Stages of Small Cell Lung Cancer
Stages of Non-Small Cell Lung Cancer

To plan the best treatment, your doctor needs to know the type of lung cancer and the extent (stage) of the disease. Staging is a careful attempt to find out whether the cancer has spread, and if so, to what parts of the body. Lung cancer spreads most often to the lymph nodes, brain, bones, liver, and adrenal glands.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of cancer cells and the same name as the original cancer. For example, if lung cancer spreads to the liver, the cancer cells in the liver are actually lung cancer cells. The disease is metastatic lung cancer, not liver cancer. For that reason, it's treated as lung cancer, not liver cancer. Doctors call the new tumor "distant" or metastatic disease.

Staging may involve blood tests and other tests:

• CT scan: CT scans may show cancer that has spread to your liver, adrenal glands, brain, or other organs. You may receive contrast material by mouth and by injection into your arm or hand. The contrast material helps these tissues show up more clearly. If a tumor shows up on the CT scan, your doctor may order a biopsy to look for lung cancer cells.
  
  
• Bone scan: A bone scan may show cancer that has spread to your bones. You receive an injection of a small amount of a radioactive substance. It travels through your blood and collects in your bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of your bones on a computer screen or on film.
  
  
• MRI: Your doctor may order MRI pictures of your brain, bones, or other tissues. MRI uses a powerful magnet linked to a computer. It makes detailed pictures of tissue on a computer screen or film.
  
  
• PET scan: Your doctor uses a PET scan to find cancer that has spread. You receive an injection of a small amount of radioactive sugar. A machine makes computerized pictures of the sugar being used by cells in the body. Cancer cells use sugar faster than normal cells, and areas with cancer look brighter on the pictures.

Stages of Small Cell Lung Cancer

Doctors describe small cell lung cancer using two stages:

• Limited stage: Cancer is found only in one lung and its nearby tissues.
  
  
• Extensive stage: Cancer is found in tissues of the chest outside of the lung in which it began. Or cancer is found in distant organs.

The treatment options are different for limited and extensive stage small cell lung cancer. See the Treatment ¹ section for information about treatment choices.

Stages of Non-Small Cell Lung Cancer

Doctors describe non-small cell lung cancer based on the size of the lung tumor and whether cancer has spread to the lymph nodes or other tissues:

• Occult stage: Lung cancer cells are found in sputum or in a sample of water collected during bronchoscopy, but a tumor cannot be seen in the lung.
  
  
• Stage 0: Cancer cells are found only in the innermost lining of the lung. The tumor has not grown through this lining. A Stage 0 tumor is also called carcinoma in situ. The tumor is not an invasive cancer.
  
  
• Stage IA: The lung tumor is an invasive cancer. It has grown through the innermost lining of the lung into deeper lung tissue. The tumor is no more than 3 centimeters across (less than 1 ¼ inches). It is surrounded by normal tissue and the tumor does not invade the bronchus. Cancer cells are not found in nearby lymph nodes.
  
  
• Stage IB: The tumor is larger or has grown deeper, but cancer cells are not found in nearby lymph nodes. The lung tumor is one of the following (see the picture of the main bronchus and pleura ²):
  • The tumor is more than 3 centimeters across.
  • It has grown into the main bronchus.
  • It has grown through the lung into the pleura.
  
  
• Stage IIA: The lung tumor is no more than 3 centimeters across. Cancer cells are found in nearby lymph nodes.
  
  
• Stage IIB: The tumor is one of the following:
  • Cancer cells are not found in nearby lymph nodes, but the tumor has invaded the chest wall, diaphragm, pleura, main bronchus, or tissue that surrounds the heart (see the picture of the diaphragm ²).
  • Cancer cells are found in nearby lymph nodes, and one of the following:
    • The tumor is more than 3 centimeters across.
    • It has grown into the main bronchus.
    • It has grown through the lung into the pleura.
  
  
• Stage IIIA: The tumor may be any size. Cancer cells are found in the lymph nodes near the lungs and bronchi, and in the lymph nodes between the lungs but on the same side of the chest as the lung tumor.
  
  
• Stage IIIB: The tumor may be any size. Cancer cells are found on the opposite side of the chest from the lung tumor or in the neck. The tumor may have invaded nearby organs, such as the heart, esophagus, or trachea. More than one malignant growth may be found within the same lobe of the lung. The doctor may find cancer cells in the pleural fluid.
  
  
• Stage IV: Malignant growths may be found in more than one lobe of the same lung or in the other lung. Or cancer cells may be found in other parts of the body, such as the brain, adrenal gland, liver, or bone.

You can find pictures of the stages of lung cancer and information about their treatment choices on the NCI Web site (http://www.cancer.gov/cancertopics/types/lung). Or you can call the Cancer Information Service at 1-800-4-CANCER.

Glossary Terms

A small gland that makes steroid hormones, adrenaline, and noradrenaline. These hormones help control heart rate, blood pressure, and other important body functions. There are two adrenal glands, one on top of each kidney. Also called suprarenal gland.

A group of abnormal cells that remain in the place where they first formed. They have not spread. These abnormal cells may become cancer and spread into nearby normal tissue. Also called stage 0 disease.

A dye or other substance that helps show abnormal areas inside the body. It is given by injection into a vein, by enema, or by mouth. Contrast material may be used with x-rays, CT scans, MRI, or other imaging tests.

The thin muscle below the lungs and heart that separates the chest from the abdomen.

The muscular tube through which food passes from the throat to the stomach.

Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues. Also called infiltrating cancer.

Having to do with metastasis, which is the spread of cancer from the primary site (place where it started) to other places in the body.

A procedure in which radio waves and a powerful magnet linked to a computer is used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or x-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints, and the inside of bones. Also called magnetic resonance imaging, NMRI, and nuclear magnetic resonance imaging.

Cancer cells are found in sputum (mucus coughed up from the lungs), but no tumor can be found in the lung by imaging or bronchoscopy, or the primary tumor is too small to be assessed.

A procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body. Also called positron emission tomography scan.

The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.