Non-Small Cell Lung Cancer Staging 

Non-Small Cell Lung Cancer Staging 

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The American Joint Committee on Cancer (AJCC) tumor/node/metastasis (TNM) classification and anatomic stage/prognostic grouping for non–small cell lung cancer are presented below. [1]

See Clinical Presentations of Lung Cancer: Slideshow, a Critical Images slideshow, to help efficiently distinguish lung carcinomas from other lung lesions, as well as how to stage and treat them.

Table 1. TNM Classification for Non-Small Cell Lung Cancer (Open Table in a new window)

Primary tumor (T)

T0

No evidence of primary tumor

Tis

Carcinoma in situ

Squamous cell carcinoma in situ (SCIS)

Adenocarcinoma in situ (AIS):  adenocarcinoma with pure lepidic pattern, ≤ 3 cm in greatest dimension

T1

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

T1a

Tumor ≤ 1 cm in greatest dimension.  A superficial, spreading tumor of any size whose invasive component is limited to the bronchial wall and may extend proximal to the main bronchus also is classified as T1a, but those tumors are uncommon. 

T1b

Tumor > 1 cm but ≤ 2 cm in greatest dimension

T2

Tumor > 3 cm but ≤ 5 cm or having any of the following features:

T2 tumors with these features are classified as T2a if ≤ 4 cm or if the size cannot be determined and T2b if > 4 cm but ≤ 5 cm

T2a

T2b

T3

T4

Tumor > 7 cm or tumor of any size that invades one or more of the following:  diaphragm, mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, or carina; or separate tumor nodule(s) in an ipsilateral lobe different from that of the primary

Regional lymph nodes (N)

NX

Regional lymph nodes cannot be assessed

N0

No regional node metastasis

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 the contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)

Distant metastasis (M)

M0

No distant metastasis

M1

Distant metastasis

M1a

M1b

 

Table 2. Anatomic stage/prognostic groups. (Open Table in a new window)

Stage

T

N

M

0

Tis

N0

M0

IA1

T1mi

N0

M0

T1a

N0

M0

IA2

T1b

N0

M0

IA3

T1c

N0

M0

IB

T2a

N0

M0

IIA

T2b

N0

M0

IIB

T1a

N1

M0

T1b

N1

M0

T1c

N1

M0

T2a

N1

M0

T2b

N1

M0

T3

N0

M0

IIIA

T1a

N2

M0

T1b

N2

M0

T1c

N2

M0

T2a

N2

M0

T2b

N2

M0

T3

N1

M0

T4

N0

M0

T4

N1

M0

IIIB

T1a

N3

M0

T1b

N3

M0

T1c

N3

M0

T2a

N3

M0

T2b

N3

M0

T3

N2

M0

T4

N2

M0

IIIC

T3

N3

M0

T4

N3

M0

IVA

T Any

N Any

M1a

T Any

N Any

M1b

IVB

T Any

N Any

M1c

 

 

National Comprehensive Cancer Network Guidelines V 2.2018. Available at http://www.nccn.org.. Accessed: January 15, 2018.

Primary tumor (T)

T0

No evidence of primary tumor

Tis

Carcinoma in situ

Squamous cell carcinoma in situ (SCIS)

Adenocarcinoma in situ (AIS):  adenocarcinoma with pure lepidic pattern, ≤ 3 cm in greatest dimension

T1

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

T1a

Tumor ≤ 1 cm in greatest dimension.  A superficial, spreading tumor of any size whose invasive component is limited to the bronchial wall and may extend proximal to the main bronchus also is classified as T1a, but those tumors are uncommon. 

T1b

Tumor > 1 cm but ≤ 2 cm in greatest dimension

T2

Tumor > 3 cm but ≤ 5 cm or having any of the following features:

T2 tumors with these features are classified as T2a if ≤ 4 cm or if the size cannot be determined and T2b if > 4 cm but ≤ 5 cm

T2a

T2b

T3

T4

Tumor > 7 cm or tumor of any size that invades one or more of the following:  diaphragm, mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, or carina; or separate tumor nodule(s) in an ipsilateral lobe different from that of the primary

Regional lymph nodes (N)

NX

Regional lymph nodes cannot be assessed

N0

No regional node metastasis

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 the contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)

Distant metastasis (M)

M0

No distant metastasis

M1

Distant metastasis

M1a

M1b

Stage

T

N

M

0

Tis

N0

M0

IA1

T1mi

N0

M0

T1a

N0

M0

IA2

T1b

N0

M0

IA3

T1c

N0

M0

IB

T2a

N0

M0

IIA

T2b

N0

M0

IIB

T1a

N1

M0

T1b

N1

M0

T1c

N1

M0

T2a

N1

M0

T2b

N1

M0

T3

N0

M0

IIIA

T1a

N2

M0

T1b

N2

M0

T1c

N2

M0

T2a

N2

M0

T2b

N2

M0

T3

N1

M0

T4

N0

M0

T4

N1

M0

IIIB

T1a

N3

M0

T1b

N3

M0

T1c

N3

M0

T2a

N3

M0

T2b

N3

M0

T3

N2

M0

T4

N2

M0

IIIC

T3

N3

M0

T4

N3

M0

IVA

T Any

N Any

M1a

T Any

N Any

M1b

IVB

T Any

N Any

M1c

Marvaretta M Stevenson, MD Assistant Professor, Division of Medical Oncology, Duke University Medical Center

Disclosure: Nothing to disclose.

Jasmeet Anand, PharmD, RPh Adjunct Instructor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Christopher D Braden, DO Hematologist/Oncologist, Chancellor Center for Oncology at Deaconess Hospital; Medical Director, Deaconess Hospital Outpatient Infusion Centers; Chairman, Deaconess Hospital Cancer Committee

Christopher D Braden, DO is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology

Disclosure: Nothing to disclose.

Nagla Abdel Karim, MD, PhD Associate Professor of Medicine, Associate Director of Experimental Therapeutics, Division of Hematology/Oncology, University of Cincinnati Cancer Institute, Department of Internal Medicine, University of Cincinnati College of Medicine

Nagla Abdel Karim, MD, PhD is a member of the following medical societies: American Medical Association, American Society of Clinical Oncology, Egyptian American Medical Association, Egyptian Cancer Society, International Association for the Study of Lung Cancer

Disclosure: Nothing to disclose.

Non-Small Cell Lung Cancer Staging 

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