Lung tumor
Other
Staging

Author: Deepali Jain, M.D. (see Authors page)

Revised: 4 January 2017, last major update September 2012

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: staging lung tumor
Cite this page: Staging. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/lungtumorstaging.html. Accessed November 22nd, 2017.
Primary tumor (T)
  • 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
  • T0: No evidence of primary tumor
  • Tis: Carcinoma in situ
  • T1: Tumor 3 cm or less in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus (i.e., not in the main bronchus); also includes the uncommon, superficial tumor of any size with its invasive component limited to the bronchial wall, which may extend proximally to the main bronchus
  • T1a: Tumor 2 cm or less in greatest dimension
  • T1b: Tumor more than 2 cm but 3 cm or less in greatest dimension
  • T2: Tumor more than 3 cm but 7 cm or less or tumor with any of the following features (T2 tumors with these features are classified T2a if 5 cm or less):
    • Involves main bronchus
    • 2 cm or more distal to the carina
    • Invades visceral pleura (PL1 or PL2)
    • Associated with atelectasis or obstructive pneumonitis that extends to the hilar region but does not involve the entire lung
  • T2a: Tumor more than 3 cm but 5 cm or less in greatest dimension
  • T2b: Tumor more than 5 cm but 7 cm or less in greatest dimension
  • T3: Tumor more than 7 cm or one that directly invades any of the following: parietal pleura (PL3), chest wall (including superior sulcus tumors), diaphragm, phrenic nerve, mediastinal pleura, parietal pericardium; or tumor in the main bronchus (less than 2 cm distal to the carina but without involvement of the carina); or associated atelectasis or 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, carina; separate tumor nodule(s) in a different ipsilateral lobe
Regional lymph nodes (N)
  • NX: Regional lymph nodes cannot be assessed
  • N0: No regional lymph node metastasis
  • N1: Metastasis in ipsilateral peribronchial or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension
  • N2: Metastasis in ipsilateral mediastinal or subcarinal lymph node(s)
  • N3: Metastasis in 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 with pleural nodules or malignant pleural (or pericardial) effusion
  • M1b: Distant metastasis

  • Notes:
    • Most pleural (and pericardial) effusions are due to tumor
    • In a few patients, however, multiple cytopathologic examinations of pleural (pericardial) fluid are negative for tumor, and the fluid is nonblood and is not an exudate
    • Where these elements and clinical judgment dictate that the effusion is not related to the tumor, the effusion should be excluded as a staging element and the patient should be classified as M0
Staging / staging classifications
Occult carcinoma:TXN0M0
Stage 0:TisN0M0
Stage IA:T1a - bN0M0
Stage IB:T2aN0M0
Stage IIA:T2bN0M0orT1a - T2aN1M0
Stage IIB:T2bN1M0orT3N0M0
Stage IIIA:T1a - T2bN2M0orT3N1 - N2M0orT4N0 - N1M0
Stage IIIB:Any TN3M0orT4N2 - N3M0
Stage IV:Any TAny NM1a - b