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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