TNM staging system for lung cancer (seventh edition)

Primary tumor (T)
T1	Tumor ≤3 cm diameter, surrounded by lung or visceral pleura, without invasion more proximal than lobar bronchus*
T1a	Tumor ≤2 cm in diameter
T1b	Tumor >2 cm but ≤3 cm in diameter
T2	Tumor >3 cm but ≤7 cm, or tumor with any of the following features:
	Involves main bronchus, ≥2 cm distal to carina
	Invades visceral pleura
	Associated with atelectasis or obstructive pneumonitis that extends to the hilar region but does not involve the entire lung
T2a	Tumor >3 cm but ≤5 cm
T2b	Tumor >5 cm but ≤7 cm
T3	Tumor >7 cm or any of the following:
	Directly invades any of the following: chest wall, diaphragm, phrenic nerve, mediastinal pleura, parietal pericardium, main bronchus <2 cm from carina (without involvement of carina)
	Atelectasis or obstructive pneumonitis of the entire lung
	Separate tumor nodules in the same lobe
T4	Tumor of any size that invades the mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina, or with separate tumor nodules in a different ipsilateral lobe
Regional lymph nodes (N)
N0	No regional lymph node metastases
N1	Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension
N2	Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s)
N3	Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)
Distant metastasis (M)
M0	No distant metastasis
M1	Distant metastasis
M1a	Separate tumor nodule(s) in a contralateral lobe; tumor with pleural nodules or malignant pleural or pericardial effusion
M1b	Distant metastasis (in extrathoracic organs)
Stage groupings
Stage IA	T1a-T1b	N0	M0
Stage IB	T2a	N0	M0
Stage IIA	T1a,T1b,T2a	N1	M0
	T2b	N0	M0
Stage IIB	T2b	N1	M0
	T3	N0	M0
Stage IIIA	T1a,T1b,T2a,T2b	N2	M0
	T3	N1,N2	M0
	T4	N0,N1	M0
Stage IIIB	T4	N2	M0
	Any T	N3	M0
Stage IV	Any T	Any N	M1a or M1b

* The uncommon superficial spreading tumor of any size with its invasive component limited to the bronchial wall, which may extend proximal to the main bronchus, is also classified as T1a.

Adapted from: Goldstraw P, Crowley J, Chansky K, et al. The IASLC Lung Cancer Staging Project: Proposals for the revision of the TNM stage groups in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol 2007; 2:706.

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TNM staging system for lung cancer (seventh edition)