Non-Small Cell Lung Cancer: Stages

What does stage of a cancer mean?

The stage of a cancer is how much and how far the cancer has spread in your body. Your healthcare provider uses exams and tests to find out the size of the cancer and where it is. He or she can also see if the cancer has grown into nearby areas, and if it has spread to other parts of your body. The stage of a cancer is one of the most important things to know when deciding how to treat the cancer.

What are the stages of non-small cell lung cancer?

The stage of non-small cell lung cancer (NSCLC) is based on these things:

• Size and extent of your tumor

• Whether lymph nodes are involved and, if so, how many

• Whether the cancer has spread to other parts of your body

The stages of NSCLC are described using the TNM staging system.

The TNM system

The TNM system is a standard system for describing how much a cancer has spread. Here's what the letters stand for in the TNM system:

• T tells how large a tumor is and whether it has grown into nearby structures.

• N tells whether the lymph nodes near the tumor are cancerous.

• M tells whether the cancer has spread (metastasized) to other organs in the body, such as your brain, bones, or liver.

Numbers are assigned to each of the T, N, and M categories. Once your doctor has determined your T, N, and M categories, he or she uses this information in a process called stage grouping. Stage grouping is used to find out your overall disease stage. The staging groups are called occult cancer or they're labeled with Roman numerals 0 to 4 (0, I, II, III, IV). The higher the stage, the more cancer there is. Stage IV is the highest stage.

Stage groupings

These are the stages of non-small cell lung cancer. Each TNM category has a number value from X (it hasn't been determined) to 4 (the highest). The TNM values are used to put the cancer into one of these stages:

Occult (hidden) cancer

This means you have cancer cells in your sputum (the mucus from the lungs) or other lung fluids, but the main tumor can't be found. The cancer has not spread to your lymph nodes or to other parts of your body.
You may hear your doctor use these TNM terms for this stage: TX, N0, M0.

Stage 0 or carcinoma in situ

 

The cancer is very tiny and is only in the cells lining your air passages. It has not invaded deeper into lung tissues or spread outside the lungs.
You may hear your doctor use these TNM terms for this stage: Tis (in situ), N0, M0.

Stage I

This stage is divided into subgroups using letters and numbers.
Stage IA1: Can be either of these:
The tumor is only in the lung and is not bigger than 3 cm (centimeters) across. The part of the tumor that's deeper in the lung tissues is no more than 1/2 cm across. The TNM terms for this stage are T1mi ("mi" stands for minimally invasive), N0, M0.
or
The tumor is only in the lung and is not bigger than 1 cm across. It has not spread into the sac-like membrane that surrounds the lung or to the main airways (the bronchi). The TNM terms for this stage are T1a, N0, M0.
Stage IA2: The tumor is only in the lung and is bigger than 1 cm, but less than 2 cm across. It has not spread into the sac-like membrane that surrounds the lung or to the main airways (the bronchi). The TNM terms for this stage are T1b, N0, M0.
Stage IA3: The tumor is only in the lung and is bigger than 2 cm, but less than 3 cm across. It has not spread into the sac-like membrane that surrounds the lung or to the main airways (the bronchi). The TNM terms for this stage are T1c, N0, M0.
Stage IB: The tumor has not spread outside the lungs and is one or more of these:
It's bigger than 3 cm, but less than 4 cm acrossIt has grown into one of the bronchiIt has grown into the sac-like membrane that surrounds the lungIt's partly blocking the airwaysThe TNM terms for this stage are T2a, N0, M0.

Stage II

This stage is divided into subgroups using letters and numbers.
Stage IIA: The tumor has not spread outside the lungs and is one or more of these:

• It's bigger than 4 cm, but less than 5 cm across

• It has grown into one of the bronchi

• It has grown into the sac-like membrane that surrounds the lungIt's partly blocking the airways

• The TNM terms for this stage are T2b, N0, M0.

Stage IIB: Can be any of these:
The tumor is not bigger than 3 cm across. It has not spread into the sac-like membrane that surrounds the lung or to the main airways (the bronchi). It has spread into nearby lymph nodes on the same side as the cancer. It has not spread to other parts of the body. The TNM terms for this stage are T1a or T1b or T1c, N1, M0.
or
The tumor is one or more of these:

• It's bigger than 3 cm, but less than 5 cm across

• It has grown into one of the bronchi

• It has grown into the sac-like membrane that surrounds the lung

• It's partly blocking the airways

It also has spread into nearby lymph nodes on the same side as the cancer. It has not spread to other parts of the body. The TNM terms for this stage are T2a or T2b, N1, M0.
or
The tumor is one or more of these:

• It's bigger than 5 cm, but less than 7 cm across

• It has grown into the sac-like membrane that surrounds the lung, the chest wall, the phrenic nerve, or the sac-like membrane that surrounds the heart

• There are 2 or more tumors in the same lobe of the lung

It has not spread into nearby lymph nodes or to other parts of the body. The TNM terms for this stage are T3, N0, M0.

Stage III

This stage is divided into subgroups using letters and numbers.
Stage IIIA: Can be any these:
The tumor is no bigger than 3 cm across. It has not spread into the sac-like membrane that surrounds the lung or to the main airways (the bronchi). It has spread to lymph nodes between the lungs or around the place where the windpipe (trachea) splits into the 2 main bronchi on the same side as the cancer. It has not spread to other parts of the body. The TNM terms for this stage are T1a or T1b or T1c, N2, M0.
or
The tumor is one or more of these:

• It's bigger than 3 cm, but less than 5 cm across

• It has grown into one of the bronchi

• It has grown into the sac-like membrane that surrounds the lung

• It's partly blocking the airways

It has also spread to lymph nodes between the lungs or around the place where the windpipe (trachea) splits into the 2 main bronchi on the same side as the cancer.

