Tumor, Node, Metastasis International Staging System for Lung Cancer

Stage	TNM Descriptors	5-Year Survival Rate, %
		Clinical Stage	Surgical-Pathologic Stage
IA IB IIA IIB IIB IIIA IIIB IV	T1 N0 M0 T2 N0 M0 T1 N1 M0 T2 N1 M0 T3 N0 M0 T3 N1 M0 T1–2–3 N2 M0 T4 N0–1–2 M0 T1–2–3–4 N3 M0 Any T any N M1	61 38 34 24 22 9 13 7 3 1	67 57 55 39 38 25 23 <5 <3 <1

TUMOR (T) STATUS

• T0 No evidence of a primary tumor
• TX Primary tumor cannot be assessed, or tumor proven by the presence of malignant cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy
• 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 lobar bronchus (i.e., not in main bronchus)
• T2 Tumor with any of following: >3 cm in greatest dimension; involves main bronchus, >2 cm distal to the carina; invades visceral pleura; associated with atelectasis or obstructive pneumonitis extending to hilum but does not involve entire lung
• T3 Tumor of any size that directly invades any of the following: chest wall (including superior sulcus tumors), diaphragm, mediastinal pleura, parietal pericardium; or tumor in main bronchus <2 cm distal to carina but without involvement of carina; or associated atelectasis or obstructive pneumonitis of entire lung
• T4 Tumor of any size that invades any of the following: mediastinum, heart, great vessels, trachea, esophagus, vertebral body, carina; or tumor with a malignant pleural or pericardial effusion^a, or with satellite tumor nodule(s) within the ipsilateral primary-tumor lobe of the lung.

LYMPH NODE (N) INVOLVEMENT

• NX Regional lymph nodes cannot be assessed
• N0 No regional lymph node metastasis
• N1 Metastasis to ipsilateral peribronchial and/or ipsilateral hilar lymph nodes, and intrapulmonary nodes involved by direct extension of the primary tumor
• N2 Metastasis to ipsilateral mediastinal and/or subcarinal lymph nodes(s)
• N3 Metastasis to contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)

DISTANT METASTASIS (M)

• MX Presence of distant metastasis cannot be assessed
• M0 No distant metastasis
• M1 Distant metastasis present^b

^a Most pleural effusions associated with lung cancer are due to tumor. However, in a few patients with multiple negative cytopathologic exams of a non-bloody, non-exudative pleural or pericardial effusion that clinical judgment dictates is not related to the tumor, the effusion should be excluded as a staging element and the patient’s disease staged as T1, T2, or T3.

^b Separate metastatic pulmonary tumor nodule(s) in the ipsilateral nonprimary tumor lobe(s) of the lung are classified as M1.

References:

1. Mountain CF. Revisions in the International System for Staging Lung Cancer. Chest. 1997 Jun;111(6):1710-7.[Medline]