AJCC and TNM staging system for lung cancer

American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) staging system for lung cancer

AJCC TNM Staging System of Lung Cancer

T = Primary Tumor

  • T0 No evidence of primary tumor
  • T1 ≤3 cm, surrounded by lung/visceral pleura, and no invasion of mainstem bronchus
  • T1a ≤2cm
  • T1b >2 cm and ≤3 cm
  • T2 >3 cm and ≤7 cm, involvement of mainstem bronchus ≥2 cm from carina, invasion of visceral pleura, or obstructive atelectasis of part of lung
  • T2a >3 cm and ≤5 cm
  • T2b >5 cm and ≤7 cm
  • T3 >7 cm, invasion of chest wall, mediastinal pleura, diaphragm, parietal pericardium, mainstem bronchus <2 cm from carina, obstructive atelectasis of entire lung, or presence of separate tumor nodules in same lobe of lung
  • T4 Invasion of mediastinal structures, or presence of separate tumor nodules in different ipsilateral lobe of lung

N = Regional Lymph Nodes

  • N0 No regional lymph node metastases
  • N1 Ipsilateral hilar, peribronchial, or intrapulmonary lymphadenopathy
  • N2 Ipsilateral mediastinal or subcarinal lymphadenopathy
  • N3 Supraclavicular, scalene, contralateral mediastinal, or contralateral hilar lymphadenopathy

M = Distant Metastasis

  • M0 No distant metastasis
  • M1 Distant metastasis
  • M1a Presence of separate tumor nodules in contralateral lung or metastatic involvement of pleura
  • M1b Presence of distant metastases


  • 0 Carcinoma in situ
  • IA T1 N0 M0
  • IB T2a N0 M0
  • IIA T1-2a N1 M0, T2b N0 M0
  • IIB T2b N1 M0, T3 N0 M0
  • IIIA T1-2 N2 M0, T3 N1-2 M0, T4 N0-1 M0
  • IIIB T4 N2 M0, Any T N3 M0
  • IV Any T Any N M1

Note : Any T4 or N2 lesion is at least stage IIIA, any N3 lesion is at least stage IIIB, and any M1 lesion is stage IV. Patients with stage 0 to IIIA lesions are generally treated with surgery, whereas patients with stage IIIB and IV lesions are generally treated with medical therapy.

Are there any other staging systems used in patients with SCLC?

The Veterans Administration Lung Study Group (VALSG) system is also used, and it classifies SCLC as either limited stage disease (LD) or extensive stage disease (ED). With LD, cancer is confined to one hemithorax and may be present in regional lymph nodes or ipsilateral supraclavicular nodes, all of which can be encompassed in a safe radiotherapy field. Otherwise, ED is present. This system is used as the majority of patients with SCLC undergo nonsurgical treatment.

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