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North Central Florida Advanced Practice Nurses

AJCC 2010 TNM Staging & Grouping System

Posted over 4 years ago

Primary tumor (T) involvement is as follows:

  • Tx - Primary tumor cannot be assessed
  • T0 - No evidence of 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 (not in the main bronchus)
  • T1a - Tumor 2 cm or less
  • T1b - Tumor more than 2 cm but 3 cm or less
  • T2 - Tumor more than 3 cm but 7 cm or less
  • T2a - Tumor more than 3 cm but 5 cm or less
  • T2b - Tumor more than 5 cm but 7 cm or less
  • T3 - Tumor more than 7 cm or one that invades any of the following: parietal pleura, chest wall, diaphragm, phrenic nerve, mediastinal pleura, or parietal pericardium; or tumor in the main bronchus (< 2 cm distal to carina but without involvement of the carina); or associated atelectasis or obstructive pneumonitis of the entire lung or separate tumor nodule in the same lobe¬†
  • T4 - Tumor of any size that invades the following: mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, or carina; separate tumor in a different ipsilateral lobe.

Lymph node (N) involvement is as follows:

  • Nx - Regional nodes cannot be assessed
  • N0 - No regional node metastasis
  • N1 - Metastasis in ipsilateral peribronchial and/or ipsilateral hilar nodes and intrapulmonary nodes, including involvement by direct extension¬†
  • N2 - Metastasis in ipsilateral mediastinal and/or subcarinal node
  • N3 - Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene node, or supraclavicular node

Metastatic (M) involvement is as follows:

  • M0 - No metastasis
  • M1 - Distant metastasis
  • M1a - Separate tumor nodule in a contralateral lobe tumor with pleural nodules or malignant pleural effusion
  • M1b - Distant metastasis

For TNM staging, NSCLC is divided into 4 stages, with further subdivision of stages I-III into A and B subtypes. These stages have important therapeutic and prognostic implications, which are discussed later.

Stage grouping of the TNM system is as follows:

  • Stage 0 - TisN0M0
  • Stage 1A - T1aN0M0 / T1bN0M0
  • Stage 1B - T2aN0M0
  • Stage IIA - T2bN0M0 / T1aN1M0 / T1bN1M0 / T1bN1M0 / T2aN1M0
  • Stage IIB - T2bN1M0 / T3N1M0
  • Stage IIIA - T1aN2M0 / T1bN2M0 / T2aN2M0 / T3N1M0 / T3N2M0 / T4N1M0
  • Stage IIIB - T1aN3M0 / T1bN3M0 / T2aN3M0 / T2bN3M0 / T3N3M0 / T4N2M0 / T4N3M0
  • Stage IV - Any T, any N, M1a / Any T, any N, M1b
  • Pleural or pericardial effusion is M1a not T4
  • Separate tumor in the contralateral lung is considered M1a
  • M1b designates distant metastases