After a lung cancer diagnosis, one of the first steps doctors will take is to try to determine the size of the cancer in the body and where it is located. This is called staging. As cancer spreads to new parts of the body, or metastasizes, it also increases in stage. There are 5 stages of cancer:

You may also see stages written in Roman numerals (I-IV). Some of these stages are further divided into sub-stages. It’s important to know what stage and sub-stage of lung cancer you have because it can help determine your treatment options.

Over the last few years, there have been new advancements in testing and treatment for all different stages of lung cancer. 

The information related to staging here is simplified to help you better understand lung cancer and should not take the place of discussion with your treatment team. Talking with them will help you fully understand your cancer diagnosis.

Stage 0

What’s happening in the body: The tumor is limited to the lining layer of airways and has not spread elsewhere.

The goal for your treatment team: Removing the tumor from the body.

Stage 1

What’s happening in the body: The cancer has not yet spread beyond the lungs.

Stage 1 is further divided into 2 sub-stages: stage 1A and stage 1B

  • Stage 1A: The cancer is only in the lung and is 3 cm or less
  • Stage 1B: The tumor has one or more of the following characteristics: it's between 3 cm and 4 cm and may have spread to the bronchus or the membrane on the outer surface of the lung

The goal for your treatment team:  Removing the tumor from the body through surgery may be the only treatment needed. Chemotherapy after surgery may be used for people with a high risk of the cancer returning.

Stage 2

What’s happening in the body: The tumor may have spread to the lymph nodes on the same lung as where the cancer started.

Stage 2 is further divided into 2 sub-stages: stage 2A and stage 2B

  • Stage 2A: The tumor is between 4 cm and 5 cm and has not spread to nearby lymph nodes in the lung where the cancer first appeared
  • Stage 2B: The tumor has grown larger or has spread to nearby lymph nodes in the lung where the tumor first appeared

The goal for your treatment team:  At this stage, the tumor can be removed by surgery. Any lymph nodes likely to have cancer in them may also be removed. Sometimes chemotherapy and/or radiation therapy is recommended before and/or after surgery.

Stage 3

What’s happening in the body: Stage 3 lung cancer is in the lungs but may also have grown into other organs in the chest.

Stage 3 has three substages:

  • Stage 3A: The primary tumor, also known as the original tumor, may have spread to nearby lymph nodes. There may be multiple tumors of various sizes
  • Stage 3B: The primary tumor may have spread to the lymph nodes on the same side or opposite side of the chest from where it started, above the collarbone, or in the space between the lungs. There may be multiple tumors of various sizes
  • Stage 3C: The large primary tumor may have grown and spread to the lymph nodes on the opposite side of the chest from where it started, above the collarbone, or in the space between the lungs. There may be multiple tumors of various sizes

The goal for your treatment team: For people with stage 3 NSCLC, the goal of treatment, when possible, is to remove the tumor from the body. Depending on the size and location of the cancer, surgery may be used alone or in combination with other treatments such as chemotherapy and radiation therapy. 

If surgery is not an option and you are in fairly good health, treating with a combination of chemotherapy and radiation therapy given at the same time may be recommended. This is known as concurrent chemoradiation. Concurrent chemoradiation is given for 6 to 7 weeks,* but depending on how you receive it, it could be longer or shorter. It has also been proven to have certain advantages. A clinical study showed it has significant benefits over receiving them one at a time:

  • Cancer may shrink after treatment
  • Your chances of living longer may increase
  • Cancer may disappear after treatment

Your doctor will be able to determine the best treatment plan for you based on your specific cancer. In fact, there’s a specific treatment option for people with stage 3 NSCLC whose cancer can't be removed by surgery, and has not progressed after a combination of chemotherapy and radiation therapy.  Find out about this treatment. You and your doctor will work closely together to figure out the best next steps. 

Stage 4

What’s happening in the body: Stage 4 lung cancer is the most advanced form of the disease. In stage 4, the cancer is called metastatic, which means the cancer has spread away from the lungs, or to another part of the body, such as the liver or other organs, or to fluid in the areas around the lungs or the heart.

Stage 4 is split into 2 substages: stage 4A and stage 4B

  • Stage 4A: Cancer may have spread within the chest and/or to distant parts of the body as a single tumor 
  • Stage 4B: Cancer may have spread to distant parts of the body as multiple tumors 

The goal for your treatment team:  At this stage, the goal is to ease any symptoms resulting from the lung cancer. Treatments like surgery, chemotherapy and/or radiation therapy, targeted therapy, and immunotherapy may be recommended to relieve and manage symptoms. Talk to your doctor to decide the right treatment option for your specific type of lung cancer. You can also learn more about a treatment available for people with EGFR+ stage 4 NSCLC.

 

*Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Non-Small Cell Lung Cancer V.7.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed September 20, 2019. To view the most recent and complete version of the guideline, go online to NCCN.org. 

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