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Staging is used in most types of cancer to identify how far the cancer has spread. An updated version of the most widely used staging system for lung cancer was introduced in 2009.
This new system will help doctors plan the best treatment for people with lung cancer. It can also help to give an idea of the likely outcome of treatment.
There are different systems for staging lung cancer. A common one is described in detail in our section on staging of lung cancer|. You may find it helpful to read this section alongside the information here.
If you’ve already been told the stage of your lung cancer, it may help to check with your doctors whether they’ve used this new system or a different one.
We hope this information helps you to understand lung cancer staging. Remember, your doctor or any of your healthcare team will be able to answer any further questions you may have.
When we breathe in, air passes from our nose or mouth through the windpipe (trachea), which divides into two tubes (airways), one going to each lung. These are known as the right and left bronchus.
The right and left bronchus divide to form smaller tubes called bronchioles, which carry air through the lungs. At the end of the bronchioles are millions of tiny air sacs called alveoli. In the alveoli, oxygen is absorbed from the air we breathe in and passes into the bloodstream to be circulated around the body.
View a large copy of the diagram of the lungs|
Carbon dioxide is a waste gas that needs to be removed from the body. It passes from the bloodstream into the alveoli and is then breathed out by the lungs.
The right lung has three main areas (called lobes) and the left lung has two. Many lung cancers start in the cells lining the bronchi and are called carcinomas of the bronchus.
The lymph nodes are part of the lymphatic system, which is part of our immune system. There are lymph nodes throughout our body, connected by a network of tiny lymphatic tubes. Cancer cells can affect nearby lymph nodes and may spread to other parts of the body through the lymphatic system.
The stage of a cancer is a term used to describe its size, position and whether it has spread beyond the place in the body where it started. Knowing the extent of the cancer helps the doctors decide on the best treatment.
There are two main types of lung cancer: small cell and non-small cell. The 2009 staging system can be used for both types.
However, many doctors use the TNM staging system when planning treatment for small cell lung cancer|. In this system, small cell lung cancer may be described as 'limited disease' (meaning the cancer is in one lung, in nearby lymph nodes or in fluid around the lung), or 'extensive disease' (meaning the cancer has spread outside the lung, within the chest area or to other parts of the body).
The TNM staging system is used worldwide. It can be used for different types of cancer.
Different sorts of cancer behave differently, so the TNM staging system varies slightly from one type of cancer to another. Numbers and letters may be added after the T, N and M to describe in more detail the exact size and extent of the cancer. For example, T (tumour) is usually numbered from 1-4.
The new TNM system for lung cancer is quite complicated but your doctors can help you understand what it may mean for you.
The 2009 TNM system for lung cancer has been revised and follows the tumour staging system below.
The tumour is 3cm or less at its widest point.
The tumour is more than 3cm but no bigger than 7cm across. It may affect the main airway (bronchus) or the membrane covering the lung (pleura), or the lung may have partially collapsed.
The tumour measures over 7cm. The lung has completely collapsed, or there are two or more tumours in the same lobe of the lung, or the tumour has spread to one of the following:
The tumour is any size that has spread to the central area of the chest (mediastinum), the heart, a major blood vessel, the windpipe (trachea), the nerve that controls the voicebox, the gullet (oesophagus), a spinal bone, or the main bronchus where it divides. Or there is another tumour in a different lobe in the same lung.
There are different groups of lymph nodes in the lungs. The doctors will look closely to see which, if any, are affected. The following is a guide to the lymph node staging:
There is no cancer in the lymph nodes.
There are cancer cells in the nearby lymph nodes in the same side of the chest as the cancer.
There are cancer cells in lymph nodes in the centre of the chest (still on the same side), or in the nodes under the place in the chest where the windpipe (trachea) divides into the left and right bronchus.
There are cancer cells in lymph nodes on the opposite side of the chest, or in the nodes at the top of the lungs, or by the collarbone on either side of the chest.
The cancer hasn’t spread to anywhere else in the body.
The cancer has spread to the opposite lung; the person has fluid around the lungs (malignant pleural effusion) or heart (malignant pericardial effusion), which contains cancer cells (M1a); or the cancer has spread to other parts of the body (M1b).
The T, N and M stages are often grouped together to make a number stage. A cancer may also be given a stage from 1-4. These stages may also have letters to describe the stage more accurately. Different combinations of T, N and M make up the different stages, and the same stage may have more than one description.
This table shows the number system for lung cancer staging.
Thank you to Dr D Gilligan, Consultant Clinical Oncologist, and all the people affected by cancer who reviewed this edition.
Reviewing information is just one of the ways you could help when you join our Cancer Voices network|.
Content last reviewed: 1 January 2013
Next planned review: 2015
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© Macmillan Cancer Support 2013
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