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Staging NSCLC

What is staging and why is it important?

Understanding if and where lung cancer has spread (the stage) is important to determining what options are available for treatment.    

What tests and procedures are used to stage lung cancer?

Imaging tests
In lung cancer, x-rays, CT scans, MRI scans, PET scans and bone scans (a type of scan that can tell if cancer has spread to the bones) are used to find out more about the cancer. These tests show where the cancer is, what the tumor(s) looks like, the size of the tumor(s), and if the cancer has spread (and if so, where).  

Biopsy
A biopsy is used to provide information about the kind of lung cancer, the size of the tumor and growth into other tissues and organs.  

Laboratory tests
Blood, urine, and other tests can show how organs such as the liver are functioning and provide valuable information about whether lung cancer has spread.

Non-Small Cell Lung Cancer

Non-small cell lung cancer is one of several cancers staged using the TNM system. The cancer is staged according to the size of the tumor (T), the extent to which the cancer has spread to the lymph nodes (N), and the extent to which the cancer has spread beyond the lymph nodes, or metastasis (M).

How Does The TNM Staging System Work?

T is for Tumor
How big is the tumor? Where is it located? Has it spread to nearby tissue?

N is for Lymph Node
Has the cancer spread to the lymph nodes in and around the lungs? For more information on the lymph system and lymph nodes, see Lymph System

M is for Metastasis
Has the cancer spread to other parts of the body?

T is for Tumor

TX

The primary tumor cannot be assessed OR the presence of a tumor was only proven by the finding of cancer cells in sputum or bronchial washings BUT not seen in imaging tests or bronchoscopy

T0

No evidence of a primary tumor

Tis

"In situ" - cancer is only in the area where the tumor started and has not spread to nearby tissues

T1

The tumor is less than 3 cm (just slightly over 1 inch), has not spread to the membranes that surround the lungs (visceral pleura), and does not affect the air tubes (bronchi) that branch out on either side from the windpipe (trachea)

T1a

The tumor is less than 2 cm

T1b

The tumor is larger than 2 cm but less than 3 cm

T2

The tumor is larger than 3 cm but less than 7 cm OR involves the main air tubes (bronchus) that branch out from the windpipe (trachea) or the membranes that surround the lungs (visceral pleura). The tumor may partially block the airways but has not caused the entire lung to collapse (atelectasis) or to develop pneumonia

T2a

The tumor is larger than 3 cm but less than or equal to 5 cm

T2b

The tumor is larger than 5 cm but less than or equal to 7 cm

T3

The tumor is more than 7 cm OR touches an area near the lung (such as the chest wall or diaphragm, or sac surrounding the heart- pericardium) OR has grown into the main air tubes (bronchus) that branch out from the windpipe (trachea) but not the area where the windpipe divides OR has caused one lung to collapse (atelectasis) or pneumonia in an entire lung OR there is a separate tumor(s) in the same lobe

T4

The tumor is of any size AND has spread to the area between the lungs (mediastinum), heart, trachea, esophagus, backbone or the place where the windpipe (trachea) branches OR there is a separate tumor(s) in a different lobe of the same lung

N is for Lymph Nodes

NX

Regional lymph nodes cannot be assessed

N0

No cancer found in the lymph nodes

N1

Cancer has spread to lymph nodes within the lung or to the area where the air pipes (bronchus) that branch out from the windpipe enter the lung, but only on the same side of the lung as the tumor (ipsilateral)

N2

Cancer has spread to lymph nodes near where the windpipe (trachea) branches into the left and right air tubes (bronchi) or near the area in the center of the lung (mediastinum) but only on the same side of the lung as the tumor

N3

Cancer has spread to lymph nodes found on the opposite side of the lung as the tumor (contralateral) or lymph nodes in the neck

M is for Metastases

MX

Cancer spread cannot be assessed

M0

Cancer has not spread

M1

Cancer has spread

M1a

Cancer has spread: Separate tumor(s) in a lobe in the opposite lung from the primary tumor (contralateral) , OR malignant nodules in the membrane that surrounds the lung (pleura) OR malignant excess fluid (effusion) in the pleura or membrane that surrounds the heart (pericardium)

M1b

Cancer has spread to distant part of the body such as brain, kidney, bone

After the T, N, and M have been determined, the cancer is then staged accordingly: 

Overall stage

T

N

M

Stage 0

Tis (in situ)

N0

M0

Stage IA

T1a, b

N0

M0

Stage IB

T2a

N0

M0

Stage IIA

T1a, b
T2a
T2b

N1
N1
N0

M0
M0
M0

Stage IIB

T2b
T3

N1
N0

M0
M0

Stage IIIA

T1, T2
T3
T4

N2
N1, N2
N0, N1

M0
M0
M0

Stage IIIB

T4
Any T

N2
N3

M0
M0

Stage IV

Any T

Any N

M 1a, b

About The TNM Staging System

The TNM staging system:

  • Was created by merging the staging systems of the American Joint Committee on Cancer (AJCC) http://www.cancerstaging.org/ and the International Union Against Cancer (UICC) http://www.uicc.org/ in 1987
  • Is one of the most commonly used cancer staging systems
  • Standardizes cancer staging internationally

Source:

International Association for the Study of Lung Cancer. Goldstraw P, ed. Staging Handbook in Thoracic Oncology. Orange Park: Editorial Rx Press; 2009.