Lung Cancer Staging and Treatment Goals

An important test is to find out the staging of your cancer. Staging involves a variety of tests that can help show your doctors how advanced the tumor is by its size and the kind of cell it is.


The TNM staging system is used for most types of cancer. It gives your doctor critical information to help determine your prognosis and the right treatment for you.

Tumor size
T stands for the main tumor's size and how far it extends
Lymph nodes
N represents how far it reaches to any lymph nodes that are close by
Other tumors
M describes any other tumors caused by spreading cancer cells

A number from 0 to 4 (Roman numbers I, II, III, IV) is added to each letter to describe the size of the main tumor and degree of cancer spread.

The TNM combinations indicate what stage your tumor is. This information helps the doctor prepare you for what needs to be done next. Always ask him or her questions if you have any. The more you understand, the more you can partner with your doctor. Here are general descriptions of stage grouping and what they mean.


Stage groupings

Stage 0

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

The goal of treatment: At this stage, cancer is often curable with surgery alone.

Stage 1

What’s happening in the body: The cancer has not yet spread beyond the lungs and is less than 5 cm wide.

The goal of treatment: At stage 1, surgery may be the only treatment needed. Chemotherapy and/or radiation therapy after surgery may lower the chance of cancer returning.

Stage 2

What’s happening in the body: The cancer is between 5 cm and 7 cm and may have spread to the lymph nodes.

The goal of treatment: At this stage, surgery to remove part of the lung or the whole lung may be recommended. Any lymph nodes likely to have cancer in them may also be removed. Sometimes chemotherapy and/or radiation therapy is recommended before surgery takes place in order to shrink the tumor and make it easier to remove. Chemotherapy and/or radiation therapy may also be recommended after surgery to remove any cancer that was left behind.

Stage 3

What’s happening in the body: Tumors may have spread to the outside of the lung and possibly into lymph nodes outside the lung. Unlike in stage 4 lung cancer, the cancer has not spread, or metastasized, throughout the whole body. Stage 3 lung cancer is divided into 3 substages: 3A, 3B, and 3C. The substage is based on how big the cancer is, and how far it has spread.

The goal of treatment: For people with stage 3 NSCLC, the goal of treatment is to get rid of cancer and stop it from returning. If surgery is not an option, treatment is usually a combination of chemotherapy and radiation therapy.

Adding different types of doctors to your team at this stage can help increase your chances for a better outcome. These could include:

  • A radiation oncologist
  • A pulmonologist (a lung doctor)
  • A thoracic surgeon (a surgeon specializing in organs in the chest, including the lungs)

Stage 4

What’s happening in the body: This is the most advanced form of lung cancer, and is often referred to as metastatic disease. The cancer has spread beyond the lung and into the other lung, the bloodstream, or the fluid surrounding the heart or lungs. The cancer may have spread outside of the chest.

The goal of treatment: Treatments like surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy may be recommended to relieve and manage symptoms. It’s important to work with your treatment team to decide the best treatment for you.


Know your BIOMARKER

Biomarker testing is the key to getting the right type of treatment for your lung cancer. Biomarkers are changes in our molecules or genes, which can be a sign of cancer. Sometimes these changes appear on the cancer cells themselves. These biomarkers can help your doctor identify the type of cancer you have. Once identified, you and your doctor can find a treatment that gives your body the right tools to fight your cancer.

Here is a list of common biomarkers you may be tested for:

  • Programmed cell death ligand-1 (PD-L1)
  • Epidermal growth factor receptor (EGFR)
  • Kirsten rat sarcoma (KRAS)
  • Mesenchymal-epithelial transition factor (MET)
  • Anaplastic lymphoma kinase (ALK)
  • ROS proto-oncogene 1, receptor tyrosine kinase (ROS1)
  • B-Raf proto-oncogene, serine/threonine kinase (BRAF)
  • Neurotrophic receptor tyrosine kinase (NTRK)

Outcome

If you've been diagnosed with lung cancer, it can be frightening. It's natural to wonder "how long do I have?" No one can accurately tell how long a person will live with lung cancer. Your prognosis, or future health, may depend on several factors. These include the type of cancer, the stage, and response to course of treatment. It can be frustrating if you feel that you're not getting the answers you're looking for in terms of expected prognosis. But the truth is, your healthcare team cannot predict how long you'll live with lung cancer. Continue to partner with them to feel comfortable with your treatment plan. And do all you can to stay positive and make the most of every day.

The 5-year survival rate

You may hear the doctor mention a 5-year survival rate. This statistic depends on a person's cancer stage. It refers to the percentage of people alive 5 years after being diagnosed.