Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The TNM classification for lung cancer is a tool used to assess the progression of lung cancer based on three main components: the size and extent of the primary tumor (T), the involvement of nearby lymph nodes (N), and the presence of distant metastasis (M). By analyzing these factors, the calculator categorizes the cancer into distinct stages, providing a standardized way to understand the severity and spread of the disease. Here's how it works:

- **Tumor Classification (T):** 
  - Tx: The primary tumor cannot be assessed.
  - Tis: Carcinoma in situ, with the earliest form of tumor that has not spread.
  - T1mi, T1a, T1b, T1c: Tumors of increasing size, still relatively small (up to 3 cm).
  - T2a, T2b: Larger tumors (up to 5 cm) that may invade certain parts of the lung.
  - T3, T4: Even larger tumors (up to 7 cm) or tumors invading major structures or showing additional nodules.

- **Lymph Node Classification (N):**
  - Nx: Lymph nodes cannot be assessed.
  - N0: No lymph node metastasis.
  - N1: Metastasis in nearby or regional nodes.
  - N2: Metastasis in specific mediastinal nodes.
  - N3: Metastasis in more distant or contralateral nodes.

- **Distant Metastasis (M):**
  - M0: No distant metastasis.
  - M1a, M1b: Presence of metastasis in the same or a single other organ.
  - M1c: Multiple metastases in multiple organs.

By inputting these three parameters, the calculator determines the overall stage of lung cancer through a series of predefined conditions:

- If the cancer is classified as "Tis" with no node involvement (N0) and no metastasis (M0), the stage is classified as Stage 0, indicating a very early stage.
- Early stages such as Stage IA, IB, and IIA are characterized by small tumors with limited node involvement and no metastasis.
- As the tumor size increases or node involvement becomes significant, the stage progresses to IIB, IIIA, IIIB, and eventually IIIC, each indicating more advanced local and nodal disease.
- The presence of distant metastasis (M1a, M1b, or M1c) automatically pushes the classification to Stage IV, with IVB representing the most advanced and widespread disease due to multiple extrathoracic metastases.

Through this structured interpretation, medical professionals can understand the extent of lung cancer and guide treatment decisions based on the specific stage identified.

The calculator in question is the TNM Classification for Lung Cancer. TNM stands for Tumor, Node, Metastasis, and it is a globally recognized system used to stage lung cancer. This classification applies specifically to patients diagnosed with lung cancer.

The clinical utility of the TNM Classification for Lung Cancer is to provide a standardized way to describe the extent of disease progression. It helps in determining the appropriate treatment strategy, predicting patient prognosis, and facilitating communication among healthcare providers. 

The TNM system classifies lung cancer based on three parameters: the size and extent of the primary tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). Each parameter is assigned a numerical value, with higher numbers indicating more advanced disease.

There are no specific exclusion criteria for the use of the TNM Classification for Lung Cancer. However, it is not applicable to patients with benign lung tumors or those with cancers originating from other organs that have metastasized to the lungs.

TNM classification for lung cancer

The Eastern Cooperative Oncology Group (ECOG) performance status calculator is designed to evaluate a patient's functional ability and categorize it into a specific score from 0 to 5. This quantitative measure helps clinicians make informed decisions about treatment based on the patient's capacity for daily activities and self-care. Here's how it operates:

The user provides input by selecting the description that best matches the patient's current condition from a list of predefined options. These options encapsulate various levels of activity and ability:

- A patient who is "Fully active, able to carry on all pre-disease performance without restriction" is assigned a score of ECOG PS 0. This indicates that the patient is not limited in any capacity by their disease.
- If a patient is "Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, such as light housework, office work," they receive an ECOG PS 1. This means the patient can perform some self-care and work activities but faces restrictions with strenuous tasks.
- "Ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours" corresponds to an ECOG PS 2. This reflects moderate impairment, where the patient is active for the majority of the day but not capable of work activities.
- A patient who is "Capable of only limited self-care, confined to bed or chair more than 50% of waking hours" gets an ECOG PS 3. This score denotes significant limitation, as the patient is mobile for less than 50% of the time and requires assistance for most activities.
- With "Completely disabled, cannot carry on any self-care, totally confined to bed or chair," the patient is categorized as ECOG PS 4, indicating severe impairment and complete dependency.
- Finally, if the patient is "Dead," they are assigned an ECOG PS 5.

These score assignments help standardize assessments, providing an objective measure of a patient's status which can be pivotal in guiding medical decisions and evaluating treatment options.

The Eastern Cooperative Oncology Group (ECOG) performance status, also known as the ECOG score, is a widely used tool in oncology to assess a patient's level of functioning in terms of their ability to care for themselves, daily activity, and physical ability (walking, working, etc.). It is applicable to patients with cancer of any type and at any stage.

