Lung Cancer Staging

TIP ... The Glossary has more information on the medical and scientific terms you'll see in this section.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body.

Doctors use diagnostic tests to determine the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosisThe likely outcome or course of a disease; the chance of recovery or recurrence. There are different stage descriptions for different types of cancer.

The stage of both small cell and non-small cell lung cancer is described by a number, zero (0) through four (Roman numerals I through IV are used). One way to determine the staging of lung cancer is to find out whether the cancer can be completely removed by a surgeon. To completely remove the lung cancer, the surgeon must remove the cancer along with the surrounding, normal lung tissue. Small cell lung cancerA fast-growing cancer that forms in tissues of the lung and can spread to other parts of the body; named "small" for how the cancer cells look under a microscope is also sometimes described as limited-stageCancer that is in the lung where it started and may have spread to the area between the lungs or to the lymph nodes above the collarbone or extensive-stageCancer that has spread widely throughout a lung, to the other lung, to lymph nodes on the other side of the chest, or to distant organs, which are less specific descriptions.

Note: You may also hear about the TNM classification, because the stages below have been developed based on a combination of:

T:  The size of the primary tumorAn abnormal mass of tissue that results when cells divide more than they should or do not die when they should
N:  Whether and how regional lymph nodesA rounded mass of lymphatic tissue surrounded by a capsule of connective tissue are affected by the cancer
M:  Whether there is distant metastasisThe spread of cancer from the primary site, or place where it started, to other places in the body

The stage of lung cancer is described by a number, zero through 4 (Roman numerals I through IV are usually used).

Stage 0

This is called in situ disease, meaning the cancer is “in place” and has not invaded nearby tissues and spread outside the lung.

Lung cancer: stage 0

Stage I

A stage one (I) lung cancer is a small tumor that has not spread to any lymph nodesA rounded mass of lymphatic tissue surrounded by a capsule of connective tissue. Lymph nodes filter lymph, the clear fluid that carries cells to fight infections and other diseases, and store lymphocytes (white blood cells), making it possible for a surgeon to completely remove it if the patient is healthy enough. Stage I is divided into two substages: stage IA and stage IB, based on the size of the tumor. Smaller tumors, such as those less than 3 centimeters (cm) wide, are stage IA, and slightly larger ones (more than 3 cm but less than 5 cm wide) are stage IB.

Lung cancer: stage Ia

Lung cancer: stage Ib

Stage II

Stage two (II) lung cancer is divided into two substages: stage IIA and stage IIB. A stage IIA lung cancer describes a small tumor (less than 5 cm wide) that has spread to the nearby lymph nodes, or a slightly larger tumor (larger than 5 cm but less than 7 cm wide) that has not spread to the nearby lymph nodes. (Click on the image to see it larger.)

Lung cancer: stage IIa

Stage IIB lung cancer describes a slightly larger tumor (larger than 5 cm but less than 7 cm wide) that has spread to the lymph nodes or a larger tumor (more than 7 cm wide) that may or may not have invaded nearby structures in the lung but has not spread to the lymph nodes. (Click on the image to see it larger.)

Lung cancer: stage IIb

Sometimes stage II tumors can be removed with surgery, and other times other treatments are needed.

Stage III

Stage three (III) lung cancers are classified as either stage IIIA or stage IIIB. For many stage IIIA cancers and nearly all stage IIIB cancers, the tumor is difficult, and sometimes impossible, to remove through surgery alone. For example, the lung cancer may have spread to the lymph nodes located in the center of the chest, which is outside the lung. Or the tumor may have invaded nearby structures in the lung. Patients with stage III cancers will usually need a combination of at least two treatments, such as surgery, chemotherapy , or radiation. (Click on the images to see them larger.)

Lung cancer: stage IIIa

Lung cancer: stage IIIb

Stage IV

Stage four (IV) means the lung cancer has spread to any or all of the following:

  • The opposite lung
  • The fluid surrounding the lung or the heart
  • Distant parts of the body by way of the bloodstream

Once released in the blood, cancer can spread anywhere in the body, but it is more likely to spread to the brain, bones, liver, and adrenal glands. It is classified as stage IVA when the cancer has spread within the chest and IVB when it has spread outside of the chest.

Lung cancer: stage IV

In general, surgery is not successful for stage IV lung cancers. Lung cancer can also be impossible to remove if it has spread to the lymph nodes above the collarbone, or if the cancer has grown into vital structures within the chest, such as the heart, large blood vessels, or the main breathing tubes leading to the lungs. The doctor will recommend other treatment options.

Recurrence

Recurrent lung cancerLung cancer that has come back after a period of time during which the cancer could not be detected. The lung cancer may come back in the lung near the original tumor, in lymph nodes or in a distant organ. is lung cancer that has come back after treatment. If there is a recurrence, the cancer may need to be staged again (called restaging) using the system above. Usually, patients with recurrent cancer are treated like patients with stage IV cancer.

Prognosis

The type and stage of lung cancer and the patient’s overall health influence prognosis. Although lung cancer is treatable at any stage, only certain stages of lung cancer can be cured.

Doctors measure a patient’s general strength and health by using an index known as performance statusA measure of how well a patient is able to perform ordinary tasks and carry out daily activities. Patients who are strong enough to go about their daily activities without assistance and work outside the home can safely receive chemotherapyTreatment with drugs that kill cancer cells, radiation therapyThe use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors, and/or surgery. Treatment may not be as effective for patients with bone or liver metastasesThe spread of cancer from the primary site, or place where it started, to other places in the body from lung cancer, excessive weight loss, ongoing cigarette use, or pre-existing medical conditions, such as heart disease or emphysema.

It is important to note that a patient’s age has never been useful in predicting whether that patient will benefit from treatment. The average age of patients with lung cancer in the United States is 71. A patient’s age should never be used as the only reason for deciding what treatment is best, especially for older patients who are otherwise physically fit and have no medical problems besides lung cancer.

Information about the cancer’s stage will help the doctor recommend a treatment plan. 

Updated February 3, 2016.


Text used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer Science+Business Media. Any citation or quotation of this material must be credited to the AJCC as its primary source. The inclusion of this information herein does not authorize any reuse or further distribution without the expressed, written permission of Springer, on behalf of the AJCC.

print