Lung cancer (staging - IASLC 7th edition) (historical)

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

This staging has since been revised. See IASLC 8th edition staging.

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

TNM system

The old 7^th edition January 2010 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
  • tumour size equal or less than 3 cm 
  • not involving the main bronchus
    • T1a: smaller than 2 cm in longest dimension 
    • T1b: larger than 2 cm but smaller or equal to 3 cm 
• T2: 
  • tumour size more than 3cm but less/equal to 7cm or
  • involving the main bronchus but >2 cm from carina
  • visceral pleural involvement
  • lobar atelectasis extending to the hilum but not collapse of the entire lung 
    • T2a: larger than 3 cm but smaller than 5 cm
    • T2b: larger than 5 cm but smaller than 7 cm
• T3
  • tumour size more than 7 cm or 
  • tumour < 2 cm from carina but not involving trachea or carina
  • involvement of the chest wall, including Pancoast tumour, diaphragm, phrenic nerve, mediastinal pleura or parietal pericardium
  • separate tumour nodule(s) in the same lobe
  • atelectasis or post-obstructive pneumonitis of the entire lung
• T4
  • any size tumour with:
  • involvement of the trachea, oesophagus, recurrent laryngeal nerve, 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, including direct invasion
• 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 or pericardial effusion, pleural dissemination, or pericardial disease, and metastasis in opposite lung
  • M1b: extrathoracic metastases

AJCC staging system

• stage 0
  • TNM equivalent: carcinoma in situ
  • 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 

• lung cancer staging IASCL 7^th edition