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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 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 Stage IA

Stage IB
The tumor is larger than 3 centimeters but not larger than 4 centimeters. Cancer has not spread to the lymph nodes, OR the tumor is 4 centimeters or smaller. Cancer has not spread to the lymph nodes and one or more of the following is 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 Stage IB

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 Stage IIA

Stage IIB lung cancer (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 Stage IIB 1

Stage IIB lung cancer (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 Stage IIB 2

Stage III

Stage IIIA Lung Cancer (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 Stage IIIA 1

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 Stage IIIA 2

Stage IIIA Lung Cancer (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 Stage IIIA 3

Stage IIIB Lung Cancer (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 IIIB 1

Stage IIIB Lung Cancer (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 IIIB 2

Stage IIIC Lung Cancer
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 Stage IIIC

Stage IV

Stage IVA Lung Cancer
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 Stage IVA

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 Stage IVB
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