Reference only. Testing guidance shown is derived from published clinical guidelines and regulatory sources. It does not constitute a clinical recommendation for any individual patient. Payer coverage information is a general summary and may not reflect current policy or individual benefit design. Full disclaimer

Non-Small Cell Lung CancerICD-10: C34.1

Adenocarcinoma

The most common NSCLC histology (~40–50% of cases). Arises predominantly in peripheral lung. Has the highest prevalence of targetable driver mutations: EGFR mutations (10–35%), ALK fusions (3–7%), ROS1 fusions (1–2%), KRAS G12C (~13%), BRAF V600E (~2–4%), MET exon 14 (~3–4%), RET fusions (~1–2%), NTRK fusions (<1%), HER2 alterations (~2–4%). NCCN recommends broad molecular profiling for all adenocarcinoma regardless of stage.

AJCC TNM Staging

8th Edition (2017)

American Joint Committee on Cancer TNM staging — the primary staging system for solid tumors. Version 8 is current for most solid tumor types.

Stage ITumor ≤4 cm, no nodal or distant metastasis (T1-T2a, N0, M0). Surgically resectable.Stage IIATumor >4–5 cm, no nodal or distant metastasis (T2b, N0, M0). Resectable.Stage IIBTumor with ipsilateral hilar/peribronchial nodal involvement, or tumor >5–7 cm (T1-2/N1 or T3/N0, M0). Potentially resectable.Stage IIIAIpsilateral mediastinal or subcarinal nodal involvement, or T3-4/N1-2/M0. Potentially resectable in select cases; often requires multidisciplinary evaluation.Stage IIIB–IIICContralateral mediastinal/supraclavicular nodes, or very locally advanced disease (T3-4/N2-3/M0). Typically unresectable; treated with concurrent chemoradiation ± durvalumab.Stage IVASingle extrathoracic metastatic lesion or contralateral lung nodule or pleural/pericardial involvement. Metastatic but potentially oligometastatic.Stage IVBMultiple extrathoracic metastases in one or more organs. Widely metastatic disease.

Performance Status

ECOG Scale

Eastern Cooperative Oncology Group (ECOG) performance status scale. Critical for determining eligibility for systemic therapy and intensity of treatment.

ECOG PS 0–1Fully active or restricted in strenuous activity. Eligible for full-dose systemic therapy including platinum doublets and immunotherapy.ECOG PS 2Ambulatory, capable of self-care, up >50% of waking hours. Single-agent chemotherapy or immunotherapy monotherapy typically appropriate; combination regimens require careful evaluation.ECOG PS 3–4Limited self-care; confined to bed/chair >50% of waking hours. Systemic therapy generally not appropriate except in select cases (e.g., targeted therapy with high likelihood of response).

Recommendations reflect published guidelines as of their listed evidence dates. Staging categories without recommendations may not yet be included in this reference. Always consult current guidelines and institutional protocols.