Non-small Cell Lung Cancer Stages

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).