TNM 9th edition, in force since 1 January 2025 and built on 124,581 patients diagnosed 2011 to 2019 (British Journal of Radiology 2025; IASLCstaging project)
T : unchanged from the eighth edition. The T subcommittee tested chest wall and parietal pleural involvement against the new database and proposed no reallocation
N : N0 no nodes; N1 ipsilateral hilar or intrapulmonary; N2a a single ipsilateral mediastinal or subcarinal station; N2b multiple ipsilateral mediastinal stations with or without the subcarinal station; N3 contralateral or supraclavicular
M : M1a within the chest (contralateral lung nodules, pleural or pericardial nodules or effusion); M1b a single extrathoracic metastasis; M1c1 several metastases in one extrathoracic organ system; M1c2 several metastases across organ systems. M1c1 and M1c2 both sit in stage IVB
NICE NG122's recommendations were written against the 7th edition of the AJCC staging system, which the guideline states on the page; the clinic is two editions ahead of it
In England 34 percent of staged lung cancers in 2022 were stage I or II; in the United States 24 percent are localised, 21 percent regional and 51 percent distant at diagnosis (Cancer Research UK; SEER)
▸Advanced diseaseShow Hide where advanced disease can reach, and what treats itThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
What helpsA matched pill for each driver (osimertinib, lorlatinib, selpercatinib and others, most of which reach the brain), PD-(L)1 immunotherapy for the rest, ADCs after progression, and SBRT for a few sites.