Understanding Lung Cancer Stages

Olivia Rothgeb, Marketing and Communications Intern

Navigating your diagnosis

For people with lung cancer, one of the first steps in navigating their diagnosis comes from understanding what their lung cancer stage means for the future of their treatment. After someone is diagnosed with lung cancer, health care providers go through a process called “staging.” A “stage” is used to describe where a person’s lung cancer is located, where and if the cancer has spread, and whether or not the cancer is affecting other areas of the body. LUNGevity’s Dr. Amy Moore encourages people with lung cancer to understand the meaning of their stage so that they can play an active role alongside their healthcare team to find the right treatment.

When is lung cancer staged?

  • First staging (clinical staging): When you are first diagnosed with lung cancer, your doctor will use first staging (also known as the clinical stage) as a basis for evaluating your response to treatment. First staging uses the results from initial imaging tests and biopsies as a point of reference for your cancer either getting better or worse.
  • Second staging (surgical staging): After receiving any surgical treatments for your cancer, doctors will conduct an evaluation known as second staging (or surgical staging). Second staging adds to what your doctors already know about your lung cancer from your previous imaging tests and biopsies by examining the tumors in your lungs firsthand.
  • Restaging: If your lung cancer comes back after being treated, doctors will need to go through the process of staging your cancer again (known as restaging).

Non-Small Cell Lung Cancer (NSCLC) Staging 

Like other types of cancer, non-small cell lung cancer (NSCLC) uses the “TNM Staging System” to describe information about your cancers traits. This system helps health care providers quickly communicate information about the status of your cancer’s tumor (T), node (N), and metastasis (M).

  • T is used to describe the size of your cancer’s main tumor. 
  • N informs if the cancer has spread to the nearby lymph nodes
  • M indicates if the cancer has metastasized (spread) to other parts of the body. 

In the TNM system, stages range numerically from zero (0) to four (IV). These numbers rise in rank, from lowest to highest, based on the severity and spread of a person's lung cancer. In other words, the higher the stage number, the more advanced a person’s cancer has become.

  • Stage 0: Lung cancer cells have been found but have not spread.
  • Stage I: The lung cancer cells have created a small tumor in one lung.
  • Stage II: The tumor in the lung has continued to grow. 
  • Stage III: More tumors are found in the same lung separately from the main tumor.
  • Stage IV: Tumors have spread to both lungs and potentially the lymph nodes and other areas of the body. 

From here, each stage is also divided into substages, which provides even more detailed information about cancer’s severity and spread. Read more about NSCLC stages and substages here.

Small Cell Lung Cancer (SCLC) Staging

Small cell lung cancer (SCLC) uses a two-stage system which categorizes stages as either “limited” or “extensive.” 

  • Limited Stage:  describes cancer that is in only one lung, the tissues between the lungs, and in nearby lymph nodes. One third of SCLC diagnoses are limited stage.
  • Extensive Stage: describes cancer that has spread to both lungs, lymph nodes on both sides of the chest, and to distant organs. Extensive stage SCLC makes up two-thirds of SCLC diagnoses.

Read more information about SCLC stages here.

“There are treatments for all stages, but finding the right treatment depends on the stage of your disease,” says Dr. Moore. “Whether or not your cancer is in an early or late stage can affect your treatment options going forward. This can include surgery, radiation, chemotherapy, immunotherapy, or targeted therapies, either alone or in various combinations.” 

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