Non small cell lung cancer staging

Non-small cell lung cancer (NSCLC) staging can be accomplished both by the TNM system, or by the AJCC staging system.

For a general discussion of these tumours please refer to the article on non-small cell lung cancer (NSCLC).

Editor note - the TNM staging system for lung cancer has been updated in 2013 please help us by updating it.

TNM system

The old  7^th edition NSCLC staging is as follows ⁴

Primary tumour (T)

• Tx - malignant cells on cytology but no tumour found on bronchoscopy or imaging.
• Tis - carcinoma in situ
• T1 -
  • T1a - smaller than 2cm in longest dimension 
  • T1b - larger than 2cm but smaller or equal to 3cm 
• T2 - > 3cm in size and > 2cm from carina ; visceral pleura involvement ; lobar atelectasis
  • T2a - larger than 3cm but smaller than 5cm
  • T2b - larger than 5cm but smaller than 7cm
• T3 - < 2cm from carina but not involving trachea or carina ; involvement of chest wall, diaphragm, mediastinal pleura or parietal pericardium
• T4 -
  • involvement of the trachea, oesophagus, vertebra, great vessels or heart 
  • separate tumour nodules in the same lung but not in the same lobe

Nodal status (N)

• Nx - regional nodes cannot be assessed
• N0 - no regional nodal metastases
• N1 - ipsilateral peribronchial, hilar or intrapulmonary nodes
• N2 - ipsilateral mediastinal or subcarinal nodes
• N3 - contralateral nodal involvement ; ipsilateral or contralateral scalene or supraclavicular nodal involvement

Distant metastasis (M)

• Mx - distant metastases cannot be assessed
• M0 - no distant metastases
• M1 - distant metastases present
  • M1a - presence of a malignant pleural effusion, pleural dissemination, or pericardial disease, intra thoracic matastases 
  • M1b - extra-thoracic matastases

AJCC staging system

• stage 0
  • TNM equivalent : carcinoma in stiu
  • resectable : yes
• stage I
  • TNM equivalent : T1 or T2, N0, M0
  • resectable : yes
  • 5 year survival : 47%
• stage IIa
  • TNM equivalent : T1, N1, M0
  • resectable : yes
• stage IIb
  • TNM equivalent : T2, N1, M0 or T3, N0, M0
  • resectable : yes
  • 5 year survival : 26%
• stage IIIa
  • TNM equivalent : T1 or 2, N2, M0 or T3, N1 or 2, M0
  • resectable : yes
• stage IIIb
  • TNM equivalent : T1, 2 or 3, N3, M0 or T4, N0, 1, 2 or 3, M0
  • resectable : no
  • 5 year survival : 8%
• stage IV
  • TNM equivalent : Any T, Any N with M1
  • resectable : no
  • 5 year survival : 2%

Histological grade

• grade 1 : well differentiated
• grade 2 : moderately differentiated
• grade 3 : poorly differentiated
• grade 4 : undifferentiated

See also

• bronchogenic carcinoma
• small cell lung cancer staging