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In medicine, lung cancer staging is the assessment of the extent to which lung cancer has spread from its original source. As with most cancers, staging is an important part in determining how serious the cancer is and how best to treat it. Because a lung cancer diagnosis can be both scary and overwhelming, we at Rocky Mountain Cancer Centers (RMCC) believe it is best that you have as much information as possible regarding lung cancer staging and treatment options. 

Lung Cancer Staging

As mentioned above, cancer staging is the process of gathering information to determine the location and extent of your lung cancer, as well as if it has spread (metastasized) to other parts of your body. 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 information gathered from the staging process determines the stage of the disease, which assists your doctor in understanding the seriousness of the cancer, providing an optimal treatment plan, identifying potential clinical trials for viable treatment options, and even providing chances of survival (prognosis). 

After determining a diagnosis of small cell (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. 

Staging Small Cell Lung Cancer

Sometimes, additional tests and procedures may be used in the small cell lung cancer staging process. These might include: 

  • 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 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:

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 lung. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ (localized).
  • 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.
    • 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 and part of the lung has collapsed or developed pneumonitis (inflammation of the lung).
  • Stage II: Stage II is divided into stages IIA and IIB:
    • Stage IIA: The tumor is 3 centimeters or smaller and cancer has spread to nearby lymph nodes on the same side of the chest as the tumor.
    • Stage IIB:
      • Cancer has spread to nearby lymph nodes on the same side of the chest as the tumor and 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 2 centimeters or more 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 and part of the lung has collapsed or developed pneumonitis (inflammation of the lung).
          ​OR
      • Cancer has not spread to lymph nodes and one or more of the following is true:
        • The tumor may be any size, and cancer has spread to the chest wall, or the diaphragm, or the pleura between the lungs, or membranes surrounding the heart.
        • Cancer has spread to the main bronchus of the lung and is no more than 2 centimeters from the carina (where the trachea meets the bronchi), but has not spread to the trachea.
        • Cancer blocks the bronchi and the whole lung has collapsed or developed pneumonitis (inflammation of the lung).
  • Stage III: Stage III is divided into stages IIIA and IIIB:
    • Stage IIIA
      • Cancer has spread to lymph nodes on the same side of the chest as the tumor. The tumor may be any size. One or more of the following is true:
        • Cancer may have spread to the main bronchus, the chest wall, the diaphragm, the pleura around the lungs, or the membrane around the heart, but has not spread to the trachea.
        • Part or all of the lung may have collapsed or developed pneumonitis (inflammation of the lung).
    • Stage IIIB: the tumor may be any size and has spread:
      • To lymph nodes above the collarbone or in the opposite side of the chest from the tumor; and/or to any of the following:
      • Heart
      • Major blood vessels that lead to or from the heart    
      • Chest wall
      • Diaphragm
      • Trachea
      • Esophagus
      • Sternum (chest bone) or backbone
      • More than one place in the same lobe of the lung
      • The fluid of the pleural cavity surrounding the lung
  • Stage IV: In Stage IV, cancer may have spread to lymph nodes and has spread to another lobe of the lungs or to other parts of the body, such as the brain, liver, adrenal glands, kidneys, or bone.
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