T staging most Cancers
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Now I have enough information from multiple authoritative textbooks to compile a comprehensive answer on T staging across major cancers. Let me synthesize this.
T Staging of Major Cancers (AJCC/TNM System)
The T (primary tumor) descriptor reflects the size and/or local extent of the primary tumor. It is combined with N (nodal) and M (metastasis) to derive the overall TNM stage. The criteria differ significantly by organ site because each tissue has unique anatomic layers and adjacent structures.
General Principles
| Prefix | Meaning |
|---|---|
| cT | Clinical T (from physical exam + imaging, before surgery) |
| pT | Pathologic T (from surgical specimen analysis) |
| ypT | Post-neoadjuvant therapy pathologic T |
| rT | Restaging at recurrence |
| TX | Cannot be assessed |
| T0 | No evidence of primary tumor |
| Tis | Carcinoma in situ |
(Schwartz's Principles of Surgery, 11e)
1. Lung Cancer (8th Edition TNM)
| Stage | Criteria |
|---|---|
| Tis | Carcinoma in situ |
| T1a(mi) | Minimally invasive adenocarcinoma |
| T1a | ≤1 cm |
| T1b | >1–2 cm |
| T1c | >2–3 cm |
| T2 | >3–5 cm or invades visceral pleura / mainstem bronchus (not carina) / associated with atelectasis |
| T2a | >3–4 cm |
| T2b | >4–5 cm |
| T3 | >5–7 cm or invades chest wall, phrenic nerve, parietal pericardium; satellite nodule in same lobe |
| T4 | >7 cm or invades mediastinum, trachea, carina, great vessels, esophagus, vertebra, diaphragm; satellite nodule in different ipsilateral lobe |
(Fishman's Pulmonary Diseases & Disorders, 2-Vol Set)
2. Breast Cancer (AJCC 8th Edition)
| Stage | Criteria |
|---|---|
| Tis (DCIS) | Ductal carcinoma in situ |
| Tis (Paget) | Paget disease of nipple without underlying invasive/in situ carcinoma |
| T1mi | ≤1 mm |
| T1a | >1–5 mm |
| T1b | >5–10 mm |
| T1c | >10–20 mm |
| T2 | >20–50 mm |
| T3 | >50 mm |
| T4a | Extension to chest wall (not pectoralis muscle alone) |
| T4b | Ulceration and/or satellite skin nodules and/or edema (peau d'orange), not meeting inflammatory criteria |
| T4c | T4a + T4b |
| T4d | Inflammatory carcinoma |
(Schwartz's Principles of Surgery, 11e)
3. Colorectal Cancer
| Stage | Criteria |
|---|---|
| Tis | Intramucosal; involves lamina propria, does not breach muscularis mucosa |
| T1 | Invades submucosa (through muscularis mucosa, not into muscularis propria) |
| T2 | Invades muscularis propria |
| T3 | Through muscularis propria into pericolorectal tissues |
| T4a | Through visceral peritoneum |
| T4b | Directly invades or adheres to adjacent organs or structures |
(Schwartz's Principles of Surgery, 11e)
4. Oral Cavity Cancer
| Stage | Criteria |
|---|---|
| Tis | Carcinoma in situ |
| T1 | Tumor ≤2 cm AND depth of invasion (DOI) <5 mm |
| T2 | Tumor ≤2 cm with DOI 5–10 mm, or 2–4 cm with DOI <10 mm |
| T3 | Tumor >4 cm or DOI >10 mm |
| T4 | Invades adjacent structures (cortical bone, inferior alveolar nerve, floor of mouth, skin, extrinsic tongue muscles, maxillary sinus) |
5. Oropharynx & Hypopharynx
| Stage | Criteria |
|---|---|
| Tis | Carcinoma in situ |
| T1 | ≤2 cm |
| T2 | >2–4 cm |
| T3 | >4 cm; hypopharynx: any size with laryngeal fixation |
| T4 | Invades adjacent structures (oropharynx: pterygoid muscles, mandible, hard palate, larynx; hypopharynx: thyroid/cricoid cartilage, carotid artery, prevertebral fascia, thyroid, esophagus) |
