What is lung cancer staging?
Lung cancer staging defines the extent of lung cancer in your body and guides your treatment. It tells you about the size of the tumor and how far it has spread. Stage 0 lung cancer has spread the least, while stage 4 has the most.
Understanding the lung cancer stages is important because it’s the first step in creating a plan for your lung cancer treatment. In general, lung cancer in the earliest stages is easier to treat. However, continued advances in care mean you now have even more options for later stages of lung cancer.
Regardless of stage, our lung cancer teams will guide you through your choices and answer your questions. Many of our locations offer advanced tools and tests that help with lung cancer staging and give you access to innovative treatment options so that you feel confident in the path ahead.
TNM staging for lung cancer
TNM staging for lung cancer is a system used by your care team. In lung cancer, TMN staging is commonly used for non-small cell lung cancer. If you have small-cell lung cancer, your team may use a different staging system.
TNM staging places your specific cancer into stages 0 to 4, as well as substages identified by three letters:
Tumor (T)
Your care team will look at the size and location of the tumor and how far it has spread in the lungs.
Node (N)
Cancer often spreads to nearby lymph nodes, which are part of your immune system. Your team will look for cancer that has spread to these regional nodes.
Metastasis (M)
When cancer spreads to other areas of the body, it’s called metastasis or metastatic lung cancer. Your care team will look for signs of lung cancer in distant areas like the liver, brain or bones.
Etapas del cáncer de pulmón de células no pequeñas
The most common type of lung cancer is non-small cell lung cancer (NSCLC). It’s grouped into five different stages. Usually, the lower the stage number, the better the prognosis for treatment and long-term remission. Stage 0 and stage 1 are the earliest stages, where the cancer has not spread outside the lung. In stages 2, 3 and 4, the lung cancer has begun to spread to lymph nodes or other organs.
Our cancer teams are highly experienced in diagnosing and staging lung cancer. We offer advanced testing and expertise to help guide the staging process and give you the information you need to make informed choices about your care.
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Stage 0 lung cancer
Stage 0 lung cancer
This first stage of lung cancer means that abnormal cells or cancer have only developed inside the lining of air passages in the lungs; they haven’t spread further into other lung tissues or other areas of the body. At stage 0, you may not have any symptoms, and this stage of lung cancer is often only found during an imaging test like a lung cancer screening.
If your team finds early-stage lung cancer on an imaging test, many of our locations offer specialized clinics to coordinate your care and connect you with treatment. The primary treatment for stage 0 lung cancer is surgery or endobronchial therapies, which help remove or destroy the cancer cells while preserving healthy lung tissue.
The two types of stage 0 lung cancer are:
- Adenocarcinoma in situ: The abnormal cells are still “in place” where they started in the lining of the lung’s glandular tissue.
- Squamous cell carcinoma in situ: The abnormal cells are still “in place” where they started in tissues that line the respiratory tract.
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Stage 1 lung cancer
Stage 1 lung cancer
Stage 1 lung cancer includes small-sized tumors located in only one lung. The cancer has not spread to any of the regional lymph nodes or anywhere outside of the lung. You may start to have symptoms, such as shortness of breath, a persistent cough, coughing up blood or blood-stained mucus.
With our dedicated cancer programs, we’ll help you coordinate all your treatments so you can access the care you need. Surgery is the primary treatment for stage 1A and 1B lung cancer, but in some cases, radiation is used. In stage 1B, chemotherapy and targeted therapy may be recommended following your surgery.
- Stage 1A: The tumor is less than or equal to 3 centimeters in size. In this substage, it does not involve a membrane around your lung (the visceral pleura) and does not involve the main bronchus.
- Stage 1B: A few factors may place your cancer in stage 1B:
- The tumor is between 3 and 4 centimeters in size.
- In this substage, smaller tumors that involve the visceral pleura have grown into the main bronchus.
- The tumors may have caused changes in the lung due to obstruction of your airway.
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Stage 2 lung cancer
Stage 2 lung cancer
At stage 2, lung cancer has started to grow, and it may have spread to nearby lymph nodes. Your symptoms could include a cough, bronchitis or pneumonia that doesn’t go away. Other symptoms include weight loss, coughing blood, chest pain, hoarse voice, shortness of breath, wheezing or tiredness.
Your care team will work with you to plan your care, which could include several treatment options. Surgery is often still used at this stage, but chemotherapy and immunotherapy may also be recommended before or after surgery. In some situations, targeted therapy and radiation therapy may be offered. Our lung cancer experts will guide you through the entire process.
