Primary Tumour (T)

TX

Primary tumour cannot be assessed, or tumour proven by the presence of malignant cells in sputum or bronchial washings but not visualised by imaging or bronchoscopy.

T0

No evidence of primary tumour

T1

Tumour £ 3 cm in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus^a {ie not in the main bronchus}

T2

Tumour with any of the following features of size or extent:

> 3cm in greatest dimension

Involves main bronchus, ³ 2 cm distal to the carina

Invades the visceral pleura

Associated with atelectasis or obstructive pneumonitis that extends to the hilar region but does not involve the entire lung

T3

Tumour of any size that directly invades any of the following: chest wall (including superior sulcus tumours), diaphragm, mediastinal pleura, parietal pericardium; or tumour in the main bronchus <2cm distal to the carina, but without involvement of the carina; or associated atelectasis or obstructive pneumonitis of the entire lung.

T4

Tumour of any size that invades any of the following: mediastinum, heart, great vessels, trachea, oesophagus, vertebral body, carina; or tumour with a malignant pleural or pericardial effusion^b, or with satellite tumour nodule(s) within the ipsilateral primary-tumour lobe of the lung.

Regional Lymph Nodes (N)

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 tumour.

N2

Metastasis to ipsilateral 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^c

a) The uncommon superficial tumour of any size with its invasive component limited to the bronchial wall, which may extend proximal to the main bronchus, is also classified T1

b) Most pleural effusions associated with lung cancer are due to tumour. However, there are a few patients in whom multiple cytopathology examinations of pleural fluid show no tumour. In these cases, the fluid is non bloody and is not an exudate. When these elements and clinical judgement dictate that the effusion is not related to the tumour, the effusion is not related to the tumour, the effusion should be excluded as a staging element and the patient’s disease should be staged T1, T2 or T3. Pericardial effusion is classified according to the same rules.

c) Separate metastatic tumour nodule(s) in the ipsilateral non-primary tumour lobe(s) of the lung are also classified M1.

Stage

TNM subset

0

Carcinoma in situ

IA

T1N0M0

IB

T2N0M0

IIA

T1N1M0

IIB

T2N1M0, T3N0M0

IIIA

T3N1M0, T1N2M0

T2N2M0, T3N2M0

IIIB

T4N0M0, T4N1M0

T4N2M0, T1N3M0

T2N3M0, T3N3M0, T4N3M0

IV

Any T Any N M1

*Staging is not relevant for occult carcinoma, designated TXN0M0