Lung Cancer - Non-Small Cell: Stages

Approved by the Cancer.Net Editorial Board, 05/2020

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. Use the menu to see other pages.

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 NSCLC 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. This is because lung cancer is different in each person and treatment works differently for each tumor.

Cancer stage grouping

The stage of NSCLC is based on a combination of several factors, including:

  • The size and location of the tumor

  • Whether it has spread to the lymph nodes and/or other parts of the body.

There are 5 stages for NSCLC: stage 0 (zero) and stages I through IV (1 through 4). One way to determine the staging of NSCLC 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, healthy lung tissue and often nearby lymph nodes. Learn more about treatment options for NSCLC.

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.

Stage I

A stage 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 2 substages based on the size of the tumor:

  • Stage IA tumors are 3 centimeters (cm) or less in size. Stage IA tumors may be further divided into IA1, IA2, or IA3 based on the size of the tumor.

  • Stage IB tumors are more than 3 cm but 4 cm or less in size.

Stage II

Stage II lung cancer is divided into 2 substages:

  • A stage IIA cancer describes a tumor larger than 4 cm but 5 cm or less in size that has not spread to the nearby lymph nodes.

  • Stage IIB lung cancer describes a tumor that is 5 cm or less in size that has spread to the lymph nodes. A stage IIB cancer can also be a tumor more than 5 cm wide that has not spread to the lymph nodes.

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

Stage III

Stage III lung cancers are classified as either stage IIIA, IIIB, or IIIC. The stage is based on the size of the tumor and which lymph nodes the cancer has spread to. Stage III cancers have not spread to other distant parts of the body.

For many stage IIIA and stage IIIB cancers, the tumor may be difficult or sometimes impossible, to remove with surgery. Stage IIIC cancers cannot be removed with surgery. 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. Stage III cancers that cannot be treated with surgery can often be successfully treated with systemic therapy and radiation therapy (see Types of Treatment).

Stage IV

Stage IV means the lung cancer has spread to more than 1 area in the other lung, the fluid surrounding the lung or the heart, or distant parts of the body through the bloodstream. Once cancer cells get into the blood, the cancer can spread anywhere in the body. But, NSCLC is more likely to spread to the brain, bones, liver, and adrenal glands. Stage IV NSCLC is divided into 2 substages:

  • Stage IVA cancer has spread within the chest and/or has spread to 1 area outside of the chest.

  • Stage IVB has spread outside of the chest to more than 1 place in 1 organ or to more than 1 organ.

In general, surgery is not an option for most stage IIIB, IIIC, or IV lung cancers. Lung cancer can also be impossible to remove if it has spread to the lymph nodes above the collarbone. It can also be impossible to remove if it has grown into vital structures within the chest. These vital structures include the heart, large blood vessels, or the main breathing tubes leading to the lungs. In these situations, the doctor will recommend other treatment options.

Recurrent NSCLC

Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017), published by Springer International Publishing.

Prognosis

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

Your doctor may use an index known as "performance status" to guide your treatment and determine your prognosis. This index measures a person's general strength and health. People who are strong enough to continue daily activities without assistance can safely receive chemotherapy, radiation therapy, or surgery. For people with bone or liver metastases from lung cancer, excessive weight loss, ongoing tobacco use, or pre-existing medical conditions, such as heart disease or emphysema, treatment may not be as effective.

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 people 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 will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.