Lung Cancer Staging

It is important that patients are staged accurately and in a timely manner. Familiarize yourself with the basics of lung cancer staging and talk to your doctor about how your stage informs the next steps of your care.  

The Role of Staging

How and when is lung cancer staged? 

The timing and exact procedures involved in the staging process might differ from person to person. In general, the process begins with physicians examining the results from all the imaging tests and biopsies done before treatment and assigning the patient a clinical stage.   

It is recommended some patients receive pre-treatment intranodal staging (sometimes called invasive nodal staging or intrathoracic staging). This type of staging examines whether any of the lymph nodes in the chest and lung are cancerous. If the cancer has not spread to other organs in the body, it is especially important to know exactly how far it has spread regionally, so the cancer can be treated completely.   

This type of staging is ideally performed before treatment is started and may provide information that changes the clinical stage to be more accurate. For some lung cancer patients, pre-treatment intranodal staging can be done at the same time as diagnosis using a procedure called EBUS-TBNA (endobronchial ultrasound transbronchial needle aspiration). EBUS-TBNA is a minimally invasive procedure that combines a device called a bronchoscope with a needle inserted to remove tissue or fluid samples from lymph nodes. Intranodal staging can also be done using a procedure called mediastinoscopy.  

If a patient’s first treatment is surgery to remove the lung cancer, physicians may assign a pathological stage (also called the surgical stage) after the procedure. The pathological stage combines the information from the clinical stage with any new information learned about the cancer through surgery. This provides a more accurate stage and informs treatment options.   

 If the cancer recurs (comes back) after treatment, the cancer is restaged, often repeating the same tests that were done the first time.    

What goes into the lung cancer stage? 

Three factors are used to determine cancer stage (sometimes referred to as the TNM classification system).   

• T – Tumor size and location  
• N – Regional lymph node involvement. Lymph nodes are small ball-shaped immune system organs distributed throughout the body. It is important to know whether the cancer has spread to the lymph nodes around the lung and in the chest.  
• M – Metastasis status refers to which organs the cancer has spread.  

Values are assigned to T, N and M, to provide more information about the cancer and inform the stages listed below.  

Non-small Cell Lung Cancer Stages

NSCLC 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.  

Stage 0 (carcinoma/tumor in-situ) is an early-stage lung cancer that is only in the top lining of the lung or bronchus and has not spread.   

Stage I is divided into two sub-stages, 1A and 1B, based on the size of the tumor. In Stage I, the cancer has not spread to the lymph nodes or other parts of the body.   

Stage II is divided into stage IIA and IIB, with each stage then broken into additional sections, depending on: the size of the tumor, where it is found, and whether or not the cancer has spread to the lymph nodes. These tumors may be larger than those in stage I and/or have begun to spread to nearby lymph nodes. In stage II, the cancer has not spread to distant organs.  

Stage III is divided into IIIA, IIIB or IIIC, depending on the size and location of the tumor and how far it has spread. Most commonly, the cancer has spread to the lymph nodes in the mediastinum (the area in the chest between the lungs).   

Stage IV is the most advanced form of NSCLC. In this stage, the cancer has metastasized, or spread, to the lining of the lung or other areas of the body.

Small Cell Lung Cancer Stages

Small cell lung cancer is described using two stages: limited and extensive.   

Limited stage is only in one lung with or without spread to the lymph nodes in the mediastinum (area in the chest between the lungs).   

Extensive stage has spread to tissue outside the originally affected lung like the opposite lung or distant organs.  

Staging and Treatment  

Lung cancer treatment is evolving at a rapid pace. Lung nodules are often treated with surgery when they are caught at an early stage. Lung nodules found at later stages may be treated with a combination of surgery, chemotherapy, radiation, immunotherapy and targeted therapy.   

Learn about the different types of treatment options for each stage of lung cancer.

Accurate staging leads to more precise treatment. Talk to your doctor about your lung cancer stage and how it impacts your treatment options.