Staging of lung cancer

Knowing the extent of the cancer helps the doctors decide on the most appropriate treatment.

Generally, cancer is divided into four stages:

• Stage 1 The cancer is small and localised.
• Stages 2 or 3 The cancer has spread into surrounding areas.
• Stage 4 The cancer has spread to other parts of the body.

If the cancer has spread to distant parts of the body, this is known as secondary or metastatic cancer. If the cancer comes back after initial treatment it’s known as recurrent cancer.

The current staging system is used for both small cell and non-small cell lung cancers. This aims to 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. 

Staging small cell lung cancers Back to top

Although the current staging system is for both non-small cell and small cell lung cancers, there is another system that has been used for many years, which you may hear your doctors refer to. This system divides small cell lung cancers into two stages:

• Limited disease – the cancer cells can be seen only in one lung, in nearby lymph nodes, or in fluid around the lung (known as a pleural effusion).
• Extensive disease – it’s clear that the cancer has spread outside the lung, within the chest area or to other parts of the body.

Small cell lung cancer often spreads outside the lung quite early on. Even if the doctor can’t see any evidence of the spread on your scans, it’s likely that some cancer cells will have broken away and travelled through the bloodstream or lymphatic system.

To be safe, small cell lung cancers are usually treated as though they have spread, whether any secondary cancer can be seen or not.

Staging non-small cell lung cancer Back to top

Non-small cell lung cancer is usually divided into four stages.

Stage 1

The cancer is very localised and hasn’t spread to the lymph nodes. This stage is divided in two:

• Stage 1A The cancer is no bigger than 3cm in size.
• Stage 1B The cancer is larger than 3cm, or is growing into the main airway of the lung (bronchus). The cancer may also have spread to the membrane covering the lung (pleura), or has made the lung partially collapse.

Stage 2

Stage 2 cancer is also divided in two:

• Stage 2A The cancer is small and measures 3cm or less, and affects nearby lymph nodes.
• Stage 2B Either the cancer is larger than 3cm and in the nearby lymph nodes; or there is no cancer in the lymph nodes but the tumour has made the lung collapse; or it has grown into the:

• chest wall
• membrane covering the lung (pleura)
• muscle layer below the lungs (diaphragm)
• covering of the heart (pericardium).

Stage 3

Stage 3 cancer is also divided in two:

• Stage 3A The cancer is any size and has spread to the lymph nodes in the middle of the chest (mediastinum), but not to the other side of the chest; or the cancer has spread into tissue around the lung near to where it started. This can be into:

• the chest wall
• the covering of the lung (pleura)
• the middle of the chest (mediastinum)
• other lymph nodes close to the affected lung.

• Stage 3B The cancer has spread to:

• lymph nodes on either side of the chest or above the collarbone
• another major structure such as the gullet (oesophagus), the heart, windpipe (trachea) or to a main blood vessel; or there may be two or more tumours in the same lung or a collection of fluid containing cancer cells around the lung (pleural effusion).

Stage 4

The cancer has spread to a distant part of the body such as the liver, bones or the brain.