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.
As doctors learn new information about lung cancer, the staging system may be updated or changed. The International Association for the Study of Lung Cancer (IASLC) is expected to issue updated staging information in 2009, and these changes may mean that more patients could be recommended for adjuvant chemotherapy (chemotherapy after surgery). Learn more about lung cancer Treatment.
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 individuals respond to treatment differently.
Staging is different for NSCLC and small cell lung cancer. Each staging system is described below.
Staging of NSCLC
The stage of NSCLC is described by a number, one through four (Roman numerals I through IV). One way to determine the staging of NSCLC 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 I and II
In general, NSCLC that is stage one (I) or two (II) has a size and location that makes it possible for a surgeon to completely remove it. Stage I cancer has not spread to any lymph nodes. Stage II cancer may involve lymph nodes, but the lymph nodes are contained within the surrounding lung, so they may be removed along with the section of lung where the cancer started.
Larger image
Larger image
Stage III
Stage three (III) NSCLC is difficult, and sometimes impossible, to remove. For example, lung cancer may spread to the lymph nodes located in the center of the chest, which is outside the lung. In this 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.
When the cancer has spread to lymph nodes in the center of the chest, on the same side as where the cancer started, it is known as stage three-A (IIIA). When the cancer spreads to lymph nodes on the opposite side of the chest, it is known as stage three-B (IIIB). In general, surgery is not successful for any stage IIIB 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 into the fluid surrounding the lung, 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; all of these conditions are considered stage IIIB.
Larger image
Stage IV
Stage four (IV) means NSCLC has spread to different sections (lobes) of the lung, or to distant sites within the body by way of the bloodstream. Once released in the blood, NSCLC can spread anywhere in the body, but has a tendency to spread to the brain, bones, liver, and to the adrenal glands.
Larger image
Staging of small cell lung cancer
Because almost all small cell lung cancer has spread outside the lung when discovered, very few patients with small cell lung cancer are treated with surgery, and all receive chemotherapy. Some patients with small cell lung cancer can benefit from radiation therapy. The staging for small cell lung cancer helps identify which patients can be treated with radiation therapy in addition to chemotherapy.
Small cell lung cancer is classified as either limited stage or extensive stage:
- Limited stage means the cancer is located on one side of the chest and involves a single region of the lung and adjacent lymph nodes. This region can be treated in its entirety with radiation therapy. About 30% of patients have limited stage.
- Extensive stage means the cancer has spread to other regions of the chest, or outside of the chest, and cannot be treated completely with radiation therapy. Most patients (70%) have extensive stage disease and are treated with chemotherapy only.
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, Sixth Edition (2002) published by Springer-Verlag New York, www.springer-ny.com.
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 to 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.
Last Updated: July 20, 2009
