Lung cancer (staging - IASLC 7th edition) (historical)

Non-small cell lung cancer (NSCLC) staging can be accomplished both by the TNM system, or by the AJCC staging system.

For a general discussion of these tumours please refer to the article on non-small cell lung cancer (NSCLC).

TNM system

The current  7^th edition NSCLC staging is as follows ⁴:

Primary tumour (T)

• Tx: malignant cells on cytology but no tumour found on bronchoscopy or imaging.
• Tis: carcinoma in situ
• T1:
  • T1a: smaller than 2 cm in longest dimension 
  • T1b: larger than 2 cm but smaller or equal to 3 cm 
• T2: >3 cm in size and >2 cm from carina, or visceral pleural involvement, or lobar atelectasis
  • T2a: larger than 3 cm but smaller than 5 cm
  • T2b: larger than 5 cm but smaller than 7 cm
• T3:
  • ​<2 cm from carina but not involving trachea or carina
  • involvement of chest wall, diaphragm, mediastinal pleura or parietal pericardium, separate tumour nodule(s) in the same lobe
• T4:
  • involvement of the trachea, oesophagus, vertebra, great vessels or heart 
  • separate tumour nodules in the same lung but not in the same lobe

Nodal status (N)

• Nx: regional nodes cannot be assessed
• N0: no regional nodal metastases
• N1: ipsilateral peribronchial, hilar or intrapulmonary nodes
• N2: ipsilateral mediastinal or subcarinal nodes
• N3: contralateral nodal involvement ; ipsilateral or contralateral scalene or supraclavicular nodal involvement

Distant metastasis (M)

• Mx: distant metastases cannot be assessed
• M0: no distant metastases
• M1: distant metastases present
  • M1a: presence of a malignant pleural effusion, pleural dissemination, or pericardial disease, intrathoracic metastases (metastasis in opposite lung)
  • M1b: extrathoracic metastases

AJCC staging system

• stage 0
  • TNM equivalent: carcinoma in stiu
  • resectable: yes
• stage I
  • TNM equivalent: T1 or T2, N0, M0
  • resectable: yes
  • 5 year survival: 47%
• stage IIa
  • TNM equivalent: T1, N1, M0
  • resectable: yes
• stage IIb
  • TNM equivalent: T2, N1, M0 or T3, N0, M0
  • resectable: yes
  • 5 year survival: 26%
• stage IIIa
  • TNM equivalent: T1 or 2, N2, M0 or T3, N1 or 2, M0
  • resectable: yes

--------------- accepted cut off between resectable and non resectable ----------

• stage IIIb
  • TNM equivalent: T1, 2 or 3, N3, M0 or T4, N0, 1, 2 or 3, M0
  • resectable: no
  • 5 year survival: 8%
• stage IV
  • TNM equivalent: any T, any N with M1
  • resectable: no
  • 5 year survival: 2%

Histological grade

• grade 1: well differentiated
• grade 2: moderately differentiated
• grade 3: poorly differentiated
• grade 4: undifferentiated