Lung Cancer Staging

TX Primary tumor cannot be assessed, or tumor proven by the presence of malignant cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy

T0 No evidence of primary tumor

Tis Carcinoma in situ

T1 Tumor 3 cm or less in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus (for example, not in the main bronchus)1

T1a Tumor 2 cm or less in greatest dimension

T1b Tumor more than 2 cm but 3 cm or less in greatest dimension

T2 Tumor more than 3 cm but 7 cm or less or tumor with any of the following features (T2 tumors with these features are classified T2a if 5 cm or less): involves main bronchus, 2 cm or more distal to the carina; invades visceral pleura (PL1 or PL2); associated with atelectasis or obstructive pneumonitis that extends to the hilar region but does not involve the entire lung

T2a Tumor more than 3 cm but 5 cm or less in greatest dimension

T2b Tumor more than 5 cm but 7 cm or less in greatest dimension

T3 Tumor more than 7 cm or one that directly invades any of the following: parietal pleural (PL3), chest wall (including superior sulcus tumors), diaphragm, phrenic nerve, mediastinal pleura, parietal pericardium; or tumor in the main bronchus less than 2 cm distal to the carina1 but without involvement of the carina; or associated atelectasis or obstructive pneumonitis of the entire lung or separate tumor nodule(s) in the same lobe

T4 Tumor of any size that invades any of the following: mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina, separate tumor nodule(s) in a different ipsilateral lobe

Distant Metastasis (M)

M0 No distant metastasis

M1 Distant metastasis

M1a Separate tumor nodule(s) in a contralateral lobe, tumor with pleural nodules or

malignant pleural (or pericardial) effusion2

M1b Distant metastasis (in extrathoracic organs)

Regional Lymph Nodes (N)

NX Regional lymph nodes cannot be assessed

N0 No regional lymph node metastases

N1 Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension

N2 Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s)

N3 Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)

 

			N0	N1	N2	N3
			No regional lymph node metastasis	Metastasis in ipsilateral pulmonary or hilar lymph nodes	Metastasis in ipsilateral mediastinal/subcarinal lymph nodes	Metastasis in contralateral mediastinal/hilar or lymph supraclavicular nodes
T1	Tumor < 3 cma
	T1a	Tumor ≤ 2 cma	IA-T1aN0	IIA-T1aN1	IIIA-T1aN2	IIIB-T1aN3
	T1b	Tumor > 2 cm but ≤ 3 cma	IA-T1bN0	IIA-T1bN1	IIIA-T1bN2	IIIB-T1bN3
T2	Tumor > 3 cm but ≤ 7 cma or tumor with#. Invading visceral pleura, bronchus ≥ 2 cm from carina, atelectasis extending to hilum, but not involving the entire lung
	T2a	Tumor > 3 cm but ≤ 5 cma	IB-T2aN0	IIA-T2aN1	IIIA-T2aN2	IIIB-T2aN3
	T2b	Tumor > 5 cm but ≤ 7 cma	IIA-T2bN0	IIB-T2bN1	IIIA-T2bN2	IIIB-T2bN3
T3	Tumor > 7 cma; OR invading chest wall diaphragm, phrenic nerve, mediastinal pleura, pericardium; OR tumor < 2 cm distal to the carina, OR atelectasis of entire lung; OR separate tumor nodule(s) in same lobe
	T3>7	Tumor > 7 cma	IIB-T3>7N0	IIIA-T3>7N1	IIIA-T3>7N2	IIIB-T3>7N3
	T3Inv	Invading chest wall diaphragm, phrenic nerve, mediastinal pleura, pericardium	IIB-T3InvN0	IIIA-T3InvN1	IIIA-T3InvN2	IIIB-T3InvN3
	T3Centr	Tumor < 2 cm distal to the carina	IIB-T3CentrN0	IIIA-T3CentrN1	IIIA-T3CentrN2	IIIB-T3CentrN3
	T3Satell	Separate tumor nodule(s) in same lobe	IIB-T3SatellN0	IIIA-T3SatellN1	IIIA-T3SatellN2	IIIB-T3SatellN3
T4	Tumor invading heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, spine; OR tumor nodules(s) in a different ipsilateral lobe
	T4Inv	Tumor invading heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, spine	IIIA-T4InvN0	IIIA-T4InvN1	IIIB-T4InvN2	IIIB-T4InvN3
	T4Ipsi Nod	Tumor nodules(s) in a different ipsilateral lobe	IIIA-T4Ipsi NodN0	IIIA-T4Ipsi NodN1	IIIB-T4Ipsi NodN2	IIIB-T4Ipsi NodN3