Stages Of Lung Cancer.

Stages Of Lung Cancer.

 

Making an educated treatment decision begins with the stage, or progression, of the disease. Using the results from your diagnostic tests, your care team at Cancer Treatment Centers of America^® (CTCA) will develop an appropriate treatment plan for you.

  [Lung cancer diagnostics and treatment options]

Lung cancer stages

Small cell lung cancer staging

Small cell lung cancer makes up less than 20 percent of lung cancers and is typically caused by tobacco smoking. It often starts in the bronchi, then quickly grows and spreads to other parts of the body, including the lymph nodes. Small cell lung cancer stages are classified in two ways:

• Limited stage: The cancer is found in one lung, sometimes including nearby lymph nodes.
• Extensive stage: Cancer has spread to the other lung, the fluid around the lung (the pleura) or to other organs in the body.
  

Non-small cell lung cancer staging
Non-small cell lung cancer staging uses the TNM system:

• Tumor (T) describes the size of the original tumor.
• Lymph node (N) indicates whether the cancer is present in the lymph nodes.
• Metastasis (M) refers to whether cancer has spread to other parts of the body, usually the liver, bones or brain.

A number (0-4) or the letter X is assigned to each factor. A higher number indicates increasing severity. The letter X means the information could not be assessed. For instance, a T1 score indicates a smaller tumor than a T2 score. Once the T, N and M scores have been assigned, an overall stage is assigned.
Stages of non-small cell lung cancer:

• Occult stage non-small cell lung cancer: Cancer cells are found in sputum, but no tumor can be found in the lung by imaging tests or bronchoscopy, or the tumor is too small to be checked.
• Stage 0 non-small cell lung cancer: Cancer at this stage is also known as carcinoma in situ. The cancer is tiny in size and has not spread into deeper lung tissues or outside the lungs.
• Stage I non-small cell lung cancer: Cancer may be present in the underlying lung tissues, but the lymph nodes remain unaffected.
• Stage II non-small cell lung cancer: The cancer may have spread to nearby lymph nodes or into the chest wall.
• Stage III non-small cell lung cancer: The cancer is continuing to spread from the lungs to the lymph nodes or to nearby structures and organs, such as the heart, trachea and esophagus.
• Stage IV non-small cell lung cancer: The cancer has metastasized throughout the body and may now affect the liver, bones or brain.

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Small cell lung cancer limited stage

Patients with small cell lung cancer (SCLC) will either be diagnosed in the limited or extensive stage of the disease. In limited stage small cell lung cancer, the cancer resides in one lung or in the nearby tissue. While the cancer may have spread to nearby lymph nodes or into the tissue between the lungs, the limited stage means that it has not metastasized to other organs in the body.
Due to the aggressive nature of small cell lung cancer, about 25 percent of patients are diagnosed with the disease in the limited stage. With a limited diagnosis, the median survival rate is about 16-24 months, with 14 percent at a five-year survival rate.
There are numerous treatment options available for patients with advanced-stage disease at CTCA^®.

Small cell lung cancer extensive stage

Patients with small cell lung cancer (SCLC) will either be diagnosed in the limited or extensive stage of the disease. In the extensive stage, cancer has spread to tissue outside of the originally affected lung. Extensive stage small cell lung cancer can mean that the opposite lung now has the disease, or the cancer has spread further into distant organs, such as the liver or brain.
Common treatments for extensive-stage small cell lung cancer: People in fairly good health are often treated with chemotherapy; surgery is typically not an option. Patients who respond well to chemotherapy may receive radiation therapy to the brain, to prevent the development of brain metastases, and may also undergo radiation therapy to the chest. Radiation therapy may also be used on other areas of the body to relieve symptoms caused by the spread of cancer.

