After a lung cancer diagnosis, the oncologist will review data from images and pathology reports to determine the extent of the cancer. As with most cancers, staging is an important part of determining which treatments are most likely to work best. In general, earlier-stage lung cancers are more likely to have the best outcomes. 

Stages by Type of Lung Cancer

After determining a diagnosis of small cell lung cancer (SCLC) or non-small cell lung cancer (NSCLC), additional testing determines if the cancer cells have spread within your chest or to other parts of your body. Information gathered determines the stage of the disease and the treatment plan. The staging for small cell lung cancer is different from non-small cell lung cancer. 

Staging Small Cell Lung Cancer

One or more of the following tests and procedures may be used in the small cell lung cancer staging process: 

  • Laboratory tests.
  • Bone marrow aspiration and biopsy. This is the removal of bone marrow, blood, and a small piece of bone, which is done by inserting a hollow needle into the hip bone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
  • MRI (magnetic resonance imaging).
  • Endoscopic ultrasound (EUS).
  • Lymph node biopsy. This involves the removal of all or part of a lymph node, which will be viewed under a microscope to look for cancer cells by a pathologist.
  • Radionuclide bone scan.

Stages of Small Cell Lung Cancer:

Small cell lung cancer falls under one of two categories: limited and extensive.  

In limited-stage small cell lung cancer, cancer is found in one lung, the tissues between the lungs, and nearby lymph nodes only. Alternatively, extensive-stage small cell lung cancer has spread outside of the lung in which it began or to other parts of the body.

 

Staging Non-Small Cell Lung Cancer

There are times where additional tests and procedures may be used in the non-small cell lung cancer staging process as well. These might include: 

  • Lymph node biopsy.
  • Mediastinoscopy. This is a surgical procedure that looks at the organs, tissues, and lymph nodes between the lungs for abnormal areas. It involves your oncologist making an incision (cut) at the top of the breastbone, and then inserting a mediastinoscope into the chest. A mediastinoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer.
  • Anterior mediastinotomy. This is a surgical procedure used to look at the organs and tissues between the lungs and between the breastbone and heart for abnormal areas. Sometimes, it is called the Chamberlain procedure.

Stages of Non-Small Cell Lung Cancer:

The staging system most often used for lung cancer is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of information:

  • The size and extent of the main tumor (T)
  • The spread to nearby (regional) lymph nodes (N)
  • The spread (metastasis) (M) to other organs of the body

The cancer care team will use the data collected to determine the T, N, and M which then correlates with a stage of cancer. 

Because staging for NSCLC can be incredibly complex, it is important to ask your RMCC oncologist to explain it in a way you understand. The stages of NSCLC is as follows: 

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, or the primary tumor is too small to be checked.

Stage 0 (Carcinoma in Situ)

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

Stage I

Cancer has formed. Stage I is divided into stages IA and IB:

Stage IA

The tumor is in the lung only and is 3 centimeters or smaller.

lung-cancer-stage1A-1

Stage IB

One or more of the following is true:

  • The tumor is larger than 3 centimeters.
  • Cancer has spread to the main bronchus of the lung, and is at least 2 centimeters from the carina (where the trachea joins the bronchi).
  • Cancer has spread to the innermost layer of the membrane that covers the lungs.
  • The tumor partly blocks the bronchi or bronchioles and part of the lung has collapsed or developed pneumonitis (inflammation of the lung).

lung-cancer-stage1B

 

Stage II

Stage IIA:

The tumor is larger than 4 centimeters but not larger than 5 centimeters. Cancer has not spread to the lymph nodes and one or more of the following may be found: (a) cancer has spread to the main bronchus but has not spread to the carina; and/or (b) cancer has spread to the inner membrane that covers the lung; and/or (c) part of the lung or the whole lung has collapsed or has pneumonitis (inflammation of the lung).

lung-cancer-stage2A

Stage IIB (1)

The primary tumor is 5 centimeters or smaller and cancer has spread to the lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus.

lung-cancer-stage2B1

Stage IIB (2)

Cancer has not spread to lymph nodes and one or more of the following is found: (a) the primary tumor is larger than 5 centimeters but not larger than 7 centimeters; and/or (b) there are one or more separate tumors in the same lobe of the lung as the primary tumor; and/or cancer has spread to any of the following: (c) the chest wall and/or the membrane that lines the inside of the chest wall, (d) the nerve that controls the diaphragm, and/or (e) the outer layer of tissue of the sac around the heart.