- Stage 2A: Stage 2A lung cancer includes tumors greater than 4 centimeters but not more than 5 centimeters. In this substage, cancer hasn’t spread to the nearby lymph nodes but may involve the main bronchus or the tissue surrounding the lung and may have caused changes in your lung due to obstruction of the airway.
- Stage 2B: A few factors may place your cancer in stage 2B:
- In some cases, the tumor is up to 5 centimeters and has spread to nearby lymph nodes in the chest. It may have also spread to the main bronchus or tissue surrounding the lung, obstructing the airways.
- Your cancer may also be stage 2B if the original tumor is between 5 and 7 centimeters but doesn’t involve the nearby lymph nodes.
- You may also have this stage of disease if you have more than one tumor in the same part of the lung—even if the tumors are smaller in size— or if the cancer has reached areas outside the lungs, such as the chest wall, the outside lining of the heart or a nerve near the lungs that controls the diaphragm.
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Stage 3 lung cancer
Stage 3 lung cancer
Stage 3 lung cancer has spread into the lymph nodes, other lobes in the same lung or nearby tissues or organs in the chest. You may experience similar symptoms to stage 1 and stage 2 lung cancer, as well as symptoms in other organs affected by the cancer.
Your care team may still be able to remove some stage 3 tumors. However, the cancer may have spread too much for surgery to be beneficial. Based on your specific tumor and substage, your stage 3 lung cancer treatment could include chemotherapy, radiation therapy or immunotherapy. You may also have access to innovative research and clinical trials to give you even more options.
- Stage 3A: This substage is applied in a few different cases:
- The tumor is less than 5 centimeters and has spread to certain areas of lymph nodes in the chest. It may have also spread to the main bronchus or to the membranes that surround the lung or has caused changes in the lung due to obstruction of the airway.
- The original tumor is between 5 and 7 centimeters and cancer is found in the nearby lymph nodes.
- Any sized tumor has grown to the chest wall and involves the nearby lymph nodes, or the tumor involves the nearby lymph nodes and either the sac surrounding the heart or a nerve.
- The original tumor is more than 7 centimeters, one other tumor has formed in a different lobe of the same lung, or the cancer involves other tissues in the chest like the windpipe (trachea) or esophagus.
- Stage 3B: The following cases would be categorized as stage 3B:
- A tumor of less than 5 centimeters is found in lymph nodes on the other side of your chest or above the collarbone.
- The original tumor is more than 5 centimeters, or there are other tumors in the same lung and cancer is found in the lymph nodes in the center of the chest.
- The cancer has reached the chest wall, the sac around the heart or the nerve that controls the diaphragm (phrenic nerve) or a nerve that controls the vocal cords (recurrent laryngeal nerve).
- Stage 3C: The cancer has spread to the lymph nodes in the other lung or past the collarbones and the original tumor measures more than 5 centimeters. It’s also considered stage 3C when a tumor of any size involves the chest wall, sac around the heart or specific nerves, or there is a secondary tumor in the same lung.
- Stage 3A: This substage is applied in a few different cases:
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Stage 4 lung cancer
Stage 4 lung cancer
Stage 4 lung cancer is the most advanced type of lung cancer. Also known as metastatic lung cancer, it may have spread to the opposite lung or distant parts of the body. During this stage, there is a wide range of symptoms, including a cough, coughing up blood, chest pain, shortness of breath, loss of appetite, weight loss, fatigue, weakness, headaches and pain.
Treatments for metastatic lung cancer focus on managing symptoms and slowing the growth of the cancer. Surgery isn’t usually an option at this stage, but your treatment options may include chemotherapy, immunotherapy, targeted therapy or clinical trials.
- Stage 4A: In this substage, the cancer may have spread into the other lung, formed in the fluid and lining surrounding the heart or lungs, or cancer is found in a distant location like the liver, bones, adrenal gland or brain.
- Stage 4B: This is the most advanced substage of metastatic lung cancer. The cancer has spread with multiple tumors found outside the lung, including the liver, bones, adrenal gland or brain.
Along with medical treatments, you’ll have access to numerous services that support you and help you navigate this stage of cancer. You don’t have to walk through your stage 4 lung cancer journey alone.
Stage 0 lung cancer
This first stage of lung cancer means that abnormal cells or cancer have only developed inside the lining of air passages in the lungs; they haven’t spread further into other lung tissues or other areas of the body. At stage 0, you may not have any symptoms, and this stage of lung cancer is often only found during an imaging test like a lung cancer screening.
If your team finds early-stage lung cancer on an imaging test, many of our locations offer specialized clinics to coordinate your care and connect you with treatment. The primary treatment for stage 0 lung cancer is surgery or endobronchial therapies, which help remove or destroy the cancer cells while preserving healthy lung tissue.