[Lung cancer diagnostics and treatment options]

Non-small cell lung cancer occult stage

In occult-stage non-small cell lung cancer (NSCLC), cancer cells are found in the sputum (mucus from the lungs), but tumors are not immediately visible. Patients in the occult stage of lung cancer often do not have symptoms, though a persistent cough may be an indication.The five-year survival rate for patients diagnosed with occult stage non-small cell lung cancer is 60 - 80 percent.

What is occult stage lung cancer?

In occult-stage NSCLC, cancer cells are found in the sputum (mucus from the lungs), but tumors are not immediately visible. Patients in the occult stage of lung cancer often do not have symptoms, though a persistent cough may be an indication.
When cancer cells are identified, tumors can be located with imaging tools such as:

• Chest X-Ray
• MRI
• CT Scan
• Bronchoscopy

At CTCA^®, we use PET/CT (positron emission tomography/computed tomography), which combines two imaging technologies in one to detect small tumors in the lungs. Combining PET/CT technology reveals where healthy lung tissue ends and the tumor begins. A PET scan also reveals cancerous cells before any structural changes are present. This precisely pinpoints tumors, so that we can properly diagnose and stage the disease, and focus strictly on treating the cancerous tissues.
After the tumor is located (if it can be located), treatment is determined after the tumor is staged, using the TNM staging system.

TNM categories of occult stage

An occult stage NSCLC diagnosis occurs in conjunction with the following TNM categories:

• TX: Cancer cells were spotted, but no tumor can be located.
• N0: The cancer has not spread to the lymph nodes.
• M0: There cancer has not spread to organs or other areas.

Common treatment for occult-stage NSCLC
Treatment for occult-stage NSCLC depends on the patient’s overall health. Occult tumors may sometimes be removed with surgery.

Stage 0 Non-Small Cell Lung Cancer

Stage 0 non-small cell lung cancer, also known as carcinoma in situ, is another early stage of lung cancer that has not spread beyond the lungs. With this stage, only a few layers of cancer cell have been discovered in one local area, and have not broken through the top lining of the lung.
Since the cancer has not spread, the prognosis is similar to that of the occult stage, with a five-year survival rate of 60 – 80 percent.

What is stage 0 lung cancer?

This stage of lung cancer often does not present symptoms, and so the discovery of the cancer can occur when evaluating other symptoms or health issues. Symptoms that might appear are a persistent cough, shortness of breath or fatigue. Since the cancer has not spread in stage 0, outer lying symptoms such as weight loss, pain and fatigue are not as likely to occur. 

TNM categories of stage 0

A stage 0 lung cancer diagnosis occurs in conjunction with the following TNM categories:

• Tis: Cancer is found only in the top layers of cells lining the air passages, and has not extended deeper into the lung tissue.
• N0: The cancer has not spread to the lymph nodes.
• M0: There has been no spreading to distant organs or other areas.

Common treatment for stage 0 non-small cell lung cancer: Typically, the treatment for this stage is surgery to remove cancerous cells.

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Stage I Non-Small Cell Lung Cancer

In stage I non-small cell lung cancer  (NSCLC), cancer may be found in the underlying lung tissues, but not the lymph nodes.  Stage I is divided into two sub-stages, 1A and 1B, based on the size of the tumor. Each diagnosis depends on the size and location of the tumor. The five-year survival rate for patients diagnosed with stage I lung cancer is about 60-80 percent. Factors like response to treatment, health at the time of the diagnosis and quitting smoking may improve your survival rate if you are diagnosed with stage I lung cancer.
Similar to stage 0 lung cancer, stage I often does not present symptoms, and so the discovery of the cancer can occur when evaluating other symptoms or health issues. Since the cancer has not spread, other symptoms such as weight loss, pain and fatigue are not likely to occur.