The ECOG score ranges from 0 to 5, with 0 indicating fully active and able to carry on all pre-disease activities without restriction, and 5 indicating death. The score is used to determine a patient's prognosis, assess how a disease is progressing, and to determine appropriate treatment strategies. It is also often used in clinical trials to assess eligibility and to monitor patient progress.

There are no specific exclusion criteria for the use of the ECOG score, but it is important to note that it is a subjective measure and may not fully capture a patient's functional status. It is also less useful in patients with fluctuating or rapidly changing conditions.

Eastern Cooperative Oncology Group performance status (ECOG score)

The Karnofsky Performance Scale (KPS) provides a practical method to evaluate a patient's functional ability and the extent of care required based on their health status. The scale ranges from 0% to 100%, where higher percentages signify better functional capacity and health.

This tool involves selecting a descriptive statement that best reflects a patient's current condition from a predefined list. Each statement is connected to a specific KPS percentage that indicates the patient’s ability to perform daily activities and their dependency levels. Here’s how the assessment works:

- When a patient is described as "Normal, no complaints, no evidence of disease," this is assessed as KPS 100%. At this level, the individual can engage in all regular activities, including work, without needing special care.

- If a patient can "carry on normal activity" but exhibits "minor signs or symptoms of disease," they are scored at KPS 90%, indicating the capability to maintain routine activities without requiring special care.

- A description of "Normal activity with effort, some signs or symptoms of disease" aligns with KPS 80%. This suggests the patient can still carry out normal activities but might require some extra effort.

- When the condition reflects "Cares for self, unable to carry on normal activity or to do active work," it corresponds to KPS 70%. The patient can handle most personal needs independently but may need occasional assistance.

- "Requires occasional assistance but is able to care for most personal needs" is rated as KPS 60%, implying increased dependency on assistance though the patient remains mostly self-sufficient.

- At KPS 50%, for conditions described as "Requires considerable assistance and frequent medical care," the patient can live at home but needs considerable help with personal care.

- As the need for care intensifies, with descriptions like "Disabled, requires special care and assistance," the KPS drops to 40%. This marks a significant deterioration in self-care ability.

- "Severely disabled, hospital admission is indicated, death not imminent" corresponds to KPS 30%, highlighting a need for hospitalization without immediate life-threatening conditions.

- For those "Very sick," necessitating hospital admission and "active supportive treatment," the KPS is 20%, indicating critical care requirements.

- At KPS 10%, "Moribund" denotes an inability to care for oneself, with urgent need for hospital-level care and a poor prognosis.

- Lastly, "Dead" is considered as KPS 0%.

This scale is instrumental in providing a quick overview of a patient's ability to function independently and their need for medical support, thereby facilitating better care planning and resource allocation.

The Karnofsky Performance Status Scale (KPSS) is a clinical calculator used primarily in patients with cancer. It is a simple, numerical scale that measures a patient's functional status, ability to perform daily activities, and overall quality of life. The KPSS ranges from 0 (indicating death) to 100 (indicating perfect health). 

The clinical utility of the KPSS is to assess a patient's prognosis, determine appropriate treatment strategies, and monitor changes in a patient's condition over time. It is particularly useful in oncology for determining eligibility for certain treatments, such as chemotherapy or surgery, and for predicting survival outcomes. 

There are no specific exclusion criteria for the use of the KPSS. However, it is less useful in patients with non-cancer illnesses or in those with cognitive impairment who may not be able to accurately self-report their functional status.

Karnofsky Performance Scale

The Modified Glasgow Prognostic Score (mGPS) is a key tool in predicting cancer outcomes, relying on the assessment of two biochemical markers: C-reactive protein (CRP) and albumin. This score helps to categorize the prognosis into three levels: good, intermediate, and poor.

To compute the mGPS:

- C-reactive protein is evaluated first. Two options are considered:  
  - If the CRP is less than or equal to 10 mg/L, it indicates lower systemic inflammation.
  - If the CRP is greater than 10 mg/L, it signifies higher inflammation levels.

- Albumin is the second marker, with two possibilities:  
  - An albumin level of less than 3.5 g/dL [35 g/L] suggests malnutrition or potential inflammatory conditions.
  - An albumin level equal to or greater than 3.5 g/dL [35 g/L] signifies a normal nutritional status and protein reserves.

The mGPS score is derived based on the following systematic interpretation:

- If CRP is <= 10 mg/L, regardless of the albumin level, the score is mGPS 0, corresponding to a good prognosis. This combination indicates a low level of inflammation, which is a favorable signal in cancer outcomes.
 
- If CRP is > 10 mg/L and albumin is >= 3.5 g/dL [35 g/L], the score is mGPS 1, associated with an intermediate prognosis. This combination suggests elevated inflammation yet with sufficient nutritional status, resulting in a moderate outlook.

