American College of Surgeons Staging Definitions

Primary Tumor (T)
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

T0

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. More distal to the carina.
Invades the 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 atelectasis or obstructive pneumonitis of the entire lung.
T4

Tumor of any size that invades any of the following: mediastinum, hart, great vessels, trachea, esophagus, vertebral body, carina; or separate tumor nodules in the same lobe; or tumor with a malignant pleural effusion. **

  • Note: The uncommon superficial tumor of any size with its invasive component limited to the bronchial wall, which may extend proximal to the main bronchus, is also classifed T1.

  • Note: Most pleural effusions associated with lung cancer are due to tumor. However, there are a few patients in whom multiple cytopathologic examinations of pleural fluid are negative for tumor. In these cases, fluid is non-bloody and is not an exudate. When these elements and clinical judgment dictate that the effusion is not related to the tumor, the effusion is not related to the tumor, the effusion should be excluded as a staging element and the patient should be staged T1, T2 or T3

 

Regional Lymph Nodes (N)

NX

Regional lymph nodes cannot be assessed

NO

No regional lymph node metastasis

N1

Metastasis to ipsilateral peribronchial and/or ipsilateral hilar lymph nodes, and intrapulmonary nodes including involvement by direct extension of the primary tumor

N2

Metastasis to ipsilateral mediastinal and/or subcarinal lymph node(s)

N3

Metastasis to contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or suparclavicular lymph node(s)

 

Distant Metastasis (M)

MX

Distant metastasis cannot be assessed

MO

No distant metastasis

M1

Distant metastasis present
  • Note: M1 includes separate tumor nodule(s) in a different lobe (ipsilateral or contralateral).

 

Stage Grouping

Occult Carcinoma
TX
NO
MO

Stage0
Tis
NO
MO

Stage 1A

T1
NO
MO

Stage 1B

T2
NO
MO

Stage IIA
T1
N1
MO

Stage IIB

T2
N1
MO
T3
NO
MO

Stage IIIA

T1
N2
MO
T2
N2
MO
T3
N1
MO
T3
N2
MO

Stage IIB

Any T
N3
MO
T4
Any N
MO

Stage IV

Any T
Any N
M1



 Primary Site - Non-Small Cell Lung Cancer
 Treatment
Stage 0
Stage I
Stage II
Stage III
Stage IV
TOTAL
 None
 0 1 0 4 5 10
 S Only
 0 7 2 0 0 9
 R Only
 0 0 1 2 4 7
 C Only
 0 1 0 1 3 5
 H Only
 0 0 0 1 0 1
 S+R
 0 1 0 0 0 1
 S+C
 0 0 0 0 2 2
 R+C
 0 0 1 2 5 8
 R+H
 0 0 0 1 1 2
 C+O
 0 0 0 1 2 3
 S+R+C
 0 0 1 0 1 2
 R+C+H
 0 0 0 0 1 1
 R+C+O
 0 0 0 2 2 4
 S+R+C+O
 0 0 1 1 0 2
 TOTAL
 0 10 6 15 26 57

Key
S=Surgery
R=Radiation
C=Chemotherapy
H=Hormone (Steroids)
O=Other Cancer Treatment