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Cancer Staging

Key Points

• Staging describes the extent or severity of a person’s cancer. Knowing the stage of 

disease helps the doctor plan treatment and estimate the person’s prognosis (see 

Question 1).

• Staging systems for cancer have evolved over time and continue to change as 

scientists learn more about cancer (see Question 2). 

• The TNM staging system is based on the extent of the tumor (T), whether cancer 

cells have spread to nearby (regional) lymph nodes (N), and whether distant (to 

other parts of the body) metastasis (M) has occurred (see Question 3).

• Most tumors can be described as stage 0, stage I, stage II, stage III, or stage IV 

(see Question 3).

• Physical exams, imaging procedures, laboratory tests, pathology reports, and 

surgical reports provide information to determine the stage of the cancer (see 

Question 5).

1. What is staging?

Staging describes the severity of a person’s cancer based on the extent of the original 

(primary) tumor and whether or not cancer has spread in the body. Staging is important for 

several reasons:

• Staging helps the doctor plan the appropriate treatment.

• The stage can be used to estimate the person’s prognosis.

• Knowing the stage is important in identifying clinical trials that may be suitable for a particular

patient.

• Staging helps health care providers and researchers exchange information about patients; it also 

gives them a common terminology for evaluating the results of clinical trials and comparing the 

results of different trials.

Staging is based on knowledge of the way cancer progresses. Cancer cells grow and divide without 

control or order, and they do not die when they should. As a result, they often form a mass of tissue

called a tumor. As the tumor grows, it can invade nearby tissues and organs. Cancer cells can also 

break away from the tumor and enter the bloodstream or the lymphatic system. By moving through 

the bloodstream or lymphatic system, cancer cells can spread from the primary site to lymph nodes or 

to other organs, where they may form new tumors. The spread of cancer is called metastasis.

2. What are the common elements of staging systems?

Staging systems for cancer have evolved over time. They continue to change as scientists learn more 

about cancer. Some staging systems cover many types of cancer; others focus on a particular type. 

The common elements considered in most staging systems are as follows:

• Site of the primary tumor.

• Tumor size and number of tumors.

• Lymph node involvement (spread of cancer into lymph nodes).

• Cell type and tumor grade* (how closely the cancer cells resemble normal tissue cells).

• The presence or absence of metastasis.
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*Information about tumor grade is available in the National Cancer Institute (NCI) fact sheet Tumor Grade: 

Questions and Answers, which can be found at 

http://www.cancer.gov/cancertopics/factsheet/Detection/tumor-grade on the Internet. 

3. What is the TNM system?

The TNM system is one of the most widely used staging systems. This system has been accepted by the 

International Union Against Cancer (UICC) and the American Joint Committee on Cancer (AJCC). Most 

medical facilities use the TNM system as their main method for cancer reporting. PDQ®, NCI’s comprehensive 

cancer information database, also uses the TNM system. 

The TNM system is based on the extent of the tumor (T), the extent of spread to the lymph nodes (N), and 

the presence of distant metastasis (M). A number is added to each letter to indicate the size or extent of the 

primary tumor and the extent of cancer spread. 

Primary Tumor (T)

TX Primary tumor cannot be evaluated

T0 No evidence of primary tumor 

Tis Carcinoma in situ (CIS; abnormal cells are present but have not spread to neighboring

tissue; although not cancer, CIS may become cancer and is sometimes called preinvasive 

cancer)

T1, T2, T3, T4 Size and/or extent of the primary tumor

Regional Lymph Nodes (N)

NX Regional lymph nodes cannot be evaluated

N0 No regional lymph node involvement

N1, N2, N3 Involvement of regional lymph nodes (number of lymph nodes and/or extent of spread)

Distant Metastasis (M)

MX Distant metastasis cannot be evaluated

M0 No distant metastasis

M1 Distant metastasis is present

For example, breast cancer classified as T3 N2 M0 refers to a large tumor that has spread outside the breast 

to nearby lymph nodes but not to other parts of the body. Prostate cancer T2 N0 M0 means that the tumor is 

located only in the prostate and has not spread to the lymph nodes or any other part of the body. 

For many cancers, TNM combinations correspond to one of five stages. Criteria for stages differ for different 

types of cancer. For example, bladder cancer T3 N0 M0 is stage III, whereas colon cancer T3 N0 M0 is 

stage II. 

Stage Definition

Stage 0 Carcinoma in situ.

Stage I, Stage II, and Stage III Higher numbers indicate more 

extensive disease: Larger tumor size 

and/or spread of the cancer beyond 

the organ in which it first developed to 

nearby lymph nodes and/or organs 

adjacent to the location of the primary 

tumor.

Stage IV The cancer has spread to another 

organ(s).

Question 6 describes sources of additional information about staging for specific types of cancer.