It has not spread to other parts of the body. The TNM terms for this stage are T2a or T2b, N2, M0.
or
The tumor is one or more of these:

• It's bigger than 5 cm, but less than 7 cm across

• It has grown into one of the bronchi

• It has grown into the sac-like membrane that surrounds the lung, the chest wall, the phrenic nerve, or the sac-like membrane that surrounds the heart

There are 2 or more tumors in the same lobe of the lung

It has also spread to lymph nodes inside the lung or around the place where the bronchi enter the lung on the same side as the cancer.

It has not spread to other parts of the body. The TNM terms for this stage are T3, N1, M0.
or
The tumor is one or more of these:

• It's bigger than 7 cm across

• It has grown into the the space between the lungs, the windpipe (trachea), the place where the windpipe (trachea) splits into the 2 main bronchi, the heart, large blood vessels near the heart, the esophagus, the diaphragm, or the spine.

• There are 2 or more tumors in the same lobe of the lung

It may have spread to lymph nodes inside the lung and/or around the place where the bronchi enter the lung. Nodes with cancer are on the same side as the main tumor. It has not spread to other parts of the body. The TNM terms for this stage are T4, N0 or N1, M0.
Stage IIIB: Can be any of these:
The tumor is no bigger than 3 cm across. It has not spread into the sac-like membrane that surrounds the lung or to the main airways (the bronchi). It has spread to lymph nodes between the lungs and/or around the place where the windpipe (trachea) splits into the 2 main bronchi in the lung that doesn't have the main tumor. It has spread to lymph nodes near either collar bone. It has not spread to other parts of the body. The TNM terms for this stage are T1a or T1b or T1c, N3, M0.
or
The tumor is one or more of these:

• It's bigger than 3 cm, but less than 5 cm across

• It has grown into one of the bronchi

• It has grown into the sac-like membrane that surrounds the lung

• It's partly blocking the airways

It has also spread to lymph nodes between the lungs and/or around the place where the windpipe (trachea) splits into the 2 main bronchi in the lung that doesn't have cancer. It has spread to lymph nodes near the collar bones on either side of the body. It has not spread to other parts of the body. The TNM terms for this stage are T2a or T2b, N3, M0.

or
The tumor is one or more of these:

• It's bigger than 5 cm, but less than 7 cm across

• It has grown into the sac-like membrane that surrounds the lung, the chest wall, the phrenic nerve, or the sac-like membrane that surrounds the heart

• There are 2 or more tumors in the same lobe of the lung

It has also spread to lymph nodes between the lungs or around the place where the bronchi enter the lung. The nodes with cancer are on the same side as the main tumor. It has not spread to other parts of the body. The TNM terms for this stage are T3, N2, M0.
or
The tumor is one or more of these:

• It's bigger than 7 cm across

• It has grown into the the space between the lungs, the windpipe (trachea), the place where the windpipe (trachea) splits into the 2 main bronchi, the heart, large blood vessels near the heart, the esophagus, the diaphragm, or the spine.

• There are 2 or more tumors in the same lobe of the lung

It has spread to lymph nodes between the lungs or around the place the windpipe (trachea) splits into the 2 main bronchi. Nodes with cancer are on the same side as the main tumor. It has not spread to other parts of the body. The TNM terms for this stage are T4, N2, M0.
Stage IIIC: Can be either of these:
The tumor is one or more of these:

• It's bigger than 5 cm, but less that 7 cm across

• It has grown into the sac-like membrane that surrounds the lungs, the chest wall, the phrenic nerve, or the sac-like membrane that surrounds the heart

• There are 2 or more tumors in the same lobe of the lung

It has spread to lymph nodes between the lungs or around the place the windpipe (trachea) splits into the 2 main bronchi in the lung without cancer. It has spread to lymph nodes near the collar bones on either side of the body. It has not spread to other parts of the body. The TNM terms for this stage are T3, N3, M0.
or
The tumor is one or more of these:

• It's bigger than 7 cm across

• It has grown into the the space between the lungs, the windpipe (trachea), the place where the windpipe (trachea) splits into the 2 main bronchi, the heart, large blood vessels near the heart, the esophagus, the diaphragm, or the spine.

• There are 2 or more tumors in the different lobes of the same lung

It may have spread to lymph nodes between the lungs or around the place where the windpipe (trachea) splits into the 2 main bronchi in the lung without cancer. It has spread to lymph nodes near the collar bone on either side of the body. It has not spread to other parts of the body. The TNM terms for this stage are T4, N3, M0.Stage IVThis stage is divided into subgroups using letters and numbers.
Stage IVA: Can be either of these:
The tumor can be any size and may have grown into nearby tissues or lymph nodes. It's also one of these:

• It has spread to the other lung

• Cancer cells have been found in the fluid around the lung

• Cancer cells have been found in the fluid around the heart

The TNM terms for this stage are any T, any N, M1a.
or
The tumor can be any size and may have grown into nearby tissues or lymph nodes. It has also spread to one tumor outside the chest, such as a distant lymph node or another organ like the liver, bone, or brain. The TNM terms for this stage are any T, any N, M1b.
Stage IVB: The tumor is any size and may have grown into nearby tissues or lymph nodes. It has spread to more than 1 tumor outside the chest, such as a distant lymph node or another organ like the liver, bone, or brain. The TNM terms for this stage are any T, any N, M1c

Talking with your healthcare provider

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Be sure to ask your healthcare provider to explain the stage of your cancer to you in a way you can understand. Make sure to ask any questions or talk about your concerns.