Stage IA lung cancer

For patients diagnosed with stage IA non-small cell lung cancer, the cancerous tumor is 3 cm across or smaller, and it has not extended into the membranes surrounding the lungs. Stage IA lung cancer does not affect the main area of the bronchi, and has not spread to lymph nodes or other organs.
TNM categories of stage IA
A stage IA lung cancer diagnosis occurs in conjunction with the following TNM categories:

• T1A/T1B: If the tumor is 2 cm or less across it is T1A, if it is larger than 2 cm but smaller than 3 cm, it is characterized as T1B.
• N0: The cancer has not spread to the lymph nodes.
• M0: The cancer has not spread to distant organs or other areas.

Common treatments for Stage IA non-small cell lung cancer: Treatment options typically include removing one lung lobe via lobectomy, or a smaller piece of the lung with a segmentectomy. At least some lymph nodes within the lung and outside the lung may also be removed and tested for evidence of cancer cells.  We also provide therapies to ease the symptoms that can be associated with NSCLC, while improving your quality of life.
Stage IB lung cancer
In patients with stage IB lung cancer, the primary tumor is larger than 3 cm, but smaller than 5 cm. In addition, the tumor has one of the following features, and is not larger than 5 cm.

• The tumor has spread into the main bronchus, but is not within 2 cm of the carina, the cartilaginous ridged area that separates the opening of the right and left main bronchi stems.
• The tumor has spread into the thin, serous membranes surrounding the lungs, also known as the visceral pleura.
• The lung has partially collapsed, or developed an inflammation in the carina.

TNM categories of stage IB

• T2A: If the tumor is larger than 3 cm but smaller than 5 cm, it is classified as T2A. If the tumor is larger than 5 cm across but smaller than 7 cm, it is considered T2B.
• N0: The cancer has not spread to the lymph nodes.
• M0: The cancer has not spread to distant organs or other areas.

Common treatments for Stage IB non-small cell lung cancer: Treatment at this stage typically includes surgery, chemotherapy and radiation therapy. After surgery, lung tissue is biopsied and checked for the presence of cancer cells at the edges. If none is found, the margin is described as negative or clean, suggesting that the cancer had been removed. The margin is described as positive when cancer cells are found at the edge of the tissue, suggesting some cancer had not been removed. In order to destroy those cells, chemotherapy may be recommended. Another option may be to use radiation therapy after surgery.

[Lung cancer diagnostics and treatment options]

Stage II Non-Small Cell Lung Cancer

Stage II non-small cell lung cancer (NSCLC), like stages 0, IA and IB, is considered a localized cancer.These tumors are larger than those in stage I (less than 7 cm wide), and have begun to spread to nearby lymph nodes or other nearby structures. The cancer has not spread to distant organs. 

About 30 percent of lung cancers are diagnosed at this stage, and the treatment success rate is higher than later stages because the cancer is still contained in the vicinity of the lungs. For patients who complete treatment, the five-year survival rate is about 20 – 30 percent, with stage IIA lung cancer on the higher end of the spectrum.
Stage II non-small cell lung cancer is divided into stage IIA and IIB, with each stage then broken into additional sections, depending on the size of the tumor, where it is found, and whether or not the cancer has spread to the lymph nodes.

Stage IIA lung cancer

For patients diagnosed with stage IIA non-small cell lung cancer, the tumor is larger than 5 cm but less than 7 cm wide and has not spread to nearby lymph nodes. The diagnosis is the same when the tumor is less than 5 cm wide and has spread to nearby lymph nodes contained within the lung.
TNM categories of stage IIA When the stage IIA lung cancer tumor has spread to the lymph nodes, which would be characterized as N1 on the TNM scale, the cancer is staged as either T1A/T1B, N1, M0 or T2A, N1, M0. The M0 designation indicates for both cases that the cancer has not yet spread to other organs.
T1A/T1B, N1, M0

• The tumor is either 2 cm or less (T1A) or larger than 2 cm but smaller than 3 cm (T1B).
• The cancer has not grown into the membranes surrounding the lungs.
• The main branches of the bronchi are not affected.
• The cancer has spread to lymph nodes within the lungs and around the location where the bronchus connects to the lung.

