| T: Primary tumor |
|
| Tx |
Primary
tumor cannot be assessed or tumor proven by 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 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)a |
|
T1a(mi) |
Minimally invasive adenocarcinomab |
|
T1a |
Tumor <=1 cm in greatest dimensiona |
|
T1b |
Tumor >1 cm but <=2 cm in greatest dimensiona |
|
T1c |
Tumor >2 cm but <=3 cm in greatest dimensiona |
| T2 |
Tumor
>3 cm but <=5 cm or tumor with any
of the following featuresc: - 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 >3 cm but <=4 cm in greatest dimension |
|
T2b |
Tumor >4 cm but <=5 cm in greatest dimension |
| T3 |
Tumor
>5 cm but <=7 cm 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 tumors), phrenic nerve, parietal pericardium |
| T4 | Tumor
>7 cm 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, and carina
|
aThe uncommon superficial spreading tumor of any size with its invasive component limited to the bronchial wall, which may extend
proximal to the main bronchus, is also classified as T1a.
bSolitary adenocarcinoma, 3cm with a predominately lepidic pattern and 5mm invasion in any one focus.
cT2 tumors with these features are classified as T2a if 4 cm in greatest dimension or if size cannot be determined, and T2b if >4 cm but 5 cm in greatest dimension.
N: Regional lymph node involvement
Nx Regional lymph 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,
M: Distant metastasis
M0
No distant metastasis M1
Distant metastasis present M1a Separate tumor nodule(s) in a contralateral lobe; tumor with pleural or pericardial nodule(s) or malignant pleural or pericardial effusiond
M1b
Single extrathoracic metastasise M1c
Multiple extrathoracic metastases in one or more organs
dMost pleural (pericardial) effusions with lung cancer are due to tumor. In a few patients, however, multiple microscopic examinations of pleural (pericardial) fluid are negative for tumor and the fluid is nonbloody and not an exudate. When these elements and clinical judgment dictate that the effusion is not related to the tumor, the effusion should be excluded as a staging descriptor.Descriptors and T and M categories in the seventh edition and as proposed for the eighth editiona
eThis includes involvement of a single distant (nonregional) lymph node.
N categories
Descriptor in 7th edition
Proposed T/M
N0
N1
N2
N3
T1<= 1 cm
T1a IA1 (IA)
IIB (IIA)
IIIA IIIB T1 > 1–2 cm
T1b
IA2 (IA) IIB (IIA) IIIA
IIIB T1 > 2–3 cm
T1c
IA3 (IA)
IIB (IIA)
IIIA
IIIB T2 > 3–4 cm
T2a
IB
IIB (IIA)
IIIA
IIIB T2 > 4–5 cm
T2b
IIA (IB)
IIB (IIA)
IIIA
IIIB T2 > 5–7 cm
T3
IIB (IIA)
IIIA (IIB)
IIIB (IIIA)
IIIC (IIIB) T3 structures
T3
IIB
IIIA
IIIB (IIIA)
IIIC (IIIB) T3 > 7 cm
T4
IIIA (IIB)
IIIA
IIIB (IIIA)
IIIC (IIIB) T3 diaphragm
T4
IIIA (IIB)
IIIA
IIIB (IIIA)
IIIC (IIIB) T3 endobronchial: location/atelectasis 3–4 cm
T2a
IB (IIB)
IIB (IIIA)
IIIA
IIIB T3 endobronchial: location/atelectasis 4–5 cm
T2b
IIA (IIB)
IIB (IIIA)
IIIA
IIIB T4
T4
IIIA
IIIA
IIIB
IIIC (IIIB) M1a
M1a
IVA (IV)
IVA (IV)
IVA (IV)
IVA (IV) M1b single lesion
M1b
IVA (IV)
IVA (IV)
IVA (IV)
IVA (IV) M1c multiple lesions
M1c
IVB(IV)
IVB(IV)
IVB(IV)
IVB(IV)
Proposed stage groupings for the eighth edition of the TNM classification for lung cancer
Occult carcinoma
TX
N0
M0 Stage 0
Tis
N0
M0 Stage IA1
T1a(mi)
N0
M0
T1a
N0
M0 Stage IA2
T1b
N0
M0 Stage IA3
T1c
N0
M0 Stage IB
T2a
N0
M0 Stage IIA
T2b
N0
M0 Stage IIB
T1a–c
N1
M0
T2a
N1
M0
T2b
N1
M0
T3
N0
M0 Stage IIIA
T1a–c
N2
M0
T2a–b
N2
M0
T3
N1
M0
T4
N0
M0
T4
N1
M0 Stage IIIB
T1a–c
N3
M0
T2a–b
N3
M0
T3
N2
M0
T4
N2
M0 Stage IIIC
T3
N3
M0
T4
N3
M0 Stage IVA
Any T
Any N
M1a
Any T
Any N
M1b Stage IVB
Any T
Any N
M1c