Staging of lung cancer

What are the stages of lung cancer?

The stage of a cancer describes its size and position, and if it has spread from where it started. Knowing the stage helps your doctors advise the best treatment for you.

Doctors use the same staging system for non-small cell lung cancer and small cell lung cancer. Your doctor may tell you the stage of the lung cancer using a number staging system, from 1 to 4.

The staging looks at:

the size of the tumour
if the cancer has spread into nearby parts of the lung, or outside the lung
if the cancer is in lymph nodes nearby, in the chest, or further away
if the cancer has spread further outside the lung or to other parts of the body.

The staging also looks at other things, such as whether the lung has partly or fully collapsed.

Most of the number stages are also sub-divided. We have not included these here, to try to keep it simple. Your doctor or nurse can explain more about your stage of lung cancer.

Stage 1 lung cancer

This is when the cancer is no bigger than 4cm. It has not spread outside the lung or to any lymph nodes.

Stage 1 lung cancer is called early lung cancer or localised lung cancer.

Stage 2 lung cancer

The cancer can be different sizes. It may have spread to nearby lymph nodes, other parts of the lung, or areas just outside the lung.

Stage 3 lung cancer

The cancer can be any size and has usually spread to lymph nodes. It may also be growing into:

other parts of the lung
the airway
surrounding areas outside the lung.

The cancer may also have spread to tissues and structures further from the lung. But it has not spread to other parts of the body.

Stage 2 and 3 lung cancer is called locally advanced lung cancer.

Stage 4 lung cancer

The cancer can be any size. It may have spread to lymph nodes, and one or more of the following:

the cancer has spread to the lung on the other side
there are cancer cells in fluid in the pleura or around the heart
the cancer has spread to another part of the body – such as the liver, bones or brain.

Stage 4 lung cancer is called metastatic or secondary lung cancer.

Staging of small cell lung cancer (SCLC)

Doctors may also divide small cell lung cancers (SCLC) into two stages:

Limited stage – the cancer cells can be seen in one lung and in nearby lymph nodes.
Extensive stage – the cancer has spread outside the lung, to the chest area or to other parts of the body.

SCLC can spread outside the lung quite early on. Some cancer cells are likely to have spread through the blood or lymphatic system. But this can be too small to show up on scans. Because of this, doctors usually treat SCLC as if it has spread, even if scans do not show this.

About our information

References

Below is a sample of the sources used in our lung cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

National Institute for Health and Care Excellence (NICE). Lung cancer – Diagnosis and management. Clinical guideline 2019.

Metastatic non-small cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. 2018.

European Society for Medical Oncology (ESMO). Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up. 2017.

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr David Gilligan, Consultant Clinical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

use plain English
explain medical words
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We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.