Staging Lung Cancers

The staging for small cell lung cancer is different from non-small cell lung cancer. What they do have in common, however, is that a lower number stage is linked with a better outcome. 

Most patients will have some additional tests run after a diagnosis to determine if the lung cancer has spread to other areas of the body.These can include some of the following:

• MRI (magnetic resonance imaging)
• PET Scan
• Endoscopic ultrasound (EUS) of the chest 
• Radionuclide bone scan to see if cancer has spread to the bones
• Bone marrow aspiration and biopsy. If necessary the oncologist will see if the cancer has spread to the bone marrow and blood stem cells.
• Thoracoscopy: A surgical procedure to check for abnormal areas by looking at the organs inside the chest. 

Based on the information gathered from the original diagnosis, biomarker testing (if applicable) and adding imaging and other tests to see if the cancer has spread, the oncologist will establish the stage of cancer. 

Stage Groups for Small Cell Lung Cancer

The most common way doctors stage SCLC is by classifying the disease as limited stage or extensive stage.

• Limited stage. Limited stage means that the cancer is found in one lung, the tissues between the lungs, and nearby lymph nodes only.

• Extensive stage. Extensive stage is used to describe SCLC that has spread outside of the lung in which it began or to other parts of the body.

SCLC is often staged in this way because it helps the oncologist decide if a patient might benefit from more aggressive treatments.

While there is a more formal system — the TNM system — that can be used to stage lung cancer, it is primarily reserved for staging non-small cell lung cancer. SCLC is almost always staged as limited stage or extensive stage, as described above. 

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:

• (T): The size and extent of the main tumor 
• (N): The spread to nearby (regional) lymph nodes 
• (M): The spread (metastasis) 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. Staging can be very complex, but your lung cancer specialist can explain it in a way you understand. 

Non-small cell lung cancer stages range from one to four, usually expressed in Roman numerals (0 through IV). The lower the lung cancer stage, the less the cancer has spread and the better the prognosis.

Occult (Hidden) Stage

In this 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

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 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 bronchus or bronchioles 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 larger than 4 centimeters but not larger than 5 centimeters or smaller and cancer has spread to nearby lymph nodes on the same side of the chest as the tumor. 

  

• Stage IIB (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 in the lung or near the bronchus. Also, one or more of the following may be found:

  • Cancer has spread to the main bronchus, but has not spread to the carina.
  • Cancer has spread to the innermost layer of the membrane that covers the lung.
  • Part of the lung or the whole lung has collapsed or has developed pneumonitis. 

    

OR

• Stage IIB (2): The tumor is 5 centimeters, but not larger than 7 centimeters and there are one or more separate tumors in the same lobe of the lung as the primary tumor. Also, cancer has spread to any of the following:

  • The membrane that lines the inside of the chest wall.
  • Chest wall.
  • The nerve that controls the diaphragm.
  • The outer layer of tissue of the sac around the heart. 

    

Stage III

Stage III is divided into stages IIIA, IIIB, IIIC:

• 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:

  • Cancer has spread to the main bronchus, but has not spread to the carina.
  • Cancer has spread to the innermost layer of the membrane that covers the lung.
  • Part of the lung or the whole lung has collapsed or has developed pneumonitis. 

    

OR

• Stage IIIA (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:

  • The tumor is larger than 5 centimeters but not larger than 7 centimeters.
  • There are one or more separate tumors in the same lobe of the lung as the primary tumor.
  • Cancer has spread to any of the following:
    • The membrane that lines the inside of the chest wall.
    • The nerve that controls the diaphragm.
    • Outer layer of tissue of the sac around the heart. 

      

OR

• 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:

  • The tumor is larger than 7 centimeters.
  • There are one or more separate tumors in a different lobe of the lung with the primary tumor.
  • The tumor is any size and cancer has spread to any of the following:
    • Trachea.
    • Carina.
    • Esophagus.
    • Breastbone or backbone.
    • Diaphragm.
    • Heart.
    • Major blood vessels that lead to or from the heart (aorta or vena cava).
    • Nerve that controls the larynx (voice box). 

      

• Stage IIIB (1): The 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:

  • Cancer has spread to the main bronchus, but has not spread to the carina.
  • Cancer has spread to the innermost layer of the membrane that covers the lung.
  • Part of the lung or the whole lung has collapsed or has developed pneumonitis. 

    

OR

• 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:

  • There are one or more separate tumors in the same lobe or a different lobe of the lung with the primary tumor.
  • Cancer has spread to any of the following:
    • The membrane that lines the inside of the chest wall.
    • Chest wall.
    • The nerve that controls the diaphragm.
    • Outer layer of tissue of the sac around the heart.
    • Trachea.
    • Carina.
    • Esophagus.
    • Breastbone or backbone.
    • Diaphragm.
    • Heart.
    • Major blood vessels that lead to or from the heart (aorta or vena cava).
    • Nerve that controls the larynx (voice box). 

      

• 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:

  • There are one or more separate tumors in the same lobe or a different lobe of the lung with the primary tumor.
  • Cancer has spread to any of the following:
    • The membrane that lines the inside of the chest wall.
    • Chest wall.
    • The nerve that controls the diaphragm.
    • Outer layer of tissue of the sac around the heart.
    • Trachea.
    • Carina.
    • Esophagus.
    • Breastbone or backbone.
    • Diaphragm.
    • Heart.
    • Major blood vessels that lead to or from the heart (aorta or vena cava).
    • Nerve that controls the larynx (voice box). 

      

Stage IV

Stage IV is divided into stages IVA and IVB.

• 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:

  • There are one or more tumors in the lung that do not have the primary tumor.
  • Cancer is found in the lining around the lungs or the sac around the heart.
  • Cancer is found in fluid around the lungs or the heart.
  • Cancer has spread to one place in an organ not near the lung, such as the brain, liver, adrenal gland, kidney, bone, or to a lymph node that is not near the lung. 

    

• Stage IVB: Cancer has spread to multiple places in one or more organs that are not near the lung. 

  

Some of this information is gathered over time and your treatments may have already begun before they have a final determination of the stage. Based on the findings from diagnostic testing and additional imaging, a treatment plan is created and recommended to the patient. 

Learn About Lung Cancer Treatments