Lung Cancer Staging — RACP Adult Medicine MCQ

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ModerateRespiratoryLung Cancer StagingRACP Adult Medicine

A 68-year-old man presents with haemoptysis and a cavitating right upper lobe mass on CT. Bronchoscopy with biopsy reveals squamous cell carcinoma. PET-CT shows the primary tumour (4.5 cm), ipsilateral hilar lymph nodes, and no distant metastases. What is the clinical stage?

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Correct answer: A — Stage IIIA

A 4.5 cm tumour (T2b: >4 cm to ≤5 cm) with ipsilateral hilar lymph node involvement (N1) = stage IIB under the 8th edition TNM classification. However, if ipsilateral mediastinal nodes (N2) are involved, this becomes stage IIIA. PET-CT showing ipsilateral hilar nodes most likely represents N1 disease = T2bN1M0 = stage IIB. EBUS-TBNA should be performed to confirm nodal staging. If confirmed stage IIB with adequate pulmonary function, surgical resection with adjuvant chemotherapy is standard. Neoadjuvant immunotherapy is increasingly used.

Reference: Cancer Council Australia – 2021 – Lung Cancer OCP; IASLC – 2024 – 9th TNM Staging