Lung mass staging

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

According to the American Joint Committee on Cancer (AJCC) staging system, there are 4 stages of malignant lung mass, based on 3 factors: tumor size, lymph node invasion, and metastasis. Each stage is assigned a letter and a number that designate T for tumor size, N for node invasion, and M for metastasis.

Staging

The following table depicts the TNM classification for lung cancer:

TNM classification of lung cancer

T: Primary tumor TX Any of: Primary tumor cannot be assessed Tumor cells present in sputum or bronchial washing, but tumor not seen with imaging or bronchoscopy T0 No evidence of primary tumor Tis Carcinoma in situ T1 Tumor size less than or equal to 3 cm across, surrounded by lung or visceral pleura, without invasion proximal to the lobar bronchus T1a Tumor size less than or equal to 2 cm across T1b Tumor size more than 2 cm but less than or equal to 3 cm across T2 Any of: Tumor size more than 3 cm but less than or equal to 7 cm across Involvement of the main bronchus at least 2 cm distal to the carina Invasion of visceral pleura Atelectasis/obstructive pneumonitis extending to the hilum but not involving the whole lung T2a Tumor size more than 3 cm but less than or equal to 5 cm across T2b Tumor size more than 5 cm but less than or equal to 7 cm across T3 Any of: Tumor size more than 7 cm across Invasion into the chest wall, diaphragm, phrenic nerve, mediastinal pleura or parietal pericardium Tumor less than 2 cm distal to the carina, but not involving the carina Atelectasis/obstructive pneumonitis of the whole lung Separate tumor nodule in the same lobe T4 Any of: Invasion of the mediastinum, heart, great vessels, trachea, carina, recurrent laryngeal nerve, esophagus, or vertebra Separate tumor nodule in a different lobe of the same lung

N: Lymph nodes NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Metastasis to ipsilateral peribronchial and/or hilar lymph nodes N2 Metastasis to ipsilateral mediastinal and/or subcarinal lymph nodes N3 Any of: Metastasis to scalene or supraclavicular lymph nodes Metastasis to contralateral hilar or mediastinal lymph nodes

M: Metastasis MX Distant metastasis cannot be assessed M0 No distant metastasis M1a Any of: Separate tumor nodule in the other lung Tumor with pleural nodules Malignant pleural or pericardial effusion M1b Distant metastasis