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Primary Tumor (T)

TX Primary tumor cannot be assessed, or tumorproven by the presence o malignant cellsin sputum or bronchial washings but notvisualized by imaging or bronchoscopy

T0 No evidence o primary tumor

Tis Carcinoma in situ

T1 Tumor 3 cm or less in greatest dimension,surrounded by lung or visceral pleura,without bronchoscopic evidence o invasionmore proximal than the lobar bronchus

(or example, not in the main bronchus)1

T1a Tumor 2 cm or less in greatest dimension

T1b Tumor more than 2 cm but 3 cmor less in greatest dimension

T2 Tumor more than 3 cm but 7 cm or less ortumor with any o the ollowing eatures (T2tumors with these eatures are classied T2ai 5 cm or less): involves main bronchus, 2 cmor more distal to the carina; invades visceralpleura (PL1 or PL2); associated with atelectasisor obstructive pneumonitis that extends to thehilar region but does not involve the entire lung

T2a Tumor more than 3 cm but 5 cm

or less in greatest dimensionT2b Tumor more than 5 cm but 7 cm

or less in greatest dimension

A N A T O M I C S T A G E / P R O G N O S T I C G R O U P S

Occult Carcinoma TX N0 M0

Stage 0 Tis N0 M0

Stage IA T1a N0 M0

T1b N0 M0

Stage IB T2a N0 M0

Stage IIA T2b N0 M0

T1a N1 M0

T1b N1 M0

T2a N1 M0

Stage IIB T2b N1 M0

T3 N0 M0

Stage IIIA T1a N2 M0

T1b N2 M0

T2a N2 M0

T2b N2 M0

T3 N1 M0

T3 N2 M0

T4 N0 M0

T4 N1 M0

Stage IIIB T1a N3 M0

T1b N3 M0

T2a N3 M0

T2b N3 M0

T3 N3 M0

T4 N2 M0T4 N3 M0

Stage IV Any T Any N M1a

Any T Any N M1b

Notes

1The uncommon supercial spreading tumor o any size with itsinvasive component limited to the bronchial wall, which may extendproximally to the main bronchus, is also classied as T1a.

2 Most pleural (and pericardial) eusions with lung cancer are due to tumor.In a ew patients, however, multiple cytopathologic examinations o pleural(pericardial) fuid are negative or tumor, and the fuid is nonbloody and isnot an exudate. Where these elements and clinical judgment dictate thatthe eusion is not related to the tumor, the eusion should be excludedas a staging element and the patient should be classied as M0.

Definitions

T3 Tumor more than 7 cm or one that directlyinvades any o the ollowing: parietalpleural (PL3), chest wall (including superiorsulcus tumors), diaphragm, phrenic nerve,mediastinal pleura, parietal pericardium; ortumor in the main bronchus less than 2 cmdistal to the carina1 but without involvemento the carina; or associated atelectasis orobstructive pneumonitis o the entire lung orseparate tumor nodule(s) in the same lobe

T4 Tumor o any size that invades any o theollowing: mediastinum, heart, great vessels,trachea, recurrent laryngeal nerve, esophagus,vertebral body, carina, separate tumornodule(s) in a dierent ipsilateral lobe

Distant Metastasis (M)

M0 No distant metastasis

M1 Distant metastasis

M1a Separate tumor nodule(s) in a contralaterallobe, tumor with pleural nodules ormalignant pleural (or pericardial) eusion2

M1b Distant metastasis (in extrathoracic organs)

A m e r i c a n J o i n t C o m m i t t e e o n C a n c e r

Lung Cancer Staging

Financial support for AJCC 7th Edition Staging Posters

provided by the American Cancer Society

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A m e r i c a n J o i n t C o m m i t t e e o n C a n c e r

Lung Cancer StagingRegional Lymph Nodes (N)

NX Regional lymph nodescannot be assessed

N0 No regional lymphnode metastases

N1 Metastasis in ipsilateralperibronchial and/oripsilateral hilar lymph nodesand intrapulmonary nodes,including involvementby direct extension

N2 Metastasis in ipsilateralmediastinal and/orsubcarinal lymph node(s)

N3Metastasis in contralateralmediastinal, contralateralhilar, ipsilateral orcontralateral scalene, orsupraclavicular lymph node(s)

Financial support for AJCC 7th Edition Staging Posters

provided by the American Cancer Society

ILLUSTRATION

The IASLC lymph node map shownwith the proposed amalgamationof lymph into zones.

( Memorial Sloan-KetteringCancer Center, 2009.)

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