Stages of Lung Cancer

//Stages of Lung Cancer
Stages of Lung Cancer2018-03-27T15:18:32+00:00

What is staging and why is it important?

Understanding if and where lung cancer has spread (the stage) is important to determining what options are available for treatment. Imaging tests, biopsies and laboratory tests help to determine staging.

Non-Small Cell Lung Cancer

Non-small cell lung cancer is one of several cancers staged using the TNM system. The cancer is staged according to the size of the tumor (T), the extent to which the cancer has spread to the lymph nodes (N), and the extent to which the cancer has spread beyond the lymph nodes, or metastasis (M).

How Does The TNM Staging System Work?

The TNM staging system:

  • Was created by merging the staging systems of the American Joint Committee on Cancer (AJCC) http://www.cancerstaging.org/ and the International Union Against Cancer (UICC) http://www.uicc.org/ in 1987
  • Is one of the most commonly used cancer staging systems
  • Standardizes cancer staging internationally

T is for Tumor

How big is the tumor? Where is it located? Has it spread to nearby tissue?

TX Tumors are too small for testing or can’t be found with tests.
T0 No primary tumor has been found.
Tis There are abnormal or cancer cells in airways that haven’t invaded lung tissue.
T1 Tumors are in the lungs only and are not larger than 3 cm.
T1mi Tumors  grow only along the surface of lung tissue. Areas of invasion are no deeper than 0.5 cm.
T1a Tumors are 1 cm or smaller and have invaded at least 0.5 cm.
T1b Tumors are larger than 1 cm but not larger than 2 cm. Areas of invasion are at least 0.5 cm.
T1c Tumors are more than 2 cm but not larger than 3 cm. Areas of invasion are at least 0.5 cm.
T2 Tumors: a) are larger than 3 cm but not larger than 5 cm; b) have grown into the main bronchus; c) have grown into the lung’s inner lining (visceral pleura); or d) have caused lung collapse (atelectasis) or swelling (pneumonitis).
T2a Tumors are 4 cm or smaller. Other features may or may not be present. Smaller tumors with other features are also rated T2a.
T2b Tumors are larger than 4 cm. Other features may or may not be present.
T3  Tumors: a) are larger than 5 cm but not larger than 5 cm but not larger than 7 cm; b) have grown into the lung’s outer lining (parietal pleura) or nearby sites including chest wall, phrenic nerve, or the heart’s lining (pericardium); or c) there are primary and secondary tumors in the same lobe.
T4 Tumors: a) are larger than 7 cm; b) have grown into the diaphragm, mediastinum, heart or its major blood vessels, windpipe (trachea), recurrent laryngeal nerve, carina, esophagus, or spine; or c) there are secondary tumors in the same lung but different lobe than the primary tumor.

N is for Lymph Node

Has the cancer spread to the lymph nodes in and around the lungs? For more information on the lymph system and lymph nodes, see Lymph System

NX Nearby lymph nodes have not been tested.
N0 There is no cancer in nearby lymph nodes.
N1 Cancer has spread to the peribronchial nodes and/or to the hilar and intrapulmonary nodes of the lung with the primary tumor.
N2 Cancer has spread to mediastinal lymph nodes, which include subcarinal nodes, near the lung with the primary tumor.
N3 Cancer has spread to the mediaastinal or hilar nodes near the lung without the primary tumor, or to any supraclavicular or scalene lymph nodes.

M is for Metastasis

Has the cancer spread to other parts of the body?

M0 Cancer has not spread to distant sites.
M1 Cancer has spread to distant sites.
M1a Cancer has spread: a) from one lung into the other; b) into the lung’s lining (pleura) and has formed secondary nodule(s); c) into the heart’s lining (pericardium) and has formed secondary nodule(s), or d) into the fluid around the lungs or the heart.
M1b Cancer has spread to one site outside the chest area.
M1c Cancer has spread to multiple sites outside the chest area.

Stages

After the Tumor (T), Lymph Nodes (N) and Metastasis (M) have been determined, the cancer is then staged accordingly:

Overall Stage T N M
Stage 0 Tis (in situ) N0 M0
Stage IA1 T1mi, a N0 M0
Stage IA2 T1b N0 M0
Stage IA3 T1c N0 M0
Stage IB T2a N0 M0
Stage IIA T2b N0 M0
Stage IIB T1a
T1b
T1c
T2a
T2b
T3
N1
N1
N1
N1
N1
No
M0
M0
Mo
M0
M0
Mo
Stage IIIA T1a
T1b
T1c
T2a
T2b
T3
T4
T4
N2
N2
N2
N2
N2
N1
No
N1
M0
M0
M0
M0
M0
Mo
M0
M0
Stage IIIB T1a
T1b
T1c
T2a
T2b
T3
T4
N3
N3
N3
N3
N3
N2
N2
M0
M0
M0
M0
Mo
M0
M0
Stage IIIC T3
T4
N3
N3
M0
M0
Stage IVA Any T
Any T
Any N
Any N
M1a
M1a
Stage IVB Any T Any N M1c

Small Cell Lung Cancer

Small cell lung cancer is most often staged as either limited-stage or extensive-stage.

Limited-Stage

Indicates that the cancer has not spread beyond one lung and the lymph nodes near that lung.

Extensive-Stage

The cancer is in both lungs or has spread to other areas of the body.

Source:

International Association for the Study of Lung Cancer. Goldstraw P, ed. Staging Handbook in Thoracic Oncology. Orange Park: Editorial Rx Press; 2009.

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