Non-Small Cell Lung Cancer Staging 

Updated: May 17, 2017
  • Author: Marvaretta M Stevenson, MD; Chief Editor: Nagla Abdel Karim, MD, PhD  more...
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TNM Classification for Non-Small Cell Lung Cancer

[1, 2] Note that these are based on the AJCC Cancer Staging Manual, 7th Edition (2010). Although the 8th edition has been published, implementation of the new system has been delayed until January 1, 2018. The AJCC advises that, "All newly diagnosed cases through December 31st 2017 should be staged with the 7th edition." [3]

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

Primary tumor (T)
TX Primary tumor cannot be assessed, or the tumor is proven by the presence of malignant cells in sputum or bronchial washing but is 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, no bronchoscopic evidence of invasion more proximal than the lobar bronchus (not in the main bronchus); superficial spreading of tumor in the central airways (confined to the bronchial wall )
T1a Tumor ≤ 2 cm in the greatest dimension
T1b Tumor > 2 cm but ≤ 3 cm in the greatest dimension
T2 Tumor > 3 cm but ≤ 7 cm or tumor with any of the following:
  • Invades visceral pleura
  • Involves the main bronchus ≥ 2 cm distal to the carina
  • Associated with atelectasis/obstructive pneumonitis extending to hilar region but not involving the entire lung
T2a Tumor > 3 cm but ≤ 5 cm in the greatest dimension
T2b Tumor > 5 cm but ≤ 7 cm in the greatest dimension
T3 Tumor > 7 cm or one that directly invades any of the following:

  • Chest wall (including superior sulcus tumors), diaphragm, phrenic nerve, mediastinal pleura, or parietal pericardium;
Or tumor in the main bronchus < 2 cm distal to the carina but without involvement of the carina

Or associated atelectasis/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, or carina; or separate tumor nodule(s) in a different ipsilateral lobe
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 the ipsilateral mediastinal and/or subcarinal lymph node(s)
N3 Metastasis in the contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph nodes
Distant metastasis (M)
MX Distant metastasis cannot be assessed
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) effusion
M1b Distant metastasis


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

Stage T N M
Ia T1a N0 M0
T1b N0 M0
Ib T2a N0 M0
IIa T1a N1 M0
T1b N1 M0
T2a N1 M0
T2b N0 M0
IIb T2b N1 M0
T3 N0 M0
IIIa T1 N2 M0
T2 N2 M0
T3 N2 M0
T3 N1 M0
T4 N0 M0
T4 N1 M0
IIIb T4 N2 M0
T1 N3 M0
T2 N3 M0
T3 N3 M0
T4 N3 M0
IV T Any N Any M1a or 1b