- If CRP is > 10 mg/L and albumin is < 3.5 g/dL [35 g/L], the result is mGPS 2, indicating a poor prognosis. This reflects high inflammation levels coupled with low albumin, suggesting a more severe condition.

Here's a concise summary table for reference:

| C-reactive Protein | Albumin               | mGPS Score | Interpretation          |
|---------------------|-----------------------|-------------|-----------------------|
| <= 10 mg/L          | < 3.5 or >= 3.5 g/dL  | 0           | Good prognosis         |
| > 10 mg/L           | >= 3.5 g/dL           | 1           | Intermediate prognosis |
| > 10 mg/L           | < 3.5 g/dL            | 2           | Poor prognosis         |

This systematic approach enables healthcare providers to improve risk stratification in cancer patients, allowing for more tailored treatment planning.

The Modified Glasgow Prognostic Score (mGPS) is a clinical calculator used in the field of oncology to predict the prognosis of patients with cancer. It is applicable to a wide range of cancer types and stages, making it a versatile tool for clinicians. The mGPS is based on two simple, routinely measured inflammatory markers: C-reactive protein (CRP) and albumin levels. 

The clinical utility of the mGPS lies in its ability to stratify patients into different risk groups based on their inflammatory response to cancer. This can guide clinicians in making decisions about treatment strategies and follow-up plans. It can also provide valuable prognostic information to patients and their families.

There are no specific exclusion criteria for the use of the mGPS. However, it should be noted that the score may not be as accurate in patients with concurrent inflammatory or infectious conditions, as these can also affect CRP and albumin levels. Additionally, the mGPS may not be applicable to patients with rare types of cancer or those with very early or very advanced disease, as it has not been extensively validated in these groups.

Modified Glasgow Prognostic Score for cancer outcomes (mGPS)

Small cell lung cancer

Management of extensive-stage disease

Management of extensive-stage disease, systemic therapy

Symptomatic management

Symptomatic management, hemoptysis

Management of limited-stage disease

Management of limited-stage disease, adjuvant chemoradiotherapy

Management of limited-stage disease (technical considerations for radiotherapy)

Smoking cessation

Management of relapsed/refractory disease

Management of limited-stage disease, surgical resection

Symptomatic management, spinal cord compression

Staging

Symptomatic management, cough

Management of limited-stage disease, concurrent chemoradiotherapy

Biopsy and histopathology

Biopsy and histopathology, primary tumor

Management of extensive-stage disease, prophylactic cranial irradiation

Patients with transformed lung cancer

Lung transplantation

Symptomatic management, hematological toxicity

Management of limited-stage disease, prophylactic cranial irradiation

General principles

Imaging for staging

Patients with Pancoast tumor

Patients with Pancoast tumor (definitive and palliative therapy)

Chemoprevention

Management of extensive-stage disease (palliative care)

Indications for screening

Indications for screening, low-dose CT

Patients with multifocal lung cancer

Patients with multifocal lung cancer (management)

Symptomatic management (trapped lung)

Patients with second primary lung cancer

Symptomatic management, superior vena cava syndrome

Management of extensive-stage disease, consolidative radiotherapy

Initial evaluation

Biopsy and histopathology, metastases

Management of bronchial intraepithelial neoplasia

Patients with additional pulmonary nodules

Patients with additional pulmonary nodules (contralateral lobe)

Symptomatic management, airway obstruction

Alternative and complementary therapies

Symptomatic management (pain control)

Patients with Pancoast tumor (neoadjuvant therapy)

Management of extensive-stage disease (elderly patients)

Symptomatic management, pleural effusion

Molecular testing

Symptomatic management (psychological symptoms)

Symptomatic management (tracheoesophageal fistulas)

Symptomatic management, bone symptoms

Biopsy and histopathology (mediastinum)

Patients with additional pulmonary nodules (ipsilateral different lobe)

Perioperative thromboprophylaxis

Perioperative thromboprophylaxis (pneumonectomy)

As per AATS/EACTAIC/EACTS/…/SRLF 2024 guidelines, 

Patients with Pancoast tumor (evaluation)

Patients with Pancoast tumor (surgical resection)

Preoperative cardiorespiratory assessment

Symptomatic management, neurologic symptoms

Indications for screening (requirements for screening programs)

Diet

Elderly and frail patients

Patients with multifocal lung cancer (evaluation)

Surveillance after curative-intent therapy

Patients with additional pulmonary nodules (same lobe)

Management of limited-stage disease (elderly patients)

Perioperative thromboprophylaxis (lobectomy/segmentectomy)

Updated 2025 ASCO guidelines for systemic therapy in small cell lung cancer


Small cell lung cancer

Guidelines

Key sources