The two types of stage 0 lung cancer are:
- Adenocarcinoma in situ: The abnormal cells are still “in place” where they started in the lining of the lung’s glandular tissue.
- Squamous cell carcinoma in situ: The abnormal cells are still “in place” where they started in tissues that line the respiratory tract.
Stage 1 lung cancer
Stage 1 lung cancer includes small-sized tumors located in only one lung. The cancer has not spread to any of the regional lymph nodes or anywhere outside of the lung. You may start to have symptoms, such as shortness of breath, a persistent cough, coughing up blood or blood-stained mucus.
With our dedicated cancer programs, we’ll help you coordinate all your treatments so you can access the care you need. Surgery is the primary treatment for stage 1A and 1B lung cancer, but in some cases, radiation is used. In stage 1B, chemotherapy and targeted therapy may be recommended following your surgery.
- Stage 1A: The tumor is less than or equal to 3 centimeters in size. In this substage, it does not involve a membrane around your lung (the visceral pleura) and does not involve the main bronchus.
- Stage 1B: A few factors may place your cancer in stage 1B:
- The tumor is between 3 and 4 centimeters in size.
- In this substage, smaller tumors that involve the visceral pleura have grown into the main bronchus.
- The tumors may have caused changes in the lung due to obstruction of your airway.
Stage 2 lung cancer
At stage 2, lung cancer has started to grow, and it may have spread to nearby lymph nodes. Your symptoms could include a cough, bronchitis or pneumonia that doesn’t go away. Other symptoms include weight loss, coughing blood, chest pain, hoarse voice, shortness of breath, wheezing or tiredness.
Your care team will work with you to plan your care, which could include several treatment options. Surgery is often still used at this stage, but chemotherapy and immunotherapy may also be recommended before or after surgery. In some situations, targeted therapy and radiation therapy may be offered. Our lung cancer experts will guide you through the entire process.
- Stage 2A: Stage 2A lung cancer includes tumors greater than 4 centimeters but not more than 5 centimeters. In this substage, cancer hasn’t spread to the nearby lymph nodes but may involve the main bronchus or the tissue surrounding the lung and may have caused changes in your lung due to obstruction of the airway.
- Stage 2B: A few factors may place your cancer in stage 2B:
- In some cases, the tumor is up to 5 centimeters and has spread to nearby lymph nodes in the chest. It may have also spread to the main bronchus or tissue surrounding the lung, obstructing the airways.
- Your cancer may also be stage 2B if the original tumor is between 5 and 7 centimeters but doesn’t involve the nearby lymph nodes.
- You may also have this stage of disease if you have more than one tumor in the same part of the lung—even if the tumors are smaller in size— or if the cancer has reached areas outside the lungs, such as the chest wall, the outside lining of the heart or a nerve near the lungs that controls the diaphragm.
Stage 3 lung cancer
Stage 3 lung cancer has spread into the lymph nodes, other lobes in the same lung or nearby tissues or organs in the chest. You may experience similar symptoms to stage 1 and stage 2 lung cancer, as well as symptoms in other organs affected by the cancer.
Your care team may still be able to remove some stage 3 tumors. However, the cancer may have spread too much for surgery to be beneficial. Based on your specific tumor and substage, your stage 3 lung cancer treatment could include chemotherapy, radiation therapy or immunotherapy. You may also have access to innovative research and clinical trials to give you even more options.
- Stage 3A: This substage is applied in a few different cases:
- The tumor is less than 5 centimeters and has spread to certain areas of lymph nodes in the chest. It may have also spread to the main bronchus or to the membranes that surround the lung or has caused changes in the lung due to obstruction of the airway.
- The original tumor is between 5 and 7 centimeters and cancer is found in the nearby lymph nodes.
- Any sized tumor has grown to the chest wall and involves the nearby lymph nodes, or the tumor involves the nearby lymph nodes and either the sac surrounding the heart or a nerve.
- The original tumor is more than 7 centimeters, one other tumor has formed in a different lobe of the same lung, or the cancer involves other tissues in the chest like the windpipe (trachea) or esophagus.
- Stage 3B: The following cases would be categorized as stage 3B:
- A tumor of less than 5 centimeters is found in lymph nodes on the other side of your chest or above the collarbone.
- The original tumor is more than 5 centimeters, or there are other tumors in the same lung and cancer is found in the lymph nodes in the center of the chest.
- The cancer has reached the chest wall, the sac around the heart or the nerve that controls the diaphragm (phrenic nerve) or a nerve that controls the vocal cords (recurrent laryngeal nerve).
