Staging of lung cancer
What are the stages of lung cancer?
In this video Dr Ranj is joined by Dr David Gilligan to take an in-depth look at lung cancer, exploring its symptoms, testing, stages and treatment options.
The stage of a cancer describes its size and position, and if it has spread from where it started. Knowing the stage of lung cancer you have 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.
There are different staging systems that can be used. These include the number staging system and the TNM system.
You can speak to a cancer information nurse specialist on our Macmillan support line. They can help answer any questions you have about the stage of the cancer.
Number staging
Your doctor may tell you the stage of the 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.
Number staging also includes other factors, such as whether the lung has partly or fully collapsed.
- Stages 1, 2 and 4 are divided into A and B.
- Stage 3 is divided into A, B and C.
We have not included details of the divisions of each stage here, to try to keep it simple. Your cancer doctor or specialist nurse can explain more about your stage of lung cancer.
Stage 1
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
The cancer can be different sizes. It may have spread to:
- nearby lymph nodes
- other parts of the lung
- areas just outside the lung.
Stage 2 lung cancers may be called early-stage lung cancer. But some stage 2 cancers might be described as locally advanced lung cancer.
Stage 3
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 3 lung cancer is called locally advanced lung cancer.
Stage 4
The cancer can be any size. It may have spread to lymph nodes, and 1 or more of the following:
- the lung on the other side
- the fluid in the pleura or around the heart
- another part of the body – such as the liver, bones or brain.
Stage 4 lung cancer is called metastatic or advanced lung cancer.
TNM staging
The TNM staging system is another staging system. TNM stands for tumour, node and metastases. The number staging system described above uses the TNM system to group lung cancer into different stages:
- T describes the size of the tumour or cancer. It goes from T1 to T4 depending on the tumour size.
- N describes whether the lung cancer has spread to the lymph nodes. It goes from N0 to N3 depending on the which lymph nodes are involved. For example, N0 means that no lymph nodes are affected. N1 means there are cancer cells in the lymph nodes inside the lung or where the main airway enters the lung. The affected lymph nodes are on the same side as the cancer.
- M describes whether the cancer has spread (metastasised) to the other lung. Or if it has spread to other areas such as the pleura or around the heart, or other parts of the body. It ranges from M0 to M1 depending on where to and how far the cancer has spread.
The TNM staging system for lung cancer is complicated. Your doctor or nurse can give you more information about TNM lung cancer staging.
Staging of small cell lung cancer (SCLC)
Doctors may also divide small cell lung cancers into two stages:
- Limited stage – the cancer cells can be seen in 1 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.
Small cell lung cancer (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
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.
-
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 informationproductionteam@macmillan.org.uk
National Institute for Health and Care Excellence (NICE). Lung cancer – Diagnosis and management. Clinical guideline 2019. Last updated 2023. (accessed Nov 2023) Available at: https://www.nice.org.uk/guidance/ng122
European Society for Medical Oncology (ESMO). Small-cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. 2021. (accessed Nov 2023). Available at: https://www.esmo.org/guidelines/guidelines-by-topic/esmo-clinical-practice-guidelines-lung-and-chest-tumours/small-cell-lung-cancer
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. eUpdate 01 September 2021: New Locally Advanced NSCLC Treatment Recommendations (accessed Nov 2023) Available at: https://www.esmo.org/guidelines/esmo-clinical-practice-guideline-early-stage-and-locally-advanced-non-small-cell-lung-cancer
European Society for Medical Oncology (ESMO). ESMO expert consensus statements on the management of EGFR mutant non-small-cell lung cancer. 2022 (accessed Nov 2023). Available at: https://pubmed.ncbi.nlm.nih.gov/35176458/
Date reviewed
Our cancer information meets the PIF TICK quality mark.
This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our 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
- use short sentences
- use illustrations to explain text
- structure the information clearly
- make sure important points are clear.
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.