Lung Cancer Staging
Once you have been diagnosed with lung cancer, your doctor will explain the histological type of your cancer and assign it a stage. The stage precisely describes the extent of the cancer's spread within the lung and to distant parts of the body. Because curative treatment options become increasingly limited as lung cancer tumors grow and spread, your stage at diagnosis plays a crucial role in determining the best course of treatment and your survival outlook.
Patients who are treated in the earliest stages of disease typically have the greatest likelihood of success and experience the highest survival rates. This is because early stage cancer has yet to spread outside of the chest to invade distant organs. Doctors will construct a treatment plan largely based upon the stage of your cancer, while also considering important factors like your age, overall health and personal preferences.
To learn more about how the stage of your cancer affects the treatment options available to you and your expected outcome, fill out this form and a comprehensive informational packet will be mailed to you free of charge.
The primary types of lung cancer, small cell and non-small cell, do not grow and spread in a similar manner. Thus, doctors use separate staging systems because of the notable differences in preferred treatment options and patient survival rates. While both types can be assigned a numerical stage ranging from I to IV according to the American Joint Committee's International Staging System, the aggressive nature of small cell lung cancer makes a simplified two-stage system much more useful for doctors while planning treatments.
Follow the links below for more information about the symptoms, treatments and survival rates associated with each stage.
Non-Small Cell Staging
The first step for staging non-small lung cancer is assigning a TNM classification to the disease. The TNM staging system not only gives an accurate assessment of your cancer's progression, but also provides doctors with a universal language to use while communicating vital information. This is particularly useful because a single patient is typically treated by several doctors with diverse backgrounds.
- T
- describes the size of the primary tumor and reflects any signs of local spread
- N
- describes the extent of tumor growth into regional and distant lymph nodes
- M
- describes the degree of metastasis, or spread to distant regions in the body
Doctors will add numbers or letters after T, N and M to explain more about each element. Numbers zero through four are used to signify progressive disease. Presence of the letter X indicates there was not enough information to provide a numeral assessment.
Tumor Classifications
- T1
- A tumor that is 3 cm or less in size and has not spread to the lining that surrounds the lungs (pleura) or the main airways (bronchi).
- T2
- A tumor that has one or more of the following characteristics:
- It is between 3 cm and 7 cm in size
- It affects a main airway, but is not within two centimeters of the carina, the point where the windpipe (trachea) branches into the two major airways
- It has invaded the membranes that surround the lungs
- It partially clogs the airways, but has not caused the lung to collapse
- T3
- A tumor that is larger than 7 cm or invades any of the following structures within the chest: chest wall, diaphragm, mediastinal pleura, parietal pericardium or phrenic nerve. T3 also describes cases where there are two or more separate tumors in one lung, an entire lung collapses or there is a tumor within 2 cm of the carina.
- T4
- A tumor of any size that has grown into one or more of the following regions: mediastinum, great vessels, heart, trachea, esophagus, recurrent laryngeal nerve, vertebral body or carina. T4 also describes cases where there are tumors in more than one lobe of the same lung or there is an abnormal buildup of fluid around the lungs, known as malignant pleural effusion.
Nodes
The next criterion describes the extent of spreading to the lymph nodes:
- NX
- Lymph node involvement cannot be assessed
- N0
- No sign of lymph node involvement
- N1
- Cancer has spread to lymph nodes within the lung or near the area where the main airways enter the lung (hilar). This does not include lymph nodes in the lung opposite of the primary tumor.
- N2
- Cancer has spread to lymph nodes in the middle of the chest (mediastinal) or below the carina (subcarinal) on the same side as the main tumor.
- N3
- Cancer has spread to lymph nodes above the collarbone (supraclavicular) or to mediastinal or hilar lymph nodes on the opposite side of the main tumor.
Metastasis
The final factor details the extent of spreading to distant locations:
- MX
- Presence of distant metastasis cannot be assessed
- M0
- No distant metastasis is detected
- M1a
- Distant spread to the opposite lung or the presence of fluid buildup around the lungs or heart
- M1b
- Metastasis to distant lymph nodes or organs outside of the chest, such as the brain, bones, liver or adrenal glands
After evaluating the elements above as accurately as possible, your doctor will combine the information to form a string of letters and numbers. For example, T1N1M0 describes a tumor less than three inches in size that has spread to nearby lymph nodes, but shows no sign of distant spread. The TNM classification of your cancer is then given a numerical stage based on the international staging system.
International Staging System
Once a comprehensive assessment of your cancer is made, your doctor will follow guidelines set by the American Joint Committee to assign a stage ranging from I to IV. The stage number increases with the severity of your cancer, and can be divided further into substages for treatment purposes. Here is a breakdown of the international staging system by TNM classification:
| Stage | TNM Classification |
|---|---|
| StageIA | T1N0M0 |
| Stage IB | T2N0M0 |
| Stage IIA | T1N1M0 |
| Stage IIB | T2N1M0 |
| Stage IIIA | T1N2M0, T2N2M0, T3N1M0, T2N2M0 |
| Stage IIIB | Any T-T4, N3, M0; T4, Any N, M0 |
| Stage IV | Any T, Any N, M1 |
Small Cell Staging
Small cell lung cancer, which accounts for less than 20 percent of all lung cancer cases, is far more aggressive than non-small cell lung cancer. Its rapid growth pattern and early spread to distant parts of the body makes the international staging system needlessly specific for treatment purposes. Instead, doctors prefer a simplified two-stage system centered on the cancer's distant spread.
- Limited Stage: the cancer is confined to one lung and possibly lymph nodes on the same side of the chest as the primary tumor.
- Extensive Stage: the primary tumor has spread to the opposite lung, to lymph nodes on the opposite side of the chest or to distant organs.
About 30 percent of small cell lung cancers are diagnosed in the limited stage. Because at this point there is no sign of distant spread, patients have more treatment options and experience a significantly better outlook than patients with extensive stage disease. When small cell cancer spreads outside the chest, surgery is no longer an option and treatment usually focuses on alleviating symptoms to make life more comfortable for the patient.
Staging and Survival
Your expected outcome is directly related to the stage at which your lung cancer was diagnosed. If detected in its earliest stages, there is a chance that lung cancer can enter complete remission after aggressive surgery. However, curative surgery is only an option for small cell lung cancer patients in rare cases. If the cancer has spread to distant organs, the survival outlook is typically poor. In this case, doctors perform palliative treatments to lessen the pain caused by symptoms and prolong life expectancy.
Below are the five-year survival rates for the two primary types of lung cancer. This percentage reflects the percentage of patients that will survive for five years after their diagnosis. It is important to understand that these statistics may not accurately reflect the survival of an individual patient. A large number of factors contribute to your survival, but patients who can still perform normal daily functions during treatment typically have the most positive outlook.
Non-Small Cell Survival
| Stage | Five-Year Survival Rate |
|---|---|
| Stage IA | 49% |
| Stage IB | 45% |
| Stage IIA | 30% |
| Stage IIB | 31% |
| Stage IIIA | 14% |
| Stage IIIB | 5% |
| Stage IV | 1% |
Small Cell Survival
| Stage | Five-Year Survival Rate |
|---|---|
| Stage I | 31% |
| Stage II | 19% |
| Stage III | 8% |
| Stage IV | 2% |
The importance of early detection cannot be stressed enough, especially if there is a chance you have been exposed to asbestos. If you believe you were exposed to asbestos at home or the workplace, the Mesothelioma Center can help. Our Doctor Match program is a free service that can help connect you with a leading doctor and treatment center in your area.
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Last Modified Wednesday, March 14th, 2012 | Disclaimer | Privacy Policy |
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