- Stage 3C: The cancer has spread to the lymph nodes in the other lung or past the collarbones and the original tumor measures more than 5 centimeters. It’s also considered stage 3C when a tumor of any size involves the chest wall, sac around the heart or specific nerves, or there is a secondary tumor in the same lung.
Stage 4 lung cancer
Stage 4 lung cancer is the most advanced type of lung cancer. Also known as metastatic lung cancer, it may have spread to the opposite lung or distant parts of the body. During this stage, there is a wide range of symptoms, including a cough, coughing up blood, chest pain, shortness of breath, loss of appetite, weight loss, fatigue, weakness, headaches and pain.
Treatments for metastatic lung cancer focus on managing symptoms and slowing the growth of the cancer. Surgery isn’t usually an option at this stage, but your treatment options may include chemotherapy, immunotherapy, targeted therapy or clinical trials.
- Stage 4A: In this substage, the cancer may have spread into the other lung, formed in the fluid and lining surrounding the heart or lungs, or cancer is found in a distant location like the liver, bones, adrenal gland or brain.
- Stage 4B: This is the most advanced substage of metastatic lung cancer. The cancer has spread with multiple tumors found outside the lung, including the liver, bones, adrenal gland or brain.
Along with medical treatments, you’ll have access to numerous services that support you and help you navigate this stage of cancer. You don’t have to walk through your stage 4 lung cancer journey alone.
Etapas del cáncer de pulmón de células pequeñas
Usually, small-cell lung cancer is placed into one of two stages: limited-stage and extensive-stage cancer. In rare circumstances, your care team may use the TMN staging system.
Small-cell lung cancer tends to be faster-growing than non-small lung cancer and can quickly spread, reaching the extensive stage. Your treatment plan will be different based on your cancer stage, and our team will work with you to guide your next steps.
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Extensive-stage small cell lung cancer
More than 60% of cases of small-cell lung cancer have reached extensive-stage cancer when they are found. In this stage, the cancer has spread throughout one lung and may have spread to the other lung, lymph nodes or surrounding tissues.
In most cases, you’ll have chemotherapy or immunotherapy to treat this stage of small-cell lung cancer. At many of our locations, you will have access to advanced immunotherapy treatments and innovative clinical trials to care for your lung cancer.
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Limited-stage small cell lung cancer
Limited-stage small-cell lung cancer is localized, which means it’s only in one area of the chest, like a single lung. As the cancer is limited to one location, you have more treatment options at this stage, including chemotherapy and radiation therapy. Surgery could also be possible in the very early stages.
Recurrent lung cancer
Recurrent lung cancer is when your lung cancer is in remission for a year or more but then returns. It can reoccur in the same place (local recurrence), near the original tumor in lymph nodes (regional recurrence) or in areas far away from the original tumor (distant recurrence).
Unfortunately, recurrent lung cancer is relatively common. In non-small cell lung cancer, approximately 30% of people with stage 1 lung cancer have recurrent lung cancer, while more than 60% of stage 3 lung cancers return. In small-cell lung cancer, recurrence happens in as many as 70% of cases.
After lung cancer treatment, our team will continue to support you throughout your survivorship journey. You’ll have access to follow-up care and monitoring that can help you stay well and manage any signs of recurrence.
Treating recurrent lung cancer
Many of the same therapies used to treat your original lung cancer are options for recurrent lung cancer, such as chemotherapy, immunotherapy, radiation therapy, surgery, endobronchial therapies and clinical trials.
Depending on how advanced the recurrent cancer is and where it’s located, your treatment goals could aim to slow the new cancer’s growth or ease your symptoms. At our cancer centers, you’ll have resources and support to make the right choices for your treatment needs.
Compassionate support at any stage of lung cancer
Whether you’ve just been diagnosed or you’re looking for a second opinion, our lung cancer treatment centers offer support and hope for all stages of lung cancer. You’ll have access to advanced technology unavailable at most hospitals, such as robotic bronchoscopy and targeted treatments. We also have dedicated care teams working with you to plan your next steps.
Along with supporting your physical needs, you’ll receive tools and resources to care for yourself emotionally, mentally, socially and spiritually. We take a holistic approach to help you determine the care that works for you.
Some of our support resources include:
Connect with certified navigators
With our certified navigators, you have an advocate by your side at every stage of your lung cancer journey—from diagnosis to survivorship. Whether you’re unsure where to turn, need help coordinating appointments or have a quick question, your certified navigator is your first point of contact for support and guidance.
Navigators connect you with the many support resources inside and outside our hospitals and clinics. And they are also available to help your family or caregivers get the support they need.