Staging for Lung Cancer

Using the IASLC 8th edition non-small cell lung cancer staging system, which was introduced in 2016.
Since 2013, small cell lung cancer is also staged using TNM classification system.

Primary Tumor (T)
TX Primary tumor cannot be assessed, or tumor proven by presence of malignant cells in sputum or bronchial washings but not visualised by imaging or bronchoscopy
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor <3cm in greatest dimension surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus (i.e. not in the main bronchus)
  • T1a(mi): Minimally invasive adenocarcinoma
  • T1a(ss): Superficial spreading tumor in central airways (sprerading tumor of any size but confined to the tracheal or bronchial wall)
  • T1a: Tumor ≤1cm in greatest dimension
  • T1b: Tumor >1cm but ≤2cm
  • T1c: Tumor >2cm but ≤3cm
T2 Tumor >3cm but <5cm, or tumor with any of the following features:
  • Involves main bronchus regardless of distance from the carina but without involvement of the carina
  • Invades visceral pleura
  • Associated with atelectasis or obstructive pneumonitis that extends to the hilar region, involving part or all of the lung
  • T2a: tumor >3cm but ≤4cm in greatest dimension
  • T2b: tumor >4cm but ≤5cm in greatest dimension
T3 Tumor >5cm but ≤7cm in greatest dimension or associated with separate tumor nodule(s) in the same lobe as the primary tumor, or directly invades any of the following structures:
  • Chest wall (including the parietal pleura and superior sulcus)
  • Phrenic nerve
  • Parietal pericardium
T4 Tumor >7cm in greatest dimension, or associated with separate tumor nodule(s) in a different ipsilateral lobe than that of the primary tumor, or invades any of the following structures:
  • Diaphragm
  • Mediastinum
  • Heart
  • Great vessels
  • Trachea
  • Recurrent laryngeal nerve
  • Esophagus
  • Vertebral body
  • Carina
Regional Lymph Nodes (N)
NX Regional nodes cannot be assessed
N0 No regional lymph 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 contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)
Distant Metastasis (M)
M0 No Distant Metastasis
M1 Distant metastases present
  • M1a: Separate tumor nodule(s) in a contralateral lobe; tumor with pleural nodule(s) or pericardial nodule(s) or malignant pleural or pericardial effusions
  • M1b: Single extrathoracic metastasis
  • M1c: Multiple extrathoracic metastases in one or more organs

Anatomic Stage/Prognostic Groups
Stage T N M 5-year Survival
0 Tis N0 M0
Ia T1 N0 M0 92%
Ib T2a N0 M0 68%
IIa T2b N0 M0 60%
IIb T1
T2		 N1 M0 53%
IIb T3 N0 M0 53%
IIIa T1
T2		 N2 M0 36%
IIIa T3
T4		 N1 M0 36%
IIIa T4 N0 M0 36%
IIIb T1
T2		 N3 M0 26%
IIIb T3
T4		 N2 M0 26%
IIIc T3
T4		 N3 M0 13%
IVa any T any N M1a
M1b		 10%
IVb any T any N M1c 0%
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Primary Tumor (T)
TX Primary tumor cannot be assessed, or tumor is 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 ≤3cm in greatest dimension, surrounded by lung or visceral pleura, no bronchoscopic evidence of invasion, more proximal than the lobar bronchus (ie, not in the main bronchus); or superficial spreading of tumor in the central airways (confined to the bronchial wall)
  • T1a: Tumor ≤2cm in greatest dimension
  • T1b: Tumor >2cm but ≤3cm in greatest dimension
T2 Tumor >3cm but <7cm, or tumor with any of the following features:
  • Involves main bronchus ≥2cm distal to the carina
  • Invades visceral pleura
  • Associated with atelectasis/obstructive pneumonitis extending to hilar region but not involving the entire lung
  • T2a: tumor >3cm but ≤5cm in greatest dimension
  • T2b: tumor >5cm but ≤7cm in greatest dimension
T3
  • Tumor >7cm in greatest dimension or umor > 7 cm
  • Tumor that directly invades any of the following:
    • Chest wall (including the superior sulcus)
    • Parietal pleura (PL3)
    • Diaphragm
    • Phrenic nerve
    • Mediastinal pleura
    • Parietal pericardium
  • Tumor in the main bronchus <2cm distal to the carina but without involvement of the carina
  • Associated atelectasis/obstructive pneumonitis of the entire lung
  • Separate tumor nodule(s) in the same lobe
T4
  • Tumor of any size that invades any of the following structures:
    • Heart
    • Mediastinum
    • Great vessels
    • Trachea
    • Recurrent laryngeal nerve
    • Esophagus
    • Vertebral body
    • Carina
  • Separate tumor nodule(s) in a different ipsilateral lobe than that of the primary tumor
Regional Lymph Nodes (N)
NX Regional nodes cannot be assessed
N0 No regional lymph 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 contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)
Distant Metastasis (M)
M0 No Distant Metastasis
M1 Distant metastases present
  • M1a: Separate tumor nodule(s) in a contralateral lobe; tumor with pleural nodule(s) or pericardial nodule(s) or malignant pleural or pericardial effusions
  • M1b: Distant metastasis

Anatomic Stage/Prognostic Groups
Stage T N M
0 Tis N0 M0
Ia T1a
T1b		 N0 M0
Ib T2a N0 M0
IIa T1a
T1b		 N1 M0
IIa T2a N1 M0
IIa T2b N0 M0
IIb T2b N1 M0
IIb T3 N0 M0
IIIa T1
T2		 N2 M0
IIIa T1
T2
T3		 N2 M0
IIIa T4 N0 M0
IIIb any T N3 M0
IIIb T4 N2 M0
IV any T any N M1a
M1b
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