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Lung Cancer - Guidelines for processing Specimens and Reporting Tumor Stage

Appendix 4 - TNM Classification

T    Primary Tumor

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
TO No evidence of primary tumor
Tis  Carcinoma in situ
T1 Tumor 3 cm or less in greatest dimension, surrounded by lung, or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus (i.e. not in the main bronchus)†
T2

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

  • More than 3 cm in greatest dimension
  • Involves main bronchus, 2 cm or more distal to the carina
  • Invades visceral pleura
  • Associated with atelectasis or obstructive pneumonitis that extends to the hilar region but does not involve the entire lung
T3 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 atelactasis or obstructive pneumonitis of the entire lung
T4 Tumor of any size that invades any of the following: mediastinum, heart, great vessels, trachea, oesophagus, vertebral body, carina; separate tumor nodule(s) in the same lobe; tumor with malignant pleural effusion‡
    

N    Regional lymph nodes
NX  Regional lymph nodes cannot be assessed
NO   No regional lymph node metastasis
N1 Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes, including involvement by direct extension
N2  Metastasis in ipsilateral mediastinal and/or subcarinal lymph nodes.
N3  Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph nodes.
   


M    Distant Metastasis

MX Distant metastasis cannot be assessed
MO No distant metastasis
M1 Distant metastasis, includes separate tumor nodule(s) in a different lobe (ipsilateral or contralateral)


Stage Grouping of TNM Subsets (3,4)

Occult Cancer TX NO MO
Stage 0 Tis NO MO
Stage 1A T1 NO MO
Stage 1B T2 NO MO
Stage 11A T1 N1 MO
Stage 11B T2
T3 		N1
NO 		MO
MO
Stage 111A T1
T2
T3 		N2
N2
N1,N2 		MO
MO
MO
Stage 111B Any T
T4 		N3
Any N 		MO
MO
Stage 1V Any T Any N M1




†    The uncommon superficial spreading 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.

‡    Most pleural effusions with lung cancer are due to tumor. In a few patients, however, multiple cytopathological examinations of pleural fluid are negative for tumor, and the fluid is non-bloody and is not an exudate. Where these elements and clinical judgement dictate that the effusion is not related to the tumor, the effusion should be excluded as a staging element and the patient should be classified as T1, T2, or T3. This also applies to pericardial effusions.

 
Last Updated: 2002-12-06 Top
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