T2A, N1, M0
The cancer has one or more of the following features:

• The tumor is larger than 3 cm but smaller than 5 cm.
• Cancer has spread to the main bronchus and is at least 2 cm below the carina, the cartilaginous ridged area that separates the opening of the right and left main bronchi stems.
• Cancer has spread to the lining of the lung.
• Part of the lung has collapsed or developed an inflammation in the carina, which can partially clog the patient’s airways.

If the cancer has not spread to the lymph nodes, it is known as T2B, N0, M 0. The cancer will have one or more of same features listed above, except the T2B stage indicates that the tumor is between 5 and 7 cm.

Stage IIB non-small cell lung cancer

Stage IIB lung cancer also has two different subcategories, depending on the size of the tumor and whether or not it has spread to the lymph nodes.
For each category, one or more of the features listed below will be present.
T2B, N1, M0

• The tumor is between 5 and 7 cm.
• Cancer has spread to the main bronchus and is at least 2 cm away from the carina.
• Cancer has spread to the lining of the lung.
• Part of the lung has collapsed or developed an inflammation in the carina, which can partially clog the patient’s airways.

T3, N0, M0
If the cancer has not spread to the lymph nodes, it is classified as T3, N0, M0 and one or more of the following features will be present:

• The tumor is larger than 7 cm.
• The tumor has expanded into the chest wall, the diaphragm, the membranes present in the space between the lungs or the membranes located in the sac surrounding the heart.
• The cancer has spread into the main bronchus and is within 2 cm of the carina, but does not actually affect the carina.
• The airways are blocked enough that the entire lung could collapse or become inflamed.
• Two or more separate tumors are present within the same lobe of one lung.

Common treatments for stage II non-small cell lung cancer: Patients with stage II non-small cell lung cancer who can tolerate surgery typically have a lobectomy or sleeve resection to remove the cancer. Sometimes, removing the whole lung is recommended. Lymph nodes likely to contain cancerous cells may also be removed. In some cases, chemotherapy (often combined with radiation) may be recommended in an effort to shrink the tumor before surgery to remove it.

[Lung cancer diagnostics and treatment options]

Stage III Non-Small Cell Lung Cancer

In this stage, tumors are more than 3 cm wide and have spread to the lymph nodes in the center of the chest or other structures outside the lung. In stage III lung cancer, the affected lymph nodes are restricted to the same side of the body as the tumor. Stage III lung cancers are classified as either stage IIIA or IIIB, depending on the size and location of the tumor and how far it has spread.
About 30 percent of patients diagnosed with lung cancer are at stage III at the time of diagnosis. The five-year survival rate for stage IIIA lung cancer varies widely, and is about 23 percent on average. For stage IIIB lung cancer, the survival rate is about 10 percent.
For many stage IIIA cancers and nearly all stage IIIB cancers, the tumor may be difficult and sometimes impossible to remove. For example, the tumor may have spread outside the lung to lymph nodes located in the center of the chest. Or the cancer may have spread into structures near the lung. In either case, the thoracic surgeon may not able to remove all the cancerous cells and may recommend chemotherapy combined with radiation treatments prior to considering surgery.
Stage IIIA lung cancer There are three main types of stage IIIA non-small cell lung cancer, which are demonstrated below using the TNM scale.
T1 - T3, N2, M0

• The main tumor can be any size, ranging from less than 3 cm (T1) up to 7 cm (T3).
• The tumor has not grown into the space between the lungs, the heart, any large blood vessels near the heart, the trachea, the esophagus, backbone or carina (the cartilaginous ridged area that separates the opening of the right and left main bronchi stems).
• The cancer has spread to the lymph nodes around the carina, or in the space located between the lungs.
• The tumor has not spread to different lobes in the initial lung.
• The cancer has not spread to distant organs.

