Conditions

Lung Cancer Stages

Of the two main types of lung cancer, small cell and non-small cell lung cancer, non-small cell lung cancer is the more common and slower growing of the two cancers. Doctors describe the stages of non-small cell lung cancer based on the size of the lung tumor and whether cancer has spread to the lymph nodes or other tissues.¹

General Information on Staging¹

The outlook (prognosis) for people with cancer depends, to a large extent, on the cancer's stage. The stage of cancer can be one of the most important factors in choosing treatment.

The stage of the cancer is determined by results of certain tests, such as: laboratory tests to analyze tissue, blood or urine; imaging tests such as MRI or a bone scan; and, endoscopic ultrasound (an endoscope – thin, tube-like instrument with a light and lens - is inserted into the body for viewing and taking pictures).

Staging is based on knowledge of how cancer develops. Cancer cells divide and grow to form a mass of tissue called a tumor. As the tumor grows, it can invade nearby organs and tissues. Cancer cells may also break away from the tumor and enter the bloodstream or lymphatic system. By moving through the bloodstream or lymphatic system, cancer can spread from the primary site to form new tumors in other organs. The spread of cancer is called metastasis.

Occult (hidden) stage - In the occult (hidden) stage, cancer cells are found in sputum (mucus coughed up from the lungs), but no tumor can be found in the lung by imaging or bronchoscopy (a procedure that examines the inside of the air passages and lungs), or the tumor is too small to be checked.

Stage 0 (carcinoma in situ) - In stage 0, abnormal cells are found in the lining of the airways. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I - In this stage, cancer has formed. Stage I is divided into stages IA and IB. In stage IA, the tumor is in the lung only and is 3 centimeters or smaller. In stage IB, cancer has not spread to the lymph nodes and one or more of the following is true:

• The tumor is between 3 to 5 centimeters.
• Cancer has spread to the main bronchus and is at least 2 centimeters below where the trachea joins the bronchus.
• Cancer has spread to the innermost layer of the membrane that covers the lung.
• Part of the lung has collapsed or developed pneumonitis (inflammation of the lung) in the area where the trachea joins the bronchus.

Stage II - Stage II is divided into stages IIA and IIB. In stage IIA, cancer has spread to lymph nodes on the same side of the chest as the tumor. The lymph nodes with cancer are within the lung or near the bronchus. Also, one or more of the following is true:

• The tumor is not larger than 5 centimeters.
• Cancer has spread to the main bronchus and is at least 2 centimeters below where the trachea joins the bronchus.
• Cancer has spread to the innermost layer of the membrane that covers the lung.
• Part of the lung has collapsed or developed pneumonitis (inflammation of the lung) in the area where the trachea joins the bronchus.

It is also possible in this stage that cancer has not spread to lymph nodes, but one or more of the following is true:

• The tumor is between 5 and 7 centimeters.
• Cancer has spread to the main bronchus and is at least 2 centimeters below where the trachea joins the bronchus.
• Cancer has spread to the innermost layer of the membrane that covers the lung.
• Part of the lung has collapsed or developed pneumonitis (inflammation of the lung) in the area where the trachea joins the bronchus.

In stage IIB, cancer has spread to nearby lymph nodes on the same side of the chest as the tumor. The lymph nodes with cancer are within the lung or near the bronchus. Also, one or more of the following is true:

• The tumor is between 5 and 7 centimeters.
• Cancer has spread to the main bronchus and is at least 2 centimeters below where the trachea joins the bronchus.
• Cancer has spread to the innermost layer of the membrane that covers the lung.
• Part of the lung has collapsed or developed pneumonitis (inflammation of the lung) in the area where the trachea joins the bronchus.

