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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.
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:
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.
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.
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 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 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 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 grouping: T2a, N0, M0
The tumor has one or more of the following features (T2a):
The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
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 grouping: Stage IIB can have 3 possible stage groupings.
T3, N0, M0
The tumor has one or more of the following features (T3):
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 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 grouping: Stage IIIA can have 4 possible stage groupings.
T4, N0, M0
The tumor has one or more of the following features (T4):
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):
Or
The tumor has one or more of the following features (T4):
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):
OR
The tumor has one or more of the following features (T3):
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 grouping: Stage IIIB can have 3 possible stage groupings.
T2/T3, N2b, M0
The tumor has one or more of the following features (T2):
OR
The tumor has one or more of the following features (T3):
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):
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):
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 grouping: T3/T4, N3, M0
The tumor has one or more of the following features (T3):
OR
The tumor has one or more of the following features (T4):
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 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):
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 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).
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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