Lung Cancer: Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2014

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

In general, a lower number stage of lung cancer is linked with a better outcome. However, no doctor can predict how long a patient will live with lung cancer based only on the stage of disease because lung cancer is different in each person, and treatment works differently for each tumor.

Cancer stage grouping

The stage of both small cell and non-small cell lung cancer is described by a number, zero (0) through four (Roman numerals I through IV). One way to determine the staging of lung cancer is to find out whether the cancer can be completely removed by a surgeon. To completely remove the lung cancer, the surgeon must remove the cancer, along with the surrounding, normal lung tissue.

Stage 0

This is called in situ disease, meaning the cancer is “in place” and has not grown into nearby tissues and spread outside the lung.

Lung Cancer Stage 0

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Stage I

A stage one (I) lung cancer is a small tumor that has not spread to any lymph nodes, making it possible for a surgeon to completely remove it. Stage I is divided into two substages: stage IA or stage IB, based on the size of the tumor. Smaller tumors, such as those less than 3 centimeters (cm) wide are stage IA, and slightly larger ones, such as those more than 3 cm but less than 5 cm wide, are stage IB.

Lung Cancer Stage IA

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Lung Cancer Stage IB

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Stage II

Stage two (II) lung cancer is divided into two substages: stage IIA or IIB. A stage IIA cancer describes a tumor larger than 5 cm but less than 7 cm wide that has not spread to the nearby lymph nodes or a small tumor less than 5 cm wide that has spread to the nearby lymph nodes.

Lung Cancer Stage IIA

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Stage IIB lung cancer describes a tumor larger than 5 cm but less than 7 cm wide that has spread to the lymph nodes or a tumor more than 7 cm wide that may or may not have grown into nearby structures in the lung but has not spread to the lymph nodes. 

Lung Cancer Stage IIB

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Sometimes, stage II tumors can be removed with surgery, and other times, more treatments are needed.

Stage III

Stage three (III) lung cancers are classified as either stage IIIA or IIIB. For many stage IIIA cancers and nearly all stage IIIB cancers, the tumor is difficult, and sometimes impossible, to remove. For example, the lung cancer may have spread to the lymph nodes located in the center of the chest, which is outside the lung. Or, the tumor may have grown into nearby structures in the lung. In either situation, it is less likely that the surgeon can completely remove the cancer because removal of the cancer must be performed bit by bit.

Lung Cancer Stage IIIA

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Lung Cancer Stage IIIB

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Stage IV

Stage four (IV) means the lung cancer has spread to more than one area in the other lung, the fluid surrounding the lung or the heart, or distant parts of the body through the bloodstream. Once released in the blood, cancer can spread anywhere in the body, but it is more likely to spread to the brain, bones, liver, and adrenal glands. It is called stage IVA when the cancer has spread within the chest or IVB when it has spread outside of the chest.

Lung Cancer Stage IV

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In general, surgery is not successful for most stage III or IV lung cancers. Lung cancer can also be impossible to remove if it has spread to the lymph nodes above the collarbone, or if the cancer has grown into vital structures within the chest, such as the heart, large blood vessels, or the main breathing tubes leading to the lungs. The doctor will recommend other treatment options.

Recurrent: Recurrent cancer is cancer that has come back after treatment. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010), published by Springer-Verlag New York, www.cancerstaging.net

Prognosis

The type and stage of lung cancer and the patient’s overall health influence prognosis. Although lung cancer is treatable at any stage, only certain stages of lung cancer can be cured.

Doctors measure a patient’s general strength and health using an index known as performance status. Patients who are strong enough to go about their daily activities without assistance and work outside the home can safely receive chemotherapy, radiation therapy, and/or surgery. Treatment may not be as effective for patients with bone or liver metastases from lung cancer, excessive weight loss, ongoing cigarette use, or pre-existing medical conditions, such as heart disease or emphysema.

It is important to note that a patient’s age has never been useful in predicting whether a patient will benefit from treatment. The average age of patients with lung cancer in the United States is 71. A patient’s age should never be used as the only reason for deciding what treatment is best, especially for older patients who are otherwise physically fit and have no medical problems besides lung cancer.

Information about the cancer’s stage and prognosis will help the doctor recommend a treatment plan.  The next section helps explain the treatment options for this type of cancer. Use the menu on the side of your screen to select Treatment Options, or you can select another section, to continue reading this guide.