Adenocarcinoma of the lung staging

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shanshan Cen, M.D. [2]

Overview

Adenocarcinoma of the lung may be classified into several subtypes based on TNM and UICC staging system.

Staging

TNM staging:

TNM	Definition
TX	The primary tumour cannot be assessed, or there are malignant cells in the sputum or bronchoalveolar lavage but not seen on imaging or bronchoscopy.
T0	No evidence of primary tumor.
Tis	Carcinoma in situ.
T1	Tumor is 3 cm or less in size and has not spread to the visceral pleura or the main bronchi.
	T1a – Tumor is smaller than 2 cm.
	T1b – Tumor is larger than 2 cm, but smaller than 3 cm.
T2	Tumor is larger than 3 cm, but smaller than 7 cm; or the tumor has any of the following features: Cancer has spread to the main bronchi, but is not closer than 2 cm to the carina; cancer has spread to the visceral pleura; tumor is associated with obstructive pneumonitis or atelectasis.
	T2a – Tumor is larger than 3 cm, but 5 cm or less in size.
	T2b – Tumor is larger than 5 cm, but 7 cm or less in size
T3	A tumor with any of the following: Invasion of the chest wall, diaphragm, mediastinal pleura, or parietal pericardium; extension into the main bronchus, within 2 cm of the carina, but not involving the carina; obstructive pneumonitis of the entire lung.
T4	A tumor with any of: Invasion of the mediastinum, heart, great vessels, trachea, esophagus, vertebra, or carina; Separate tumor nodules in the same lobe; malignant pleural effusion.
Regional Lymph Nodes
NX	Lymph nodes cannot be assessed.
N0	No lymph nodes involved.
N1	Metastasis to ipsilateral peribronchial or ipsilateral hilar lymph nodes.
N2	Metastasis to ipsilateral mediastinal or subcarinal lymph nodes.
N3	Metastasis to any of: Ipsilateral supraclavicular lymph nodes; Ipsilateral scalene lymph nodes; Contralateral lymph nodes.
Distant Metastasis
M0	No distant metastasis.
M1	Distant metastasis is present.
	M1a – Any one of the following: separate tumour nodule(s) in the opposite lung; tumor nodules on the parietal pleura; pleural effusion or pericardial effusion.
	M1b – Distant metastasis.

UICC staging

Stage	T	N	M
Occult carcinoma	TX	N0	M0
Stage 0	Tis	N0	M0
Stage IA	T1	N0	M0
Stage IB	T2a	N0	M0
Stage IIA	T2b	N0	M0
	T1	N1	M0
	T2a	N1	M0
Stage IIB	T2b	N1	M0
	T3	N0	M0
Stage IIIA	T1	N2	M0
	T2	N2	M0
	T3	N1	M0
	T3	N2	M0
	T4	N0	M0
	T4	N1	M0
Stage IIIB	T4	N2	M0
	Any T	N3	M0
Stage IV	Any T	Any N	M1

References

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