T3, N1, M0
In this category of stage IIIA lung cancer, the disease has spread to the lymph nodes within the lung and/or where the bronchus connects with the lungs, hence the N1 rating. The lymph nodes are located on the same side as the cancer, and it has not spread to distant organs. Additionally, one or more of the following features will be true:

• The tumor is larger than 7 cm.
• The cancer has grown into the chest wall, the diaphragm, the membranes located in the space between the lungs or the sac that surrounds the heart.
• The cancer has spread into the main bronchus and is within 2 cm of the carina, but does not actually affect the carina.
• The airways are blocked enough that the entire lung could collapse or become inflamed.
• Two or more separate tumors are present within the same lobe of the main tumorous lung.

T4, N0 or N1, M0
In this type of stage IIIA non-small cell lung cancer, the cancer has not spread to distant organs, but the tumor may or may not have (N1 vs. N0) spread to the lymph nodes within the lung and/or the area where the bronchus meets the lung.
One or more of the following features will also be present:

• A tumor of any size has grown into the space between the lungs, the heart, any large blood vessels near the heart, the trachea, the esophagus, backbone or carina.
• Two or more separate tumors are present in different lobes of one lung.

Stage IIIB lung cancer

Stage IIIB lung cancer also has two different subcategories, depending on the size of the tumor and whether or not it has spread to the lymph nodes. In both instances, the cancer has not spread to distant organs (M0). For each category, one or more of the features listed below will be present.
Any T, N3, M0

• The tumor can be of any size.
• The cancer may or may not have grown into nearby structures, caused the lung to collapse or caused an inflammation/pneumonia of the entire lung.
• The cancer has spread to lymph nodes near the collarbone on either side, and/or has spread to the lymph nodes on the side opposite of the main tumor.

T4, N2, M0

• The tumor can be of any size and has grown into the space between the lungs, the heart, any large blood vessels near the heart, the trachea, the esophagus, backbone or carina, where the trachea meets the bronchi.
• Two or more separate tumors are present in different lobes of one lung.
• The cancer has spread to the lymph nodes around the carina, where the bronchi meets the trachea, or the space between the lungs.
• The affected lymph nodes are on the same side as the main tumor.

Common treatments for Stage III non-small cell lung cancer: For many stage IIIA cancers and nearly all stage IIIB cancers, the tumor may be difficult and sometimes impossible to remove. For example, the tumor may have spread outside the lung to lymph nodes located in the center of the chest. Or the cancer may have spread into structures near the lung. In either case, the thoracic surgeon may not able to remove all the cancerous cells and may recommend chemotherapy combined with radiation treatments prior to considering surgery.

[Lung cancer diagnostics and treatment options]

Stage IV Non-Small Cell Lung Cancer

Stage IV non-small cell lung cancer (NSCLC) is the most advanced form of the disease. In stage IV, the cancer has metastasized, or spread, beyond the lungs into other areas of the body. About 40 percent of NSCLC patients are diagnosed with lung cancer when they are in stage IV. The five-year survival rate for those diagnosed with stage IV lung cancer is less than 10 percent.
There are numerous treatment options available for patients with advanced-stage disease at Cancer Treatment Centers of America (CTCA). We also provide therapies to ease the symptoms that can be associated with NSCLC, while improving your quality of life.

TNM categories of stage IV

Stage IV lung cancer can be any T or N, meaning that the tumor can be any size and may or may not have grown into the nearby lymph nodes. The cancer can be categorized as either M1A or M1B. For M1A, any of the following will be true:

• The cancer has spread to the other lung.
• Cancer cells are located in the fluid surrounding the lungs (malignant pleural effusion).
• Cancer cells are located in the fluid surrounding the heart (malignant pericardial effusion).

M1B stage IV lung cancer means that the cancer has spread to distant lymph nodes or to other organs such as the bones, liver, adrenal gland, kidneys or brain.
Common treatments for stage IV non-small cell lung cancer: In stage IV lung cancer, chemotherapy is often the recommended course of treatment. Immunotherapies may also be recommended as a secondary approach. 

[Lung cancer diagnostics and treatment options]