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What do you need to know about lung cancer staging?

The system of staging was developed by oncologists for a few reasons, including to help you and your oncology team understand how advanced the lung cancer is and to help plan the appropriate treatments for that particular stage. Knowing your stage is important because it helps you also make more informed decisions with your treatment team and your loved ones.

There are 2 methods of staging, one for non-small cell lung cancer (NSCLC) and one for small cell lung cancer (SCLC). It might be easier to look at the staging process for each kind of lung cancer separately.

stages

Lung Anatomy

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Non-small cell lung cancer (NSCLC)

NSCLC is the most common form of lung cancer. It includes three sub-types: adenocarcinoma, large cell carcinoma, and squamous cell carcinoma.

Stages

Description

Occult Stage Lung cancer cells can be found in some bodily fluids, but a tumor can’t be seen in the lung in imaging tests.
Stage 0 Cancer cells are found only in the inner lining of the lung but the tumor hasn’t grown through the lining.
Stage IA The tumor is no larger than 3 centimeters in diameter. There is no surrounding tissue or lymph node involvement.
Stage IB
  • The tumor has not reached the lymph nodes and has one of the following characteristics:
    • The cancer has spread to the main bronchus
    -or-
    • The cancer has spread to the inner part of the membrane that covers the lung called the pleura
    -or-
    • The tumor is no larger than 3 centimeters in diameter
Stage IIA The tumor is no larger than 3 centimeters in diameter but cancer cells are found in the lymph nodes.
Stage IIB
  • The tumor has one of the following characteristics:
    • The cancer has not yet reached the lymph nodes but has grown into the chest wall, diaphragm, pleura, main bronchus, or tissue that surrounds the heart.
    -or-
    • The cancer is in the lymph nodes, is 3 centimeters in diameter, and it has spread to the main bronchus or the pleura (the membrane covering the lungs).
Stage IIIA The tumor can be any size, and cancer is present in lymph nodes near the lungs and between the lungs on the same side of the chest as the lung tumor.
Stage IIIB The tumor can be any size, and cancer is present in lymph nodes, on the opposite side of the chest from the tumor. Cancer has possibly spread to nearby organs, too.
Stage IV (often referred to as metastatic)
  • Defined by one or more of the following:
    • The cancer is in more than one lobe of the same lung
    • The cancer is in both lungs
    • The cancer is in other parts of the body such as the bones, liver, or brain

Potential Treatments

Below is a list of some treatments for lung cancer that your oncologist may prescribe. There are different treatment options, some of which can be used in combination with each other. Your oncology team will work with you to discuss these options and prescribe an appropriate treatment plan, keeping in mind your stage of disease and past treatments.

  • Surgery
  • Radiation therapy
    • External radiation therapy
    • Internal radiation therapy
  • Chemotherapy
    • Combination chemotherapy
  • Laser therapy
  • Targeted therapy
  • Enrollment in clinical trial
 

Small cell lung cancer (SCLC)

SCLC is a less common form of lung cancer but tends to grow faster.

Stages

Description

Potential Treatments

Limited-stage This term means the cancer is either still in the lung and it may have spread between the lungs or to nearby collarbone lymph nodes.
  • Chemotherapy
  • Combination of radiation and chemotherapy
  • Surgery plus chemotherapy
  • Surgery plus chemotherapy and radiation
Extensive-stage The cancer has spread to other parts of the body outside of the lung and lymph nodes above the collarbone.
  • Combination chemotherapy
  • Radiation therapy
  • Clinical trial
 

Stages

Description

Occult Stage
Lung cancer cells can be found in some bodily fluids, but a tumor can’t be seen in the lung in imaging tests.
Stage 0
Cancer cells are found only in the inner lining of the lung but the tumor hasn’t grown through the lining.
Stage IA
The tumor is no larger than 3 centimeters in diameter. There is no surrounding tissue or lymph node involvement.

Stage IB
  • The tumor has not reached the lymph nodes and has one of the following characteristics:
    • The cancer has spread to the main bronchus
    -or-
    • The cancer has spread to the inner part of the membrane that covers the lung called the pleura
    -or-
    • The tumor is no larger than 3 centimeters in diameter
Stage IIA
The tumor is no larger than 3 centimeters in diameter but cancer cells are found in the lymph nodes.

Stage IIB
  • The tumor has one of the following characteristics:
    • The cancer has not yet reached the lymph nodes but has grown into the chest wall, diaphragm, pleura, main bronchus, or tissue that surrounds the heart.
    -or-
    • The cancer is in the lymph nodes, is 3 centimeters in diameter, and it has spread to the main bronchus or the pleura (the membrane covering the lungs).
Stage IIIA
The tumor can be any size, and cancer is present in lymph nodes near the lungs and between the lungs on the same side of the chest as the lung tumor.

Stage IIIB
The tumor can be any size, and cancer is present in lymph nodes, on the opposite side of the chest from the tumor. Cancer has possibly spread to nearby organs, too.
Stage IV (often referred to as metastatic)
  • Defined by one or more of the following:
    • The cancer is in more than one lobe of the same lung
    • The cancer is in both lungs
    • The cancer is in other parts of the body such as the bones, liver, or brain

Potential Treatments

Below is a list of some treatments for lung cancer that your oncologist may prescribe. There are different treatment options, some of which can be used in combination with each other. Your oncology team will work with you to discuss these options and prescribe an appropriate treatment plan, keeping in mind your stage of disease and past treatments.

  • Surgery
  • Radiation therapy
    • External radiation therapy
    • Internal radiation therapy
  • Chemotherapy
    • Combination chemotherapy
  • Laser therapy
  • Targeted therapy
  • Enrollment in clinical trial
 

Small cell lung cancer (SCLC)

SCLC is a less common form of lung cancer but tends to grow faster.

Limited-stage
This term means the cancer is either still in the lung and it may have spread between the lungs or to nearby collarbone lymph nodes.
 

Potential Treatments

  • Chemotherapy
  • Combination of radiation and chemotherapy
  • Surgery plus chemotherapy
  • Surgery plus chemotherapy and radiation
Extensive-stage
The cancer has spread to other parts of the body outside of the lung and lymph nodes above the collarbone.
 

Potential Treatments

  • Combination chemotherapy
  • Radiation therapy
  • Clinical trial

"My brother was diagnosed with a 5 cm nodule on his left lung. They also found cancer in his hip and vertebrae. Are the hip and back tumors from the lung cancer or different cancers?"

Lung cancer is a cancer that starts in the lung. At some point, cells from the cancer may break away from the original tumor and spread or “metastasize,” using the blood or lymphatic system to travel to distant sites. If the tumors on the hip or vertebrae contain the same type of cells as the lung tumor, your oncologist would likely call this lung cancer “metastatic lung cancer,” which is defined as the spread of cancer from the primary site (place where it started) to other places in the body.

 

What are we learning about lung cancer and the immune system?

NEXT: Lung Cancer and the Immune System

 

When cancer advances or returns

No one ever wants to hear that their cancer has advanced to the next stage. Or that cancer has returned after one or more clean scans. But cancer—including lung cancer—can be a long journey. Understand the challenges in the journey and do your best to try and remain hopeful and positive.

 

What's new in lung cancer?

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Reflect 3 good things that happened today.

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