Understanding How Lung Cancer Staging Works - Healthline

• Doctors evaluate the size, location, and spread of tumors to determine what stage the cancer is.
• Lung cancer is identified by numbered stages 0 through 4, as it progresses, with subcategories within each stage.
• The treatment for lung cancer depends on the stage.

After you receive a lung cancer diagnosis, your doctor will want to find out where the cancer is in your body. This process is called staging.

Learning whether and where your cancer has spread can help your doctor find the right treatment for you. Your stage also helps provide an outlook.

Your doctor will assign your lung cancer a clinical stage based on the results of:

• your physical exam
• your biopsy
• imaging tests such as a computed tomography (CT) scan and magnetic resonance imaging (MRI)

If you have surgery, your doctor will also give your cancer a pathological or surgical stage. The doctor finds this stage by examining the tissue removed during the biopsy.

Lung cancers are divided into two main types: small cell lung cancers and non-small cell lung cancers (NSCLC). As many as 85 percent of lung cancer cases are NCSLC.

The five general stages for lung cancer are numbered from 0 to 4.

• Stage 0 indicates a small tumor that hasn't spread into deeper lung tissues. Doctors also call this carcinoma in situ (CIS).
• Stage 1 lung cancer is limited to the lungs and hasn't spread to the lymph nodes.
• Stage 2 lung cancer may have spread to the nearby lymph nodes.
• Stage 3 lung cancer has spread further into the lymph nodes and the middle of the chest.
• Stage 4 cancer has spread to both lungs, the fluid around the lungs, or to another part of the body.

Lung cancer can also be detected in samples before it presents as a tumor. This is known as an "occult" or "hidden" cancer.

Each general stage also gets a number and letter (A or B). Cancer with a lower number or the letter A has spread less than cancer with a higher number or the letter B.

Doctors stage lung cancer with a grouping system called TNM, which is based on:

• Tumor (T): How big the main tumor in the lung is and whether it has grown into any nearby structures or organs.
• Node (N): Whether the cancer has spread to nearby lymph nodes.
• Metastasis (M): Whether the cancer has spread (metastasized) to distant sites like the liver or brain.

The numbers after each of these letters also show how far your cancer has spread. The higher the number, the more it has spread.

Together, the stage and stage grouping tell your doctor where your cancer is in your body. People who have the same stage and stage grouping will usually get the same treatments. This staging is typically used for NSCLC.

General lung cancer stages

Small cell lung cancer stages

Small cell lung cancer is diagnosed as either limited stage or extensive stage. Your doctor might also use the TNM staging system.

Limited stage lung cancer has only reached one part of the chest.

Extensive stage lung cancer may have metastasized to the lymph nodes or other parts of the body.

Lung cancer is curable if you catch it early. The cure rates for stage 0 and stage 1 lung cancers are 80 to 90 percent. People often receive a diagnosis when their lung cancer is in a later stage.

Once the cancer has spread, it is harder to cure. Treatments can slow but not stop it. Immunotherapy has been shown to extend survival in people with NSCLC over people receiving standard courses of chemotherapy.

New treatments are improving the outlook for people with lung cancer. You may be able to try one of these treatments by enrolling in a clinical trial.

The treatment for lung cancer depends on the stage.

Stage 0 lung cancer is usually curable with surgery to remove part of the lobe of one lung. This surgery is called wedge resection or segmentectomy.

Stage 1 lung cancer is also curable with surgery to remove part of a lobe (lobectomy) or a whole lobe of the affected lung. You might get chemotherapy or radiation after surgery to prevent the cancer from coming back.

Stage 2 lung cancer treatment also involves surgery to remove a lobe or the whole lung. Any lymph nodes that might have cancer in them are also removed. You may get chemotherapy or radiation after surgery to remove any cancer cells left behind after surgery.

Stage 3 may involve surgery if your doctor thinks your cancer can be removed. This is usually in combination with chemotherapy, radiation, immunotherapy, or multiple of these treatments.

Stage 4 lung cancer has already spread by the time it's diagnosed. Surgery to remove the tumor that has spread may be part of your treatment. You'll also likely get body-wide treatments, such as chemotherapy, immunotherapy, or targeted therapy.

The staging system shows how large a lung cancer is and where in your body it has spread. Knowing your cancer stage can help your doctor find the right treatment, and inform your outlook.

If you have any questions about your stage or what it means for your prognosis, ask your doctor. Having a late-stage cancer can cause fear and anxiety. If you're experiencing these feelings, seek help and support from a therapist or counselor.

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