Staging
Staging of cancer is a process that tells a doctor if a cancer has spread, and if it has, how far. Staging is an important step in evaluating treatment options. Staging and treatments options are different for small cell lung cancer and non-small cell lung cancer. For non-small cell lung cancer, doctors use a conventional staging system that has been adopted internationally:
Staging of Non-Small Cell Lung Cancer
Occult
Description
- Cancer cells found in mucus sample, but tumor too small to be detected by imaging tests.
Treatment
- Regular bronchoscopies to look for a tumor.
Stage 0
Description
- “Carcinoma in situ.” Abnormal cells found only in inner layer of lungs. This tumor is non-invasive.
Treatment
- Continued surveillance, or consideration for resection (Surgery such as segmentectomy, or wedge resection). Other therapies could include photodynamic therapy and internal radiation therapy.
Stage Ia
Description
- Tumor has grown through inner layer of the lung and is less than 3 cm in diameter.
Treatment
- Surgery (lobectomy, sleeve resection, segmentectomy, or wedge resection), possibly followed by chemotherapy and/or radiation.
Stage Ib
Description
- Tumor has either grown larger than 3 cm in diameter, or invaded the main bronchus or pleura.
Treatment
- Surgery (lobectomy, sleeve resection, segmentectomy, or wedge resection), possibly followed by chemotherapy and/or radiation.
Stage IIa
Description
- Cancer cells found in nearby lymph nodes, but tumor 3 cm or less in diameter.
Treatment
- Surgery (lobectomy, sleeve resection, or pneumonectomy), preceded or followed by chemotherapy alone; or chemotherapy and radiation.
Stage IIb
Description
- Cancer cells found in nearby lymph nodes and tumor has either grown larger than 3 cm, or invaded the bronchus or pleura.
- OR
- Cancer not found in nearby lymph nodes, but has invaded nearby structures such as the chest wall and diaphragm.
Treatment
- Surgery (lobectomy, sleeve resection, or pneumonectomy), followed by chemotherapy alone; or chemotherapy and radiation.
Stage IIIa
Description
- Tumor may be any size. Cancer cells found in more advanced (mediastinal) lymph nodes on same side of chest as tumor.
Treatment
- Chemotherapy, immunotherapy and/or radiation therapy, possibly followed by surgery.
Stage IIIb
Description
- Tumor may be any size and found in two separate lobes on the same side; or cancer cells are found in more advanced (mediastinal) lymph nodes on the opposite side of the chest; or may have invaded nearby organs such as the heart or windpipe.
Treatment
- Chemotherapy, radiation therapy, clinical trials. Resection (surgery) may be considered for highly selected patients. Neoadjuvant chemotherapy and immunotherapy may also be suggested.
Stage IIIc
Description
- The tumor may be any size and cancer has spread to lymph nodes above the collarbone on the same side of the chest as the primary tumor or to any lymph nodes on the opposite side of the chest as the primary tumor.
Treatment
- Chemotherapy and/or radiation therapy, possibly followed by surgery.
Stage IV
Description
IVa: The tumor may be any size and cancer may have spread to lymph nodes. One or more of the following is found:
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-
- there are one or more tumors in the lung that does not have the primary tumor
- cancer is found in the fluid around the lungs or heart or there are cancer nodules in the lining around the lungs or the sac around the heart
- cancer has spread to one place in an organ or tissue not near the lung, such as the brain, adrenal gland, kidney, liver, or bone, or to a lymph node that is not near the lung
IVb: The cancer has spread to multiple places in one or more organs that arte not near the lung, such as the brain, adrenal gland, kidney, liver, distant lymph nodes or bone.
Treatment
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-
- Chemotherapy, immunotherapy, targeted therapy, clinical trials, palliative treatments.
Staging of Small Cell Lung Cancer
Doctors commonly use a 2-stage system for small cell lung cancer because it is aggressive and spreads outside the lungs early. This helps them separate the patients who may benefit from aggressive treatment from those with incurable disease. Although uncommon, small cell lung cancer can be treated surgically when identified early.
Limited
Description
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-
- Cancer is confined to one side of the chest. Cancer is in a single lung, and may have invaded lymph nodes on the same side of the chest.
Treatment
-
-
- Chemotherapy and radiation, immunotherapy,clinical trials.
Extensive
Description
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- Cancer is no longer limited to one side of the chest. Cancer may have spread to the other lung or to lymph nodes on the opposite side of the chest. It may have also spread to the pleura (fluid around lungs) or other parts of the body, such as the liver, adrenal gland, or bones.
Treatment
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-
- Chemotherapy, immunotherapy, radiation, clinical trials, palliative treatments including radiation for pain relief.
