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The TNM system is used to classify your lung cancer. It looks at three factors:

• T is for tumor
• N is for (lymph) nodes
• M is for metastasis. (Metastasis is when the cancer spreads to other parts of your body, such as your bones.)

Each factor is given a number. Generally, lower numbers mean your cancer is smaller and has not spread far (if at all).

• For T: The number tells you how big your cancer is and whether the cancer has spread outside the lung.
• For N: The number tells you whether your lung cancer has spread to your lymph nodes. Cancer cells can grow in the nodes and then travel from there to other parts of the body.
• For M: The number tells you whether your lung cancer has spread to other parts of your body.

The numbers are then sometimes followed by letters. These tell the doctor how the cancer was found and they give more detail about how far it has spread.

Here is an explanation of what each letter and number says about your cancer.^{1 2}

Key:

2 cm = 8/10 of an inch

3 cm = 1.2 inches

If your lung cancer is described as T1N1M0, it means that the tumor (lump) is 3 centimeters or smaller in size, has spread only to lymph nodes nearby and has not spread to other parts of your body.

If you have non-small-cell lung cancer, doctors use the TNM system to stage your cancer on a scale of 0 through 4. Stage 0 is the least advanced stage of lung cancer (doctors call it carcinoma in situ) and stage 4 is the most advanced. Doctors call stage 1 and stage 2 lung cancer early disease. Stage 3A is called locally advanced disease, and stages 3B and 4 are advanced disease. Most people with lung cancer have advanced disease by the time they are diagnosed.³

Here is an explanation of what stages 1 to 4 mean.⁴

• Stage 1: The cancer is only in the lung.
• Stage 2: The cancer is small but has spread to the lymph nodes closest to the affected lung (stage 2A) or into the chest wall, the outer covering of the lung, the diaphragm or the outer covering of the heart (stage 2B).
• Stage 3: The cancer has spread to the lymph nodes further away from the affected lung but is still on the same side of the chest (stage 3A) or to the lymph nodes on the other side of the chest or collar bone, or to other places in the chest (stage 3B). Stage 3B can also mean that there is more than one tumor in the lung or that fluid around the lung (also known as pleural fluid) contains cancer cells.
• Stage 4: The cancer has spread to another lobe of the lung from where it started, or to other parts of the body, for example, the liver or brain.

By the time they are diagnosed:

• A quarter of non-small-cell lung cancer patients have cancer that hasn't spread
• A fifth have cancer that has spread to nearby lymph nodes
• More than half have cancer that has spread to other distant parts of the body.⁵

If you have small-cell lung cancer, your doctors won't describe the stage in such a complicated way as for non-small-cell lung cancer.⁶ They will describe the cancer as one of two types.

• Limited stage disease: The cancer is on one side of the chest
• Extensive stage disease: The cancer has spread beyond one side of the chest.

About two-thirds of people with small-cell lung cancer have extensive disease when they are diagnosed, and about one-third have limited stage disease.⁶

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.