Lung Cancer - Small Cell: Stages

Approved by the Cancer.Net Editorial Board, 01/2021

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

Cancer stage grouping

The most common way doctors stage SCLC is by classifying the disease as limited stage or extensive stage.

  • Limited stage. Limited stage means that the cancer is only in 1 part of the chest and radiation therapy could be a treatment option. About 1 out of 3 people with SCLC have limited stage disease when first diagnosed.

  • Extensive stage. Extensive stage is used to describe SCLC that has spread to other parts of the body such as the opposite lung, bone, brain, or bone marrow. Many doctors consider SCLC that has spread to the fluid around the lung to be extensive stage as well. About 2 out of 3 people with SCLC have extensive disease when the cancer is first found.

SCLC is often staged in this way because it helps doctors decide if a patient might benefit from more aggressive treatments. Learn more about treatment options for SCLC.

There is another, more formal system – called the TNM system – to describe the different stages of lung cancer, but SCLC is almost always staged as limited stage or extensive stage, as described above. The TNM system for SCLC is much less commonly used in practice.

For SCLC, the TNM staging system gives a stage using a number, 0 through 4 (or using Roman numerals 0 to IV), based on whether the tumor can be completely removed by a surgeon. Less than 5% of people have early-stage lung cancer (stage 0, stage 1 or I, and stage 2 or II disease). About 25% of people have stage 3 (III) disease when first diagnosed. Stage 0 to stage 3 are considered limited stage. Most patients with SCLC have extensive stage, also called stage 4 (IV) disease, when first diagnosed.

TNM information 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 stage of SCLC and the patient’s overall health influence prognosis. Although SCLC is treatable at any stage, only some people with certain stages of SCLC 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 patients with SCLC 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 SCLC. Learn more about cancer and aging in another section of this website.

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.