(K.J. Lee's Essential Otolaryngology)
6. Bladder Cancer
| Stage | Criteria |
|---|---|
| Tis | Carcinoma in situ (flat tumor) |
| Ta | Non-invasive papillary carcinoma (mucosa only) |
| T1 | Invades lamina propria (subepithelial connective tissue) |
| T2 | Invades muscularis propria (detrusor) |
| T2a | Inner half of detrusor |
| T2b | Outer half of detrusor |
| T3 | Invades perivesical tissue |
| T3a | Microscopically |
| T3b | Macroscopically (palpable mass on bimanual exam after TURBT) |
| T4a | Invades prostate, uterus, vagina |
| T4b | Invades pelvic wall or abdominal wall |
Key: Ta + T1 + Tis = Non-Muscle Invasive Bladder Cancer (NMIBC); T2+ = Muscle Invasive Bladder Cancer (MIBC)
(Sabiston Textbook of Surgery, 21e; Campbell-Walsh-Wein Urology)
7. Prostate Cancer (pTNM)
| Stage | Criteria |
|---|---|
| T1 | Clinically unapparent (not palpable, not visible on imaging) |
| T1a | Incidental — ≤5% of resected tissue |
| T1b | Incidental — >5% of resected tissue |
| T1c | Identified by needle biopsy (e.g., due to elevated PSA) |
| T2 | Confined within the prostate |
| T2a | Involves ≤½ of one lobe |
| T2b | Involves >½ of one lobe, not both lobes |
| T2c | Involves both lobes |
| T3 | Extends through prostatic capsule |
| T3a | Extracapsular extension (uni- or bilateral), including microscopic bladder neck invasion |
| T3b | Invades seminal vesicle(s) |
| T4 | Tumor is fixed or invades adjacent structures (external sphincter, rectum, levator muscles, pelvic wall) |
(Robbins & Cotran Pathologic Basis of Disease; Campbell-Walsh-Wein Urology)
8. Pancreatic Cancer (AJCC 8th Edition)
| Stage | Criteria |
|---|---|
| Tis | Carcinoma in situ (PanIN-3) |
| T1 | ≤2 cm and confined to pancreas |
| T1a | ≤0.5 cm |
| T1b | >0.5–1 cm |
| T1c | >1–2 cm |
| T2 | >2–4 cm and confined to pancreas |
| T3 | >4 cm and confined to pancreas |
| T4 | Invades celiac axis, superior mesenteric artery, or common hepatic artery (regardless of size) — unresectable |
(Grainger & Allison's Diagnostic Radiology)
Quick Comparison Summary
| Cancer | T1 | T2 | T3 | T4 |
|---|---|---|---|---|
| Lung | ≤3 cm, no lobar bronchus/pleural invasion | >3–5 cm or visceral pleura/bronchus | >5–7 cm or chest wall/pericardium | >7 cm or invades mediastinum/carina |
| Breast | ≤20 mm | 20–50 mm | >50 mm | Chest wall or skin involvement |
| Colorectal | Into submucosa | Into muscularis propria | Through muscularis into pericolorectal fat | Through peritoneum or into adjacent organ |
| Oral cavity | ≤2 cm, DOI <5 mm | 2–4 cm or DOI 5–10 mm | >4 cm or DOI >10 mm | Adjacent structures |
| Bladder | Lamina propria | Muscularis propria | Perivesical fat | Adjacent organs/pelvic wall |
| Prostate | Clinically occult | Confined to prostate | Capsular extension | Fixed/invades rectum or sphincter |
| Pancreas | ≤2 cm in pancreas | 2–4 cm in pancreas | >4 cm in pancreas | Involves celiac/SMA |
Sources:
- Schwartz's Principles of Surgery, 11e — General TNM, Breast, Colorectal
- Fishman's Pulmonary Diseases & Disorders — Lung (8th edition TNM)
- K.J. Lee's Essential Otolaryngology — Head & Neck (Oral cavity, Oropharynx, Hypopharynx)
- Sabiston Textbook of Surgery, 21e — Bladder
- Campbell-Walsh-Wein Urology — Bladder, Prostate
- Robbins & Cotran Pathologic Basis of Disease — Prostate
- Grainger & Allison's Diagnostic Radiology — Pancreas
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