį naviką, N – limfmazgių būklę, M – tolimąsias metastazes.[1]
TNM sistema – tarptautiniu mastu taikomas standartas plaučių vėžiui apibūdinti. Kiekviena raidė atspindi skirtingą ligos aspektą: T – pirminį naviką, N – limfmazgių būklę, M – tolimąsias metastazes.[1]
T – pirminis navikas
TX – pirminio naviko neįmanoma įvertinti arba naviko diagnozė patvirtinta piktybinių ląstelių buvimu skrepliuose ar bronchų išplovose, tačiau ne radiologiniu tyrimu ar bronchoskopija.
T0 – pirminio naviko nėra.
Tis – carcinoma in situ.
T1 – navikas ≤ 3 cm, apsuptas plaučio ar plautinės pleuros, neišplintantis proksimaliau skiltinio broncho.
T1a – ≤ 1 cm.
T1b – > 1 cm, bet ≤ 2 cm.
T1c – > 2 cm, bet ≤ 3 cm.
T2 – navikas > 3 cm, bet ≤ 5 cm; arba išplitęs į pagrindinį bronchą, infiltravęsis į plautinę pleurą, susijęs su atelektaze.
T2a – > 3 cm, bet ≤ 4 cm.
T2b – > 4 cm, bet ≤ 5 cm.
T3 – navikas > 5 cm, bet ≤ 7 cm arba infiltravęsis į krūtinės sieną, n. phrenicus, tarpuplaučio pleurą, pasieninį perikardą; arba atskiri mazgai toje pačioje skiltyje.
T4 – navikas > 7 cm arba infiltravęsis į diafragmą, tarpuplautį, širdį, didžiąsias kraujagysles, trachėją, stemplę, stuburo slankstelius; arba mazgai skirtingoje skiltyje.
N – metastazės sritiniuose limfmazgiuose
NX – neįmanoma įvertinti.
N0 – metastazių nėra.
N1 – metastazės tos pačios pusės peribronchiniuose, vartų ar plaučio limfmazgiuose.
N2 – metastazės tos pačios pusės viršutinio ar apatinio tarpuplaučio limfmazgiuose.
N3 – metastazės priešingos pusės tarpuplaučio, vartų, skaleniniame ar viršraktikauliniame limfmazgyje.
M – atokiosios metastazės
M0 – atokiųjų metastazių nėra.
M1a – mazgai kitame plautyje; piktybinis pleuritas ar perikarditas.
M1b – viena atokioji metastazė viename organe.
M1c – kelios metastazės viename ar keliuose organuose.
Stadijų grupavimo lentelė
Stadija
T (Navikas)
N (Limfmazgiai)
M (Metastazės)
0
Tis
N0
M0
IA1
T1a
N0
M0
IA2
T1b
N0
M0
IA3
T1c
N0
M0
IB
T2a
N0
M0
IIA
T2b
N0
M0
IIB
T1a–T2b / T3
N1 / N0
M0
IIIA
T1a–T2b / T3 / T4
N2 / N1 / N0–N1
M0
IIIB
T1a–T2b / T3–T4
N3 / N2
M0
IIIC
T3–T4
N3
M0
IVA
Bet kuris T
Bet kuris N
M1a, M1b
IVB
Bet kuris T
Bet kuris N
M1c
Specialiosios stadijų nustatymo taisyklės
Paviršinis plitimas (T1a): Jei navikas plinta tik bronchų siena ir pasiekia pagrindinį bronchą, jis vis tiek priskiriamas T1a.
Efuzijos vertinimas: Skystis pleuros ar perikardo ertmėje dažniausiai reiškia M1a. Išimtis: jei punktato tyrimai neigiami, skystis nėra kruvinas ir nėra eksudato požymių – klasifikuojama kaip M0.
Abejonės taisyklė: Jei abejojama dėl T, N ar M kategorijos – pasirenkama mažesnė.
Smulkiųjų ląstelių plaučių vėžys (SLPV) – stadijos
SLPV pagal ESMO kriterijus skirstomas į dvi grupes:[3]
Neišplitęs (limited): Vėžys vienoje krūtinės ląstos pusėje, telpa į vieną spindulinio gydymo lauką. Gydoma chemoterapija + radioterapija, prognozė geresnė.
Išplitęs (extensive): Visi kiti atvejai – metastazės kitame plautyje, organuose, piktybinis pleuritas. Gydoma chemoterapija, dažnai su imunoterapija.
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