支修益教授提醒肺癌患者：得了肺癌千万不要急于治疗！科学正确的临床分期是肺癌规范化治疗的前提。不同期别的肺癌治疗原则不一样，不同期别的肺癌治疗效果也不一样，不论手术治疗料、还是放疗和化疗，肺癌治疗前一定要进行各项分期检查，明确了是哪一期肺癌，再谈论确定治疗方案。

准确的临床分期有助于医生为肺癌病人制定科学合理的治疗方案。必须的临床分期检查使那些已有肺外远处转移、本不应该做开胸手术的肺癌患者避免承受开胸探查手术之苦；同时也使那些原本并没有转移的早期肺癌患者得到及时科学的外科手术治疗，得以长期生存。

判断肺癌早期、中期或晚期的检查办法，就是通过胸部CT、纤维气管镜、腹部超声、颅脑核磁和全身骨扫描等检查了解肿瘤的大小、部位、侵及范围、有无侵及周围组织器官、有无肺外其他脏器的转移，这就是我们常讲的肺癌临床分期。由于肺癌最容易发生颅脑转移、骨转移和腹腔脏器转移，手术治疗前除外这些部位转移和确定有无肺外转移对医生和患者都至关重要。 

 

肺癌分为一期（I期）、二期（II期）、三期（III期）和四期（IV期），而I-III期肺癌又分别再分为Ia期、Ib期、IIa期、IIb期、IIIa期和IIIb期。直径小于3cm的肿瘤没有外侵，并且没有肺门和纵隔淋巴结转移，我们称之为“早期肺癌”又称之为I期肺癌；一旦有了肺门淋巴结转移，我们就把它定义为"早中期肺癌",又称之为“II期肺癌”；如果出现了纵隔淋巴结转移（同侧），我们就把他们列入“局部中晚期肺癌”又称之为“III期肺癌”！肺癌患者出现了肺外转移，如颅脑转移、骨转移、腹腔转移时，就属于晚期肺癌,又称之为“IV期肺癌”。

临床上我们经常会遇到这样的病例，患者胸片和胸部CT发现肺部孤立性结节阴影，经气管镜活检确诊是非小细胞肺癌。经人介绍的胸外科医生马上就给这位患者“成功地”实施了肺切除手术，并被告之是“早期肺癌”。自认为预后良好的病人，很短几个月时间就症状就诊发现肺外有多发转移病灶，如颅脑、肝脏、骨骼等部位的转移。事实上这位肺癌患者在手术前就已经出现了肺外转移，只是因为没有常规例行临床分期检查、没有发现肺外转移而已。如果这位患者术前作了腹部超声、颅脑核磁共振、全身骨扫描等检查,就能够及早发现肺外转移病灶，从而让病人避免开胸手术，而选择其他保守的治疗手段。

【英语园地】 Staging With Illustrations
Staging is a way of describing where cancer is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer.

Knowing the stage of lung cancer helps doctors determine what treatment is best. In general, a lower number stage of lung cancer is associated with a better outcome. However, no doctor can predict how long a patient will live with lung cancer based only on the stage of disease, because lung cancer is different in each person, and individuals respond to treatment differently.

Staging is different for NSCLC and small cell lung cancer.

Staging of NSCLC

The stage of NSCLC is described by a number, one through four (Roman numerals I-IV). One way to determine the staging of NSCLC is to determine whether the cancer can be completely removed by a surgeon. To completely remove the lung cancer, the surgeon must remove the cancer along with the surrounding, normal lung tissue.

Stage I and II

In general, NSCLC that is stage one (I) or two (II) has a size and location that makes it possible for a surgeon to completely remove it. Stage I cancer has not spread to any lymph nodes. Stage II cancer may involve lymph nodes, but the lymph nodes are contained within the surrounding lung, so they may be removed along with the section of lung where the cancer started.

Stage III

Stage three (III) NSCLC is difficult, and sometimes impossible, to remove. For example, lung cancer may spread to the lymph nodes located in the center of the chest, which is outside the lung. In this situation, it is less likely that the surgeon can completely remove the cancer because removal of the cancer has to be performed bit by bit.

When the cancer has spread to lymph nodes in the center of the chest, on the same side as where the cancer started, it is known as stage three-A (IIIA). When the cancer spreads to lymph nodes on the opposite side of the chest, it is known as stage three-B (IIIB). In general, surgery is not successful for any stage IIIB or IV lung cancer. Other situations that make a lung cancer impossible to remove are if it has spread to lymph nodes above the collarbone or into fluid surrounding the lung, or if the cancer grows into vital structures within the chest, such as the heart, large blood vessels or the main breathing tubes leading to the lungs; all of these conditions are considered stage IIIB.

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Stage IV

Stage four (IV) means NSCLC has spread to different sections (lobes) of the lung, or to distant sites within the body by way of the bloodstream. Once released in the blood, NSCLC can spread anywhere in the body, but has a tendency to spread to the brain, bones, liver, and to the adrenal glands (located above the kidneys).

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Staging of small cell lung cancer

Because almost all small cell lung cancer has spread outside the lung when discovered, very few patients with small cell lung cancer are treated with surgery, and all receive chemotherapy. Some patients with small cell lung cancer can benefit from radiation therapy. The staging for small cell lung cancer helps identify which patients can be treated with radiation therapy in addition to chemotherapy.

Small cell lung cancer is classified as either limited stage or extensive stage:

• Limited stage means the cancer is located on one side of the chest and involves a single region of the lung and adjacent lymph nodes. This region can be treated in its entirety with radiation therapy. About 30% of patients have limited stage.
  
  
• Extensive stage means the cancer has spread to other regions of the chest, or outside of the chest, and cannot be treated completely with radiation therapy. Most patients (70%) have extensive stage disease and are treated with chemotherapy only.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Sixth Edition (2002) published by Springer-Verlag New York, www.springer-ny.com.

Prognosis

The stage of lung cancer influences prognosis. While lung cancer is treatable at any stage, only certain stages of lung cancer can be cured. Some characteristics of patients are important to prognosis, regardless of whether the goal is treatment or cure.

Doctors measure a patient's general strength and vigor using an index known as performance status. Patients who are strong enough to go about their daily activities without assistance and even work outside the home can safely receive chemotherapy, radiation therapy, and/or surgery. Treatment may not be as effective for patients with bone or liver metastases from lung cancer, excessive weight loss, ongoing cigarette use, or pre-existing medical conditions such as heart disease or emphysema.

It is important to note that a patient's age has never been useful in predicting whether that patient will benefit from treatment. The average age of patients with lung cancer in the United States is 69. A patient's age should never be used as the only reason for deciding on what treatment is best, especially for older patients who are otherwise physically fit and have no other medical problems besides lung cancer.