The TNM staging (pTNM staging UICC 8th edition) criteria are as follows. pTX (primary tumor)
pTX: No primary tumor found, or cancer cells found by sputum cytology or bronchial lavage but not detected by imaging and bronchoscopy. pT0: No evidence of primary tumor. pTis: Carcinoma in situ.
pT0: no evidence of primary tumor. pTis: carcinoma in situ
pT1: tumor with a maximum diameter of ≤3 cm, surrounded by lung tissue and dirty pleura; bronchoscopy showed that the tumor invaded the lobe bronchi but not the main bronchi.
pT1mi: microinvasive adenocarcinoma.
pT1a: Tumor maximum diameter ≤1cm. pT1b: Tumor 1cm< maximum diameter ≤2cm. pT1c: Tumor 2cm< maximum diameter ≤3cm.
pT2: Tumor 3cm<maximal diameter ≤5cm; or tumor invades main bronchus. pT2: Tumor 3cm<maximal diameter ≤5cm.
(Uncommon superficially spreading tumors, regardless of size, are T1 when invasion is limited to the bronchial wall, although they may invade the main bronchus; invade the dirty pleura; have obstructive pneumonia or partial or total pulmonary atelectasis. If any 1 of these conditions is met, the tumor is classified as T2.
pT2a: tumor 3cm< maximal diameter ≤ 4cm. pT2b: tumor 4cm< maximal diameter ≤ 5cm
pT3: Tumor 5cm<maximal diameter ≤7cm. or any size tumor directly invades any 1 of the following sites, including: chest wall (including supraglottic sulcus), phrenic nerve, pericardium; isolated tumor in the same lobe.
pericardium; isolated cancer nodules in the same lung lobe. If any one of the above conditions is met, the tumor is classified as T3.
pT4: Tumor with maximum diameter >7cm; regardless of size, invading any one of the following sites, including: mediastinum, heart, great vessels, bullae, recurrent laryngeal nerve, main trachea, esophagus, vertebral body, diaphragm; isolated cancer nodules in different lung lobes on the same side.
N-Regional lymph nodes
pNX: regional lymph nodes could not be evaluated. pN0: no regional lymph node metastasis.
pN1: ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary lymph nodes with metastases, including those involved by direct invasion.
pN2: Metastases in the ipsilateral mediastinum and/or inferior bulbar lymph nodes.
pN3: Metastases to the contralateral mediastinum, contralateral hilum, ipsilateral or contralateral anterior oblique muscles, and supraclavicular lymph nodes.
M – distant metastases.
MX: distant metastases cannot be determined.
pM1a: confined to the thoracic cavity, contralateral intrapulmonary cancer nodules; pleural or pericardial nodules; or malignant pleural (pericardial) exudate.
pM1b: distant single-organ unifocal metastasis (including single non-regional lymph node metastasis) beyond the thoracic cavity.
pM1c: distant single-organ multifocal metastasis/multi-organ metastasis beyond the thoracic cavity. Clinical staging
Occult carcinoma: TisN0M0
Stage IA1: T1a(mis)N0M0, T1aN0M0 Stage IA2: T1bN0M0
Stage IA3: T1cN0M0 Stage IB: T2aN0M0
Phase IIA: T2bN0M0
Phase IIB: T1a~cN1M0, T2aN1M0, T2bN1M0, T3N0M0
Phase IIIA: T1a~cN2M0, T2a~bN2M0, T3N1M0, T4N0M0, T4N1M0
Phase IIIB: T1a to cN3M0, T2a to bN3M0, T3N2M0, T4N2M0 Phase IIIC: T3N3M0, T4N3M0
Phase IVA: any T, any N, M1a, any T, any N, M1b Phase IVB: any T, any N, M1c