Stages of Non-Small Cell Lung Cancer

by National Cancer Institute

(Page 2 of 3)

After lung cancer has been diagnosed, tests are done to find out if cancer cells have spread within the lungs or to other parts of the body.

The process used to find out if cancer has spread within the lungs or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. Some of the tests used to diagnose non-small cell lung cancer are also used to stage the disease. Other tests and procedures that may be used in the staging process include the following:

Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.

Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the brain. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Endoscopic ultrasound (EUS): A procedure in which an endoscope (a thin, lighted tube) is inserted into the body. The endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography. EUS may be used to guide fine needle aspiration biopsy of the lung, lymph nodes, or other areas.

Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells.

Mediastinoscopy: A surgical procedure to look at the organs, tissues, and lymph nodes between the lungs for abnormal areas. An incision (cut) is made at the top of the breastbone and an endoscope (a thin, lighted tube) is inserted into the chest. Tissue and lymph node samples may be taken for biopsy.

Anterior mediastinotomy: A surgical procedure to look at the organs and tissues between the lungs and between the breastbone and spine for abnormal areas. An incision (cut) is made next to the breastbone and an endoscope (a thin, lighted tube) is inserted into the chest. Tissue and lymph node samples may be taken for biopsy. This is also called the Chamberlain procedure.

Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.

The following stages are used for non-small cell lung cancer:

Occult (hidden) stage

In the occult (hidden) stage, cancer cells are found in sputum (mucus coughed up from the lungs), but no tumor can be found in the lung by imaging or bronchoscopy, or the primary tumor is too small to be checked.

Stage 0 (carcinoma in situ)

In stage 0 (carcinoma in situ), cancer is in the lung only and has not spread beyond the innermost lining of the lung.

Stage I

Stage I is divided into stages IA and IB:

Stage IA: The tumor is in the lung only and is 3 centimeters or smaller.

Stage IB: One or more of the following is true:

• The tumor is larger than 3 centimeters.
• Cancer has spread to the main bronchus of the lung, and is at least 2 centimeters from the carina (where the trachea joins the bronchi).
• Cancer has spread to the innermost layer of the membrane that covers the lungs.
• The tumor partly blocks the bronchus or bronchioles and part of the lung has collapsed or developed pneumonitis (inflammation of the lung).

Stage II

Stage II is divided into stages IIA and IIB:

Stage IIA: The tumor is 3 centimeters or smaller and cancer has spread to nearby lymph nodes on the same side of the chest as the tumor.

Stage IIB: Cancer has spread to nearby lymph nodes on the same side of the chest as the tumor and one or more of the following is true:

• The tumor is larger than 3 centimeters.
• Cancer has spread to the main bronchus of the lung and is 2 centimeters or more from the carina (where the trachea joins the bronchi).
• Cancer has spread to the innermost layer of the membrane that covers the lungs.
• The tumor partly blocks the bronchus or bronchioles and part of the lung has collapsed or developed pneumonitis (inflammation of the lung).

Cancer has not spread to lymph nodes and one or more of the following is true:

• The tumor may be any size and cancer has spread to the chest wall, or the diaphragm, or the pleura between the lungs, or membranes surrounding the heart.
• Cancer has spread to the main bronchus of the lung and is no more than 2 centimeters from the carina (where the trachea meets the bronchi), but has not spread to the trachea.
• Cancer blocks the bronchus or bronchioles and the whole lung has collapsed or developed pneumonitis (inflammation of the lung).

Stage IIIA

In stage IIIA, cancer has spread to lymph nodes on the same side of the chest as the tumor. Also:

• The tumor may be any size.
• Cancer may have spread to the main bronchus, the chest wall, the diaphragm, the pleura around the lungs, or the membrane around the heart, but has not spread to the trachea.
• Part or all of the lung may have collapsed or developed pneumonitis (inflammation of the lung).

Stage IIIB

In stage IIIB, the tumor may be any size and may have spread to any of the following:

• Heart.
• Major blood vessels that lead to or from the heart.
• Chest wall.
• Diaphragm.
• Trachea.
• Esophagus.
• Sternum (chest bone) or backbone.
• More than one place in the same lobe of the lung.
• The fluid of the pleural cavity surrounding the lung.

Cancer may have spread to lymph nodes on either side of the chest.

Stage IV

In stage IV, cancer has spread to other parts of the body or to another lobe of the lungs and may have spread to lymph nodes.

Recurrent Non-Small Cell Lung Cancer

Recurrent non-small cell lung cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the brain, lung, or other parts of the body.

About the Author

www.nci.nih.gov
The National Cancer Institute's research programs are extensive and contain many innovative initiatives. I invite you to explore our Web site to find out more about the exciting work being conducted here at NCI and by NCI-supported scientists throughout the country.