It is also possible in this stage that cancer has not spread to lymph nodes, but one or more of the following is true:

• The tumor is larger than 7 centimeters.
• Cancer has spread to the main bronchus (and is less than 2 centimeters below where the trachea joins the bronchus), the chest wall, the diaphragm, or the nerve that controls the diaphragm.
• Cancer has spread to the membrane around the heart or lining the chest wall.
• The whole lung has collapsed or developed pneumonitis (inflammation of the lung).
• There are one or more separate tumors in the same lobe of the lung.

Stage IIIA - In this stage, cancer has spread to lymph nodes on the same side of the chest as the tumor. The lymph nodes with cancer are near the sternum (chest bone) or where the bronchus enters the lung. Also: the tumor may be any size, part of the lung (where the trachea joins the bronchus) or the whole lung may have collapsed or developed pneumonitis (inflammation of the lung), there may be one or more separate tumors in the same lobe of the lung. Cancer may have spread to any of the following:

• Main bronchus, but not where the trachea joins the bronchus (a passage of airway in the respiratory tract that conducts air into the lungs)
• Chest wall
• Diaphragm and the nerve that controls it
• Membrane around the lung or lining the chest wall
• Membrane around the heart

It is also possible in this stage that: cancer has spread to lymph nodes on the same side of the chest as the tumor; the lymph nodes with cancer are within the lung or near the bronchus; the tumor may be any size; the whole lung may have collapsed or developed pneumonitis (inflammation of the lung); there may be one or more separate tumors in any of the lobes of the lung with cancer; or, cancer may have spread to any of the following:

• Main bronchus, but not where the trachea joins the bronchus
• Chest wall
• Diaphragm and the nerve that controls it
• Membrane around the lung or lining the chest wall
• Heart or the membrane around it
• Major blood vessels that lead to or from the heart
• Trachea
• Esophagus
• Nerve that controls the larynx (voice box)
• Sternum (chest bone) or backbone
• Carina (where the trachea joins the bronchi)

It is also possible in this stage that cancer has not spread to the lymph nodes, but the tumor may be any size; or, cancer has spread to any of the following:

• Heart
• Major blood vessels that lead to or from the heart
• Trachea
• Esophagus
• Nerve that controls the larynx (voice box)
• Sternum (chest bone) or backbone
• Carina (where the trachea joins the bronchi)

Stage IIIB - In this stage, cancer has spread to lymph nodes above the collarbone or to lymph nodes on the opposite side of the chest as the tumor. Also, the tumor may be any size, part of the lung (where the trachea joins the bronchus) or the whole lung may have collapsed or developed pneumonitis (inflammation of the lung), there may be one or more separate tumors in any of the lobes of the lung with cancer. Or, cancer may have spread to any of the following:

• Main bronchus
• Chest wall
• Diaphragm and the nerve that controls it
• Membrane around the lung or lining the chest wall
• Heart or the membrane around it
• Major blood vessels that lead to or from the heart
• Trachea
• Esophagus
• Nerve that controls the larynx (voice box)
• Sternum (chest bone) or backbone
• Carina (where the trachea joins the bronchi)

It is also possible in this stage that: cancer has spread to lymph nodes on the same side of the chest as the tumor; the lymph nodes with cancer are near the sternum (chest bone) or where the bronchus enters the lung; the tumor may be any size; there may be separate tumors in different lobes of the same lung; or, cancer has spread to any of the following:

• Heart
• Major blood vessels that lead to or from the heart
• Trachea
• Esophagus
• Nerve that controls the larynx (voice box)
• Sternum (chest bone) or backbone
• Carina (where the trachea joins the bronchi)

Stage IV - In this stage, the tumor may be any size and cancer may have spread to lymph nodes. One or more of the following is true:

• There are one or more tumors in both lungs.
• Cancer is found in fluid around the lungs or the heart.
• Cancer has spread to other parts of the body, such as the brain, liver, adrenal glands, kidneys, or bone.

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¹General Information About Non-Small Cell Lung Cancer [Internet]. National Cancer Institute. Available from: http://www.cancer.gov/cancertopics/pdq/treatment/non-small-cell-lung/Patient.

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