lung-cancer-stage2B2

Stage III Lung Cancer

Stage IIIA (1)

The tumor is 5 centimeters or smaller and cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are around the trachea or aorta, or where the trachea divides into the bronchi. Also, one or more of the following may be found: (a) cancer has spread to the main bronchus, but has not spread to the carina; and/or (b) cancer has spread to the inner membrane that covers the lung; and/or (c) part of the lung or the whole lung has collapsed or has pneumonitis (inflammation of the lung)

lung-cancer-stage3A1

Stage IIIA Lung Cancer (2)

Cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus. Also, one or more of the following is found: (a) the tumor is larger than 5 centimeters but not larger than 7 centimeters; and/or (b) there are one or more separate tumors in the same lobe of the lung as the primary tumor; and/or cancer has spread to any of the following: (c) the chest wall and/or the membrane that lines the inside of the chest wall, (d) the nerve that controls the diaphragm, and/or (e) the outer layer of tissue of the sac around the heart.

lung-cancer-stage3A2

Stage IIIA (3)

Cancer may have spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus. Also, one or more of the following is found: (a) the primary tumor is larger than 7 centimeters; and/or (b) there are one or more separate tumors in a different lobe of the lung with the primary tumor; and/or the tumor is any size and cancer has spread to any of the following: (c) trachea, (d) carina, (e) esophagus, (f) breastbone or backbone, (g) diaphragm, (h) heart, (i) major blood vessels that lead to or from the heart (aorta or vena cava), or the nerve that controls the larynx.

lung-cancer-stage3A3

Stage IIIB (1)

The primary tumor is 5 centimeters or smaller and cancer has spread to lymph nodes above the collarbone on the same side of the chest as the primary tumor or to any lymph nodes on the opposite side of the chest as the primary tumor. Also, one or more of the following may be found: (a) cancer has spread to the main bronchus, but has not spread to the carina; and/or (b) cancer has spread to the inner membrane that covers the lung; and/or (c) part of the lung or the whole lung has collapsed or has pneumonitis (inflammation of the lung).

lung-cancer-stage3B1

Stage IIIB (2)

The tumor may be any size and cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are around the trachea or aorta, or where the trachea divides into the bronchi. Also, one or more of the following is found: (a) there are one or more separate tumors in the same lobe or a different lobe of the lung with the primary tumor; and/or (b) cancer has spread to any of the following: the chest wall or the membrane that lines the inside of the chest wall, the nerve that controls the voice box, the trachea, the carina, the esophagus, the breastbone or backbone, the diaphragm, the nerve that controls the diaphragm, the heart, the major blood vessels that lead to or from the heart (aorta or vena cava), or the outer layer of tissue of the sac around the heart.

lung-cancer-stage3B2

Stage IIIC

The tumor may be any size and cancer has spread to lymph nodes above the collarbone on the same side of the chest as the primary tumor or to any lymph nodes on the opposite side of the chest as the primary tumor. Also, one or more of the following is found: (a) there are one or more separate tumors in the same lobe or a different lobe of the lung with the primary tumor; and/or (b) cancer has spread to any of the following: the chest wall or the membrane that lines the inside of the chest wall, the nerve that controls the voice box, the trachea, the carina, the esophagus, the breastbone or backbone, the diaphragm, the nerve that controls the diaphragm, the heart, the major blood vessels that lead to or from the heart (aorta or vena cava), or the outer layer of tissue of the sac around the heart.

lung-cancer-stage3C

 

Stage IV Lung Cancer

Stage IVA 

The tumor may be any size and cancer may have spread to the lymph nodes. One or more of the following is found: (a) there are one or more tumors in the lung that does not have the primary tumor; and/or (b) cancer is found in fluid around the lungs or heart or there are cancer nodules in the lining around the lungs or the sac around the heart; and/or (c) cancer has spread to one place in an organ or tissue not near the lung, such as the brain, adrenal gland, kidney, liver, or bone, or to a lymph node that is not near the lung.

lung-cancer-stage4A

Stage IVB Lung Cancer

The cancer has spread to multiple places in one or more organs that are not near the lung, such as the brain, adrenal gland, kidney, liver, distant lymph nodes, or bone.

lung-cancer-stage4B