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TNM stages of lung cancer TNM stands for Tumour, Node, Metastases. This staging system describes The size of the tumour (T) Whether cancer cells have spread into the lymph nodes (N) close to the cancer And whether the cancer cells have spread anywhere else in the body, metastases (M) From early 2010, a revised TNM staging system was introduced world wide. We describe the new system below. Tumour (T) The T stages for lung cancer are T1a – the tumour is contained within the lung and is smaller than 2cm across T1b – the tumour is contained within the lung and is between 2 and 3 cm across T2 – the tumour is between 3 and 7cm across or has grown into the largest airway (the main bronchus) more than 2cm below the part where it divides to go into each lung or the tumour has grown into the inner lining of the chest cavity (the visceral pleura) or the tumour has made part of the lung collapse. T2 tumours that are 5cm or smaller are classed as T2a and those larger than 5cm are T2b T3 – the tumour is larger than 7cm or has grown into one of the following structures – the chest wall, the central lining of the chest cavity (the mediastinal pleura), the muscle at the bottom of the chest cavity (the diaphragm), or the outer covering of the heart (the pericardium) or the tumour has made the whole lung collapse or there is more than one tumour nodule in the same lobe of the lung T4 – the tumour has grown into one of the following structures – the area between the lungs in the middle of the chest (the mediastinum), the heart, a major blood vessel, the wind pipe (trachea), the area where the main airway divides to go to each lung, the food pipe (oesophagus), a spinal bone, the nerve that controls the voice box, or there are tumour nodules in more than one lobe of the same lung Nodes (N) The N stages for lung cancer are N0 – there is no cancer in any lymph nodes N1 – there is cancer in the lymph nodes nearest the affected lung N2 – there is cancer in lymph nodes in the centre of the chest (mediastinum) but on the same side as the affected lung or there is cancer in lymph nodes just under where the windpipe branches off to each lung N3 – there is cancer in lymph nodes on the opposite side of the chest from the affected lung or in the lymph nodes above either collar bone or in the lymph nodes at the top of the lung Metastases (M) The M stages for lung cancer are M0 – there are no signs that the cancer has spread to another lobe of the lung or any other part of the body M1a – there are tumours in both lungs or fluid around the lung or heart that contains cancer cells (a malignant pleural effusion or pericardial effusion) M1b – there are lung cancer cells in distant parts of the body, such as the liver or bones