Table 1: TNM Descriptors for Non-Small Cell Lung Cancer

 

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 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:

  • 3 cm in greatest dimension
  • Involves main bronchus, ≥ 2cm 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 < 2cm 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, heart, great vessels, trachea, esophagus, vertebral body, carina; or

.          tumor with a malignant pleural or pericardial effusion, or with satellite tumor nodule(s) within the ipsilateral primary-tumor lobe of the lung

Regional lymph nodes (N)

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Metastasis to ipsilateral peribronchial and/or ipsilateral hilar lymph nodes, and intrapulmonary nodes involved 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 supraclavicular lymph node(s)

Distant metastasis (m)

MX

Presence of distant metastasis cannot be assessed

M0

No distant metastasis

M1

Distant metastasis present

 

after Mountain et. al.12

 


Table 2: TNM Staging

 

Stage

TNM

5-year Survival

0

Carcinoma in situ

 

IA

T1N0M0

61%

IB

T2N0M0

38%

IIA

T1N1M0

34%

IIB

T2N1M0

T3N0M0

24%

IIIA

T3N1M0

T1N2M0

T2-3N2M0

34%

IIIB

T4N0-2

T1-4N3M0

5%

IV

T1-4N0-3M1

1%

 

after Mountain et. al.12

 


Table 3: Staging—Tumor-Node Matrix

 

 

N0

N1

N2

N3

T1

IA

IIA

IIIA

IIIB

T2

IB

IIB

IIA

IIIB

T3

IIB

IIIA

IIIA

IIIB

T4

IIIB

IIIB

IIIB

IIIB

 


Table 4:  Lymph Node Stations

 

 
N2 Nodes

N2 nodes stations are designated with a single digit

N2 nodes must lie within the mediastinal pleural envelope

1 Highest mediastinal nodes

Above the upper rim of the bracheocephalic (left innominate) vein where it ascends to the left, crossing in front of the trachea at its midline

2 Upper paratracheal nodes

Below #1 and above the upper margin of the aortic arch

3 Prevascular and retrotracheal nodes

3A: prevascular; 3P: retrotracheal.  Midline nodes are ipsilateral for both sides

4 Lower paratracheal nodes

Below #2 and above the upper margin of the upper lobe bronchus and on the left, medial to the ligamentum arteriosum.

5 Subaortic (aorto-pulmonary window)

Lateral to the ligamentum arteriosum or the aorta or the left pulmonary artery, and proximal to the first branch of the left pulmonary artery

6 Para-aortic (ascending aorta or phrenic)

Anterior and lateral to the ascending aorta and the aortic arch or the innominate artery beneath a line tangential to the upper margin of the aortic arch

7 Subcarinal nodes

Caudal to the carina of the trachea, but not associated with the lower lobe bronchi or arteries within the lung

8 Paraesophageal nodes (below carina)

Adjacent to the wall of the esophagus, excluding subcarinal nodes

9 Pulmonary ligament nodes

Within the pulmonary ligament, including those in the posterior wall and lower part of the inferior pulmonary vein

 

N1 Nodes

N1 nodes are designated with two digits

N1 nodes must lie distal to the mediastinal pleural reflection

10 Hilar nodes

Distal to the mediastinal pleural reflection, adjacent to the proximal lobar bronchi and the bronchus intermedius

11 Interlobar nodes

Lying between lobar bronchi

12 Lobar nodes

Adjacent to the distal lobar bronchi

13 Segmental nodes

Adjacent to the segmental bronchi

14 Subsegmental nodes

Around the subsegmental bronchi

 

after Mountain et. al.13