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Types of Cancer > Lung Cancer > Diagnosis, Screening, and Staging
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| AJCC Staging: TNM definitions |
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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: A tumor that is 3 cm or less in greatest dimension, surrounded by lung or visceral pleura, and without bronchoscopic evidence of invasion more proximal than the lobar bronchus (i.e., not in the main bronchus). [Note: The uncommon superficial tumor of any size with its invasive component limited to the bronchial wall, which may extend proximal to the main bronchus, is also classified as T1.
· T2: A tumor with any of the following features of size or extent:
- More than 3 cm in greatest dimension
- Involves the main bronchus, 2 cm or more 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: A tumor of any size that directly invades any of the following: chest wall (including superior sulcus tumors), diaphragm, 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
· T4: A tumor of any size that invades any of the following: mediastinum, heart, great vessels, trachea, esophagus, vertebral body, carina; or separate tumor nodules in the same lobe; or tumor with a malignant pleural effusion. [Note: Most pleural effusions associated with lung cancer are due to tumor. However, there are a few patients in whom multiple cytopathologic examinations of pleural fluid are negative for tumor. In these cases, fluid is nonbloody and is not an exudate. Such patients may be further evaluated by videothoracoscopy (VATS) and direct pleural biopsies. When 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 staged as T1, T2, or T3.
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 including involvement by direct extension of the primary tumor
· N2: Metastasis to ipsilateral mediastinal and/or subcarinal lymph node(s)
· N3: Metastasis to contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)
Distant metastasis (M)
· MX: Distant metastasis cannot be assessed
· M0: No distant metastasis
· M1: Distant metastasis present.
[Note: M1 includes separate tumor nodule(s) in a different lobe (ipsilateral or contralateral).
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