4. Are all cancers staged with TNM classifications?

Most types of cancer have TNM designations, but some do not. For example, cancers of the brain and spinal 

cord are staged according to their cell type and grade. Different staging systems are also used for many 
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cancers of the blood or bone marrow, such as lymphomas. The Ann Arbor staging classification is commonly 

used to stage lymphomas and has been adopted by both the AJCC and the UICC. However, other cancers of 

the blood or bone marrow, including most types of leukemia, do not have a clear-cut staging system. Another 

staging system, developed by the International Federation of Gynecology and Obstetrics, is used to stage 

cancers of the cervix, uterus, ovary, vagina, and vulva. This system uses the TNM format. Additionally, 

childhood cancers are staged using either the TNM system or the staging criteria of the Children’s Oncology 

Group, which conducts pediatric clinical trials.

Many cancer registries, such as NCI’s Surveillance, Epidemiology, and End Results Program (SEER), use 

summary staging. This system is used for all types of cancer. It groups cancer cases into five main 

categories:

• In situ: Abnormal cells are present only in the layer of cells in which they developed.

• Localized: Cancer is limited to the organ in which it began, without evidence of spread.

• Regional: Cancer has spread beyond the primary site to nearby lymph nodes or organs and tissues.

• Distant: Cancer has spread from the primary site to distant organs or distant lymph nodes.

• Unknown: There is not enough information to determine the stage.

5. What types of tests are used to determine stage?

The types of tests used for staging depend on the type of cancer. Tests include the following:

• Physical exams are used to gather information about the cancer. The doctor examines the body by 

looking, feeling, and listening for anything unusual. The physical exam may show the location and size of 

the tumor(s) and the spread of the cancer to the lymph nodes and/or to other organs.

• Imaging studies produce pictures of areas inside the body. These studies are important tools in 

determining stage. Procedures such as x-rays, computed tomography (CT) scans, magnetic resonance 

imaging (MRI) scans, and positron emission tomography (PET) scans can show the location of the cancer, 

the size of the tumor, and whether the cancer has spread. 

• Laboratory tests are studies of blood, urine, other fluids, and tissues taken from the body. For example, 

tests for liver function and tumor markers (substances sometimes found in increased amounts if cancer is 

present) can provide information about the cancer. 

• Pathology reports may include information about the size of the tumor, the growth of the tumor into 

other tissues and organs, the type of cancer cells, and the grade of the tumor. A biopsy may be 

performed to provide information for the pathology report. Cytology reports also describe findings from 

the examination of cells in body fluids. 

• Surgical reports tell what is found during surgery. These reports describe the size and appearance of 

the tumor and often include observations about lymph nodes and nearby organs. 

6. How can a patient find more information about staging?

The doctor most familiar with a patient’s situation is in the best position to provide staging information for that 

person. For background information, PDQ contains cancer treatment summaries that describe the staging of 

each type of cancer. PDQ treatment summaries are available at http://www.cancer.gov/cancerinfo/pdq/ on

NCI’s Web site.

Information about cancer staging can also be obtained by calling NCI’s Cancer Information Service (CIS)

toll-free at 1–800–4–CANCER (1–800–422–6237). CIS information specialists also offer immediate online 

assistance through the LiveHelp link at http://www.cancer.gov/ on the Internet.

# # #
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Related NCI materials and Web pages:

• National Cancer Institute Fact Sheet 5.9, Tumor Grade: Questions and Answers

(http://www.cancer.gov/cancertopics/factsheet/detection/tumor-grade)

• National Cancer Institute Fact Sheet 5.18, Tumor Markers: Questions and Answers

(http://www.cancer.gov/cancertopics/factsheet/detection/tumor-markers)

• National Cancer Institute Fact Sheet 5.27, Interpreting Laboratory Test Results

(http://www.cancer.gov/cancertopics/factsheet/detection/laboratory-tests)

• National Cancer Institute Fact Sheet 6.20, Metastatic Cancer: Questions and Answers

(http://www.cancer.gov/cancertopics/factsheet/sites-types/metastatic)

• What You Need To Know AboutTM Cancer

(http://www.cancer.gov/cancertopics/wyntk/cancer)

How can we help?

We offer comprehensive research-based information for patients and their families, health professionals, cancer 

researchers, advocates, and the public.

• Call NCI’s Cancer Information Service at 1–800–4–CANCER (1–800–422–6237)

• Visit us at http://www.cancer.gov or http://www.cancer.gov/espanol

• Chat using LiveHelp, NCI’s instant messaging service, at http://www.cancer.gov/livehelp

• E-mail us at cancergovstaff@mail.nih.gov

• Order publications at http://www.cancer.gov/publications or by calling 1–800–4–CANCER

• Get help with quitting smoking at 1–877–44U–QUIT (1–877–448–7848)

This fact sheet was reviewed on 9/22/10