Clinical T

This input is used for staging


**Note 1:** Distance from Carina: Assume tumor is greater than or equal to 2 centimeters (cm) from carina if lobectomy, segmental resection, or wedge resection is done. **Note 2:** Specific information about visceral pleura invasion is captured in T2 and **Site-Specific Factor 2, Visceral Pleural Invasion (VPI)/Elastic Layer**. Elastic layer involvement has prognostic significance for lung cancer. **Note 3:** Bronchopneumonia is not the same thing as obstructive pneumonitis and should not be coded as such. * Bronchopneumonia is an acute inflammation of the walls of the bronchioles, usually a result of spread of infection from the upper to the lower respiratory tract * Obstructive pneumonitis is a combination of atelectasis, bronchiectasis with mucous plugging, and parenchymal inflammation that develops distal to an obstructing endobronchial lesion **Note 4:** Atelectasis is the failure of the lung to expand (inflate) completely. This may be caused by a blocked airway, a tumor, general anesthesia, pneumonia or other lung infections, lung disease, or long-term bedrest with shallow breathing. Sometimes called a collapsed lung. * For staging purposes, atelectasis must present with an obstructing tumor **Note 5:** Assign the appropriate T (sub)category (T1-T3) based on the tumor size for the following descriptions Direct tumor invasion into an adjacent ipsilateral lobe Invasion of pleura, NOS Pulmonary ligament Tumor confined to hilus Tumor confined to one lung Tumor involving main stem bronchus Confined to lung, NOS Localized, NOS **Note 6:** Separate ipsilateral tumor nodes are assigned either T3 (same lobe) or T4 (different lobe). Separate tumor nodules in the contralateral lung are assigned in M (distant metastasis). * The absence or presence of separate tumor nodules are also coded in **Site-Specific Factor 1** **Note 7:** Pulmonary Artery/Vein: An involved pulmonary artery/vein in the mediastinum is assigned T4 (involvement of major blood vessel). However, if the involvement of the artery/vein appears to be only within lung tissue and not in the mediastinum, it is not assigned T4. **Note 8:** Vocal cord paralysis (resulting from involvement of recurrent branch of the vagus nerve), superior vena cava (SVC) obstruction, or compression of the trachea or the esophagus may be related to direct extension of the primary tumor or to lymph node involvement. The treatment options and prognosis associated with these manifestations of disease extent fall within the T4-Stage IIIB category. * If the primary tumor is peripheral and clearly unrelated to vocal cord paralysis, SVC obstruction, or compression of the trachea or the esophagus, code these manifestations as mediastinal lymph node involvement, N2 in regional lymph nodes, unless there is a statement of involvement by direct extension from the primary tumor **Note 9:** Opposite (contralateral) Lung: If no mention is made of the opposite lung on a chest x-ray, assume it is not involved.


Clinical T Clinical T Display Description Registrar Notes
cX cTX Primary tumor cannot be assessed OR
Tumor proven by the presence of malignant cells in sputum or bronchial washings but
NOT visualized by imaging or bronchoscopy
Occult carcinoma

Clinical classification criteria met, evaluation done:
Physician unable to assess T
Extension cannot be determined
Tumor size (TS) unknown for T categories where TS needed to determine T
Physician assigns cTX, no other information available to determine T
c0 cT0 No evidence of primary tumor
pIS pTis Carcinoma in situ Intraepithelial, noninvasive

Stated as Tis
c1 cT1 Tumor 3 cm or less in greatest dimension, surrounded by lung or visceral pleura
WITHOUT bronchoscopic evidence of invasion more proximal than the lobar bronchus (i.e., not in the main bronchus)
Note: T1 has subcategories of T1a and T1b. Assign T1 only when there is no information available to assign one of the subcategories

Stated as T1 [NOS]
c1A cT1a Tumor 2 cm or less in greatest dimension Uncommon superficial spreading tumor of any size with its invasive component limited to the bronchial wall, which may extend proximal to the main bronchus

Stated as T1a
c1B cT1b Tumor more than 2 cm but not more than 3 cm in greatest dimension Stated as T1b
c2 cT2 Tumor more than 3 cm but not more than 7 cm; OR
Tumor with any of the following features
Involves main bronchus, 2 cm or more distal to the carina
Invades visceral pleura
Associated with atelectasis or obstructive pneumonitis that extends to the hilar region but does not involve the entire lung
Note: T2 has subcategories of T2a and T2b. Assign T2 only when there is no information available to assign one of the subcategories

Stated as T2 [NOS]
c2A cT2a Tumor more than 3 cm but not more than 5 cm in greatest dimension T2 tumor with features listed in T2 are classified T2a if 5 cm or less, or if size cannot be determined

Stated as T2a
c2B cT2b Tumor more than 5 cm but not more than 7 cm in greatest dimension T2 tumor with features listed in T2 are classified T2b if greater than 5 cm but not larger than 7 cm

Stated as T2b
c3 cT3 Tumor more than 7 cm OR
One that directly invades any of the following:
Parietal pleura
Chest wall (including superior sulcus tumors)
Phrenic nerve
Mediastinal pleura
Parietal pericardium
OR Tumor in the main bronchus less than 2 cm distal to the carina but without involvement of the carina
OR Associated atelectasis or obstructive pneumonitis of the entire lung
OR Separate tumor nodule(s) in the same lobe as the primary
Stated as T3
c4 cT4 Tumor of any size that invades any of the following:
Great vessels
Recurrent laryngeal nerve
Vertebral body
Separate tumor nodule(s) in a different ipsilateral lobe to that of the primary
Note: Invasion into mediastinal fat is T4.
However, if such an invasion is clearly limited to fat within the hilum, classification as T2a or T2b is appropriate, depending on size, unless other features dictate a higher T category

Superior sulcus tumor WITH encasement of subclavian vessels OR WITH unequivocal involvement of superior branches of brachial plexus (C8 or above)

Tumor confined to carina

Blood vessel(s), major
Azygos vein
Inferior vena cava
Pulmonary artery or vein
Superior vena cava (SVC syndrome)

Carina from lung/mainstem bronchus
Compression of esophagus or trachea not specified as direct extension

Mediastinum, extrapulmonary or NOS
Cervical sympathetic (Horner syndrome)
Recurrent laryngeal (vocal cord paralysis)

Visceral pericardium

Neural foramina

Further contiguous extension
(Except to structures specified in distant metastasis)

Stated as T4
88 88 Not applicable Primary site/histology not TNM defined
Death certificate only (DCO) case
<BLANK> BLANK See Registrar Notes Clinical classification criteria not met
Clinical classification criteria met, evaluation done:
No information about diagnostic workup
Results not documented in record
Clinical evaluation of primary tumor not done or unknown if done
Tumor first detected on surgical resection (no clinical workup)
Evidence of metastatic disease [(cM1) or (pM1)], no other workup
Only Clinical Stage Group documented (no T, N, or M information available)