Staging With Illustrations

Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine 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 (chance of recovery). There are different stage descriptions for different types of cancer.

In general, a lower number stage of lung cancer is associated 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 tumors respond to treatment differently.

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 determine 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 invaded nearby tissues and spread outside the lung.

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 and stage IB, based on the size of the tumor. Smaller tumors are stage IA, and slightly larger ones are stage IB.

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Stage II

Stage two (II) lung cancer is divided into two substages: stage IIA and IIB. A stage IIA cancer describes a slightly larger tumor that has not spread to the nearby lymph nodes or a small tumor that has spread to the nearby lymph nodes.

Stage IIB lung cancer describes a slightly larger tumor that has spread to the lymph nodes or a larger tumor that may or may not have invaded nearby structures in the lung, but has not spread to the lymph nodes.

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

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Stage III

Stage three (III) lung cancers are classified as stage IIIA and 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 spread to the lymph nodes located in the center of the chest, which is outside the lung. Or, the tumor may have invaded 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 has to be performed bit by bit.

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Stage IV

Stage four (IV) means the lung cancer has spread to multiple sites in the other lung, the fluid surrounding the lung or the heart, or distant sites within the body by way of the bloodstream. Once released in the blood, cancer can spread anywhere in the body, but has a tendency to spread to the brain, bones, liver, and to the adrenal glands.

In general, surgery is not successful for any stage III or IV lung cancer. Other situations that make a lung cancer impossible to remove are if it has spread to the lymph nodes above the collarbone, or if the cancer grows into vital structures within the chest, such as the heart, large blood vessels, or the main breathing tubes leading to the lungs.

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Recurrent: Recurrent cancer is cancer that comes back after treatment.

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 stage of lung cancer influences prognosis. While lung cancer is treatable at any stage, only certain stages of lung cancer can be cured. Some characteristics of patients are important in determining prognosis, regardless of whether the goal is treatment or cure.

Doctors measure a patient’s general strength and vigor using an index known as performance status. Patients who are strong enough to go about their daily activities without assistance and even 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 that 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 on what treatment is best, especially for older patients who are otherwise physically fit and have no other medical problems besides lung cancer.