Lung Cancer Staging

Stage 0

This is called "in situ" disease, meaning that the cancer is “in place” and has not spread from where it first developed.^{4,5,6,7,8,10,11}

Stage I

Stage I lung cancer tumors are small primary tumors that are in one lung only. Stage I lung cancer has not spread to any lymph nodes and has not metastasized. Stage I lung cancer is divided into two substages, stage IA and stage IB, based mainly on the size of the tumor.

Smaller tumors, those no more than 3 centimeters (cm) in the greatest dimension, are stage IA, while slightly larger ones—more than 3 cm but no more than 4 cm in the greatest dimension—are stage IB. Stage IB tumors may or may not have grown into the main bronchus or the lung's inner lining or have caused lung collapse or swelling.^{4,5,6,7,8,10,11}

Stage II

Like stage I lung cancer, stage II lung cancer is located in the lung where it has started. Stage II lung cancers have not metastasized to distant parts of the body.

Stage II lung cancer is divided into two stages: Stage IIA and stage IIB.^{4,5,6,7,8,10,11}

Stage IIA tumors are more than 4 cm but no more than 5 cm in the greatest dimension and have not spread to nearby lymph nodes. The tumors may or may not have grown into the main bronchus or into the lung's inner lining, or have caused lung collapse or swelling.

Stage IIB tumors are either:

• more than 5 cm but no more than 7 cm in the greatest dimension and have not spread to nearby lymph nodes. They have grown into the lung's outer lining or nearby sites including the chest wall, phrenic nerveA nerve that runs from the spinal cord to the diaphragm (the thin muscle below the lungs and heart that separates the chest from the abdomen). It causes the diaphragm to contract and relax, which  helps control breathing., or the heart's lining, or there are primary and secondary tumors in the same lobeA portion of an organ, such as the lung
  

OR

• no more than 5 cm in the greatest dimension and have spread to the peribronchialOf, relating to, occurring in, affecting, or being the tissues surrounding a bronchus nodes and/or to the hilarRelated to the hilum, on the medial side of each lung, where the main bronchus, pulmonary arteries, bronchial arteries, and nerves enter the lung and where the pulmonary veins, bronchial veins, and lymphatic vessels leave the lung and intrapulmonarySituated within, occurring within, or administered by entering the lungs nodes of the lung with the primary tumor. They may have grown into the main bronchus or into the lung's inner lining, or have caused lung collapse or swelling.^{4,5,6,7,8,10,11}
  

Stage III

Stage III lung cancer has spread within the chest but has not metastasized to distant parts of the body. It is sometimes referred to as locally advanced.

Stage III lung cancer is divided into three stages: stage IIIA, stage IIIB, and stage IIIC.^{4,5,6,7,8,10,11}

Stage IIIA tumors are either:

• more than 7 cm in the greatest dimension and have not spread to nearby lymph nodes. They may have grown into the diaphragmThe thin muscle below the lungs and heart that separates the chest from the abdomen, mediastinumThe area between the lungs. The organs in this area include the heart and its large blood vesels, the trachea, the esophagus, the thymus, and lymph nodes but not the lungs, heart or its major blood vessels, windpipe, recurrent laryngeal nerveThe branch of the vagus nerve supplying the larynx that arises below the larnyx, loops under the subclavian artery on the right side and under the arch of the aorta on the left, and returns upward to the larynx to supply all the muscles of the thyroid except the cricothyroid, carinaA ridge at the base of the trachea that separates the openings of the right and left main bronchi, esophagus, or spine, or there are secondary tumors in the same lung but a different lobe than the primary tumor
  

OR

• more than 5 cm in the greatest dimension and have spread to the peribronchial nodes and/or to the hilar and intrapulmonary nodes of the lung with the primary tumor. The tumors have grown into the lung's outer lining or nearby sites, including the chest wall, phrenic nerve, or the heart's lining, or there are primary or secondary tumors in the same lobe; and/or tumors have grown into the diaphragm, mediastinum, heart or its major blood vessels, windpipