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Non-Small Cell Lung Cancer Stages

After someone is diagnosed with non-small cell lung cancer (NSCLC), doctors will try to figure out if it has spread, and if so, how far. This is called staging. The stage of a cancer describes how much and where the cancer is in the body. It helps determine how best to treat it. Doctors also use a cancer’s stage when talking about survival statistics.

How is the stage determined?

The staging system most often used for NSCLC is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of information:

  • The size and extent of the main tumor (T): How large is the tumor? Has it grown into nearby structures or organs?
  • The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes? (See image.)
  • The spread (metastasis) to distant sites (M): Has the cancer spread to distant organs, such as the brain, bones, adrenal glands, liver, the pleural fluid, or the other lung?

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage. For more information, see Cancer Staging.

illustration showing the lungs, hilar lymph nodes, upper mediastinal lymph nodes, bronchial lymph nodes, bronchus, trachea, supraclavicular (collarbone) lymph nodes, lower mediastinal lymph nodes and subcarinal mediastinal lymph nodes

Clinical vs. pathologic stage for lung cancer

NSCLC is typically given a clinical stage based on the results of a physical exam, biopsy, and imaging tests (as described in Tests for Lung Cancer). If surgery is done, the pathologic stage (also called the surgical stage) is determined by examining tissue removed during the operation.

Stages of non-small cell lung cancer

The earliest stage of NSCLC is stage 0 (also called carcinoma in situ, or CIS). Other stages range from I (1) through IV (4). As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means cancer has spread more. And within a stage, an earlier letter (or number) means a lower stage.

Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

The stages described below are based on the most recent version of the AJCC system, version 9, effective 2024. Staging for NSCLC can be complex, so ask your doctor to explain it to you in a way you understand.

Stage grouping: TX, N0, M0

The main tumor can’t be assessed for some reason, or cancer cells are seen in a sample of sputum or lung fluids, but the cancer isn’t found with other tests, so its location can’t be determined (TX). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

Stage grouping: Tis, N0, M0

The tumor is found only in the top layers of cells lining the air passages, but it has not invaded deeper into other lung tissues (Tis, also known as carcinoma in situ). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

Stage IA1

Stage grouping: Stage IA1 can have 2 possible stage groupings.

T1mi, N0, M0

The cancer is a minimally invasive adenocarcinoma. The tumor is no larger than 3 centimeters (cm) across, and the part that has invaded into deeper lung tissues is no more than 0.5 cm across. The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

T1a, N0, M0

The tumor is no larger than 1 cm across or the tumor has not spread beyond the wall of the bronchus.  It has not grown into the membranes that surround the lungs, and does not affect the main branches of the bronchi (T1a). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

Stage IA2

Stage grouping: T1b, N0, M0

The tumor is larger than 1 cm but no larger than 2 cm across, has not grown into the membranes that surround the lungs, and does not affect the main branches of the bronchi (T1b). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

Stage IA3

Stage grouping: T1c, N0, M0

The tumor is larger than 2 cm but no larger than 3 cm across, has not grown into the membranes that surround the lungs, and does not affect the main branches of the bronchi (T1c). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

Stage IB

Stage grouping: T2a, N0, M0

The tumor has one or more of the following features (T2a):

  • It is larger than 3 cm but not larger than 4 cm across.
  • It has grown into a main bronchus, but not the carina (the point where the windpipe splits into the left and right main bronchi) and it is not larger than 4 cm across.
  • It has grown into a nearby lobe of the lung and is not larger than 4 cm across.
  • It has grown into the visceral pleura (the membranes surrounding the lungs) and is not larger than 4 cm across.
  • It is partially clogging the airways and is not larger than 4 cm across.

The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

Stage IIA

Stage grouping: Stage IIA can have 2 possible stage groupings.

T2b, N0, M0

The tumor is larger than 4 cm but not larger than 5 cm across (T2b). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

T1a/T1b/T1c, N1, M0

The tumor is no larger than 3 cm across, has not grown into the membranes that surround the lungs, and does not affect the main branches of the bronchi (T1). It has spread to lymph nodes within the lung and/or around the area where the bronchus enters the lung (peribronchial, hilar, or intrapulmonary lymph nodes). These lymph nodes are on the same side as the cancer (N1). The cancer has not spread to distant parts of the body (M0).

Stage IIB

Stage grouping: Stage IIB can have 3 possible stage groupings.

T3, N0, M0

The tumor has one or more of the following features (T3):

  • It is larger than 5 cm but not larger than 7 cm across.
  • It has grown into the chest wall, inner lining of the chest wall (parietal pleura), phrenic nerve, membrane surrounding the heart (pericardium), azygos vein, nerves that branch out of the spinal cord in the thorax (thoracic nerve roots, ie. T1 and T2), or group of nerves around the neck area (stellate ganglion). It is also not larger than 7 cm across.
  • There are 2 or more separate tumor nodules in the same lobe of a lung and is not larger than 7 cm across

The cancer has not spread to nearby lymph nodes (N0) or distant parts of the body (M0).

T1a/T1b/T1c, N2a, M0

The cancer is no larger than 3 cm across, has not grown into the membranes that surround the lungs, and does not affect the main branches of the bronchi (T1). The cancer has spread to one area of lymph nodes either below the carina where the windpipe splits into the left and right bronchi (subcarinal)) or in the space between the lungs (mediastinum). These lymph nodes are on the same side as the main lung tumor (N2a). The cancer has not spread to distant parts of the body (M0).

T2a/T2b, N1, M0

The tumor has one or more of the following features (T2):

  • It is larger than 3 cm but not larger than 5 cm across.
  • It has grown into a main bronchus, but not the carina (the point where the windpipe splits into the left and right main bronchi) and is not larger than 4 cm across.
  • It has grown into a nearby lobe of the lung and is not larger than 4 cm across.
  • It has grown into the visceral pleura (the membranes surrounding the lungs) and is not larger than 4 cm.
  • It is partially clogging the airways and is not larger than 4 cm.

It has spread to lymph nodes within the lung and/or around the area where the bronchus enters the lung (peribronchial, hilar, or intrapulmonary lymph nodes). These lymph nodes are on the same side as the cancer (N1). The cancer has not spread to distant parts of the body (M0).

Stage IIIA

Stage grouping: Stage IIIA can have 4 possible stage groupings.

T4, N0, M0

The tumor has one or more of the following features (T4):

  • It is larger than 7 cm across.
  • It has grown into the space between the lungs (mediastinum), the heart, the large blood vessels near the heart (such as the aorta), the windpipe (trachea), the tube connecting the throat to the stomach (esophagus), the thin muscle separating the chest from the abdomen (diaphragm), the backbone, or the carina.
  • There are 2 or more separate tumor nodules in different lobes of the same side of the lung.

The cancer has not spread to nearby lymph nodes (N0) or distant parts of the body (M0).

T3/T4, N1, M0

The tumor has one or more of the following features (T3):

  • It is larger than 5 cm but not larger than 7 cm across.
  • t has grown into the chest wall, inner lining of the chest wall (parietal pleura), phrenic nerve, membrane surrounding the heart (pericardium), azygos vein, nerves that branch out of the spinal cord in the thorax (thoracic nerve roots, ie. T1 and T2), or group of nerves around the neck area (stellate ganglion).  It is also not larger than 7 cm across.
  • There are 2 or more separate tumor nodules in the same lobe of a lung and is not larger than 7 cm across

Or

The tumor has one or more of the following features (T4):

  • It is larger than 7 cm across.
  • It has grown into the space between the lungs (mediastinum), the heart, the large blood vessels near the heart (such as the aorta), the windpipe (trachea), the tube connecting the throat to the stomach (esophagus), the thin muscle separating the chest from the abdomen (diaphragm), the backbone, or the carina.
  • There are 2 or more separate tumor nodules in different lobes of the same side of the lung.

It has spread to lymph nodes within the lung and/or around the area where the bronchus enters the lung (peribronchial, hilar, or intrapulmonary lymph nodes). These lymph nodes are on the same side as the cancer (N1). The cancer has not spread to distant parts of the body (M0).

T1a/T1b/T1c, N2b, M0

The cancer is no larger than 3 cm across, has not grown into the membranes that surround the lungs, and does not affect the main branches of the bronchi (T1). The cancer has spread to multiple areas of lymph nodes in the space between the lungs (mediastinum). These lymph nodes are on the same side as the main lung tumor (N2b).The cancer has not spread to distant parts of the body (M0).

T2/T3, N2a, M0

The tumor has one or more of the following features (T2):

  • It is larger than 3 cm but not larger than 5 cm across.
  • It has grown into a main bronchus, but not the carina (the point where the windpipe splits into the left and right main bronchi) and is not larger than 4 cm across.
  • It has grown into a nearby lobe of the lung and is not larger than 4 cm across.
  • It has grown into the visceral pleura (the membranes surrounding the lungs) and is not larger than 4 cm.
  • It is partially clogging the airways and is not larger than 4 cm.

OR

The tumor has one or more of the following features (T3):

  • It is larger than 5 cm but not larger than 7 cm across.
  • It has grown into the chest wall, inner lining of the chest wall (parietal pleura), phrenic nerve, membrane surrounding the heart (pericardium), azygos vein, nerves that branch out of the spinal cord in the thorax (thoracic nerve roots, ie. T1 and T2), or group of nerves around the neck area (stellate ganglion).  It is also not larger than 7 cm across.
  • There are 2 or more separate tumor nodules in the same lobe of a lung and is not larger than 7 cm across

The cancer has spread to one area of lymph nodes either below the carina where the windpipe splits into the left and right bronchi (subcarinal) or in the space between the lungs (mediastinum). These lymph nodes are on the same side as the main lung tumor (N2a). The cancer has not spread to distant parts of the body (M0).

Stage IIIB

Stage grouping: Stage IIIB can have 3 possible stage groupings.

T2/T3, N2b, M0

The tumor has one or more of the following features (T2):

  • It is larger than 3 cm but not larger than 5 cm across.
  • It has grown into a main bronchus, but not the carina (the point where the windpipe splits into the left and right main bronchi) and is not larger than 4 cm across.
  • It has grown into a nearby lobe of the lung and is not larger than 4 cm across.
  • It has grown into the visceral pleura (the membranes surrounding the lungs) and is not larger than 4 cm.
  • It is partially clogging the airways and is not larger than 4 cm.

OR

The tumor has one or more of the following features (T3):

  • It is larger than 5 cm but not larger than 7 cm across.
  • It has grown into the chest wall, inner lining of the chest wall (parietal pleura), phrenic nerve, membrane surrounding the heart (pericardium), azygos vein, nerves that branch out of the spinal cord in the thorax (thoracic nerve roots, ie. T1 and T2), or group of nerves around the neck area (stellate ganglion).  It is also not larger than 7 cm across.
  • There are 2 or more separate tumor nodules in the same lobe of a lung and is not larger than 7 cm across

The cancer has spread to multiple areas of lymph nodes in the space between the lungs (mediastinum). These lymph nodes are on the same side as the main lung tumor (N2b). The cancer has not spread to distant parts of the body (M0).

T4, N2a/N2b, M0

The tumor has one or more of the following features (T4):

  • It is larger than 7 cm across.
  • It has grown into the space between the lungs (mediastinum), the heart, the large blood vessels near the heart (such as the aorta), the windpipe (trachea), the tube connecting the throat to the stomach (esophagus), the thin muscle separating the chest from the abdomen (diaphragm), the backbone, or the carina (the point where the windpipe splits into the left and right main bronchi).
  • There are 2 or more separate tumor nodules in different lobes of the same side of the lung.

The cancer has spread to lymph nodes in the space between the lungs (mediastinum) or below the carina where the windpipe splits into the left and right bronchi. These lymph nodes are on the same side as the main lung tumor (N2). The cancer has not spread to distant parts of the body (M0).

T1/T2, N3, M0

The tumor is no larger than 3 cm across, has not grown into the membranes that surround the lungs, and does not affect the main branches of the bronchi (T1).

OR

The tumor has one or more of the following features (T2):

  • It is larger than 3 cm but not larger than 5 cm across.
  • It has grown into a main bronchus, but not the carina (the point where the windpipe splits into the left and right main bronchi) and is not larger than 4 cm across.
  • It has grown into a nearby lobe of the lung and is not larger than 4 cm across.
  • It has grown into the visceral pleura (the membranes surrounding the lungs) and is not larger than 4 cm.
  • It is partially clogging the airways and is not larger than 4 cm.

The cancer has spread to lymph nodes above the collarbone on either side of the body, and/or has spread to hilar or mediastinal lymph nodes on the other side of the body from the main tumor (N3). The cancer has not spread to distant parts of the body (M0).

Stage IIIC

Stage grouping: T3/T4, N3, M0

The tumor has one or more of the following features (T3):

  • It is larger than 5 cm but not larger than 7 cm across.
  • It has grown into the chest wall, inner lining of the chest wall (parietal pleura), phrenic nerve, membrane surrounding the heart (pericardium), azygos vein, nerves that branch out of the spinal cord in the thorax (thoracic nerve roots, ie. T1 and T2), or group of nerves around the neck area (stellate ganglion).  It is also not larger than 7 cm across.
  • There are 2 or more separate tumor nodules in the same lobe of a lung and is not larger than 7 cm across

OR

The tumor has one or more of the following features (T4):

  • It is larger than 7 cm across.
  • It has grown into the space between the lungs (mediastinum), the heart, the large blood vessels near the heart (such as the aorta), the windpipe (trachea), the tube connecting the throat to the stomach (esophagus), the thin muscle separating the chest from the abdomen (diaphragm), the backbone, or the carina.
  • There are 2 or more separate tumor nodules in different lobes of the same side of the lung.

The cancer has spread to lymph nodes above the collarbone on either side of the body, and/or has spread to hilar or mediastinal lymph nodes on the other side of the body from the main tumor (N3). The cancer has not spread to distant parts of the body (M0).

Stage IVA

Stage grouping: Stage IVA tumors can have 2 possible stage groupings

Any T, any N, M1a

The cancer can be any size and may or may not have grown into nearby structures (any T). It may or may not have reached nearby lymph nodes (any N). In addition, any of the following is true (M1a):

  • The cancer has spread to the other lung.
  • The cancer has spread to either the pleura (lining around the lungs) or pericardium (lining around the heart).
  • Cancer cells are found in the fluid around the lung (called a malignant pleural effusion).
  • Cancer cells are found in the fluid around the heart (called a malignant pericardial effusion).

Any T, any N, M1b

The cancer can be any size and may or may not have grown into nearby structures (any T). It may or may not have reached nearby lymph nodes (any N). It has spread as a single tumor outside of the chest, such as to a distant lymph node or an organ such as the liver, bones, or brain (M1b).

Stage IVB

Stage grouping: Stage IVA tumors can have 2 possible stage groupings.

Any T, any N, M1c1

The cancer can be any size and may or may not have grown into nearby structures (any T). It may or may not have reached nearby lymph nodes (any N). It has spread as more than one tumor outside the chest in a single organ (M1c1).

Any T, any N, M1c2

The cancer can be any size and may or may not have grown into nearby structures (any T). It may or may not have reached nearby lymph nodes (any N). It has spread as more than one tumor outside the chest in multiple organs (M1c2).

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The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as editors and translators with extensive experience in medical writing.

American Joint Committee on Cancer. Lung. In: AJCC Cancer Staging System. Version Nine. American College of Surgeons; 2024.

Last Revised: June 9, 2025

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