TNM Classification for Non-Small Cell Lung Cancer
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) |
|
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 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) |
T1mi | Minimally invasive adenocarcinoma: adenocarcinoma (≤ 3 cm in greatest dimension) with a predominantly lepidic pattern and ≤ 5 mm invasion in greatest dimension |
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 |
T1c | Tumor > 2 cm but ≤ 3 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 |
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 directly invading any of the following: parietal pleural (PL3), chest wall (including superior sulcus tumors), phrenic nerve, parietal pericardium; or separate tumor nodule(s) in the same lobe as the primary |
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 |
Separate tumor nodule(s) in a contralateral lobe tumor; tumor with pleural or pericardial nodules or malignant pleural or pericardial effusion. Most pleural (pericardial) effusion with lung cancer are a result of the tumor. In a few patients, however, multiple miscroscopic examinations of pleural (pericardial) fluid are negative for tumor, and the fluid is nonbloody and not an exudate. If these elements and clinical judgment dictate that the effusion is not related to the tumor, the effusion should be excluded as a staging descriptor. |
M1b |
Single extrathoracic metastasis in a single organ and involvement of a single nonregional node |
M1c | Multiple extrathoracic metastases in a single organ or in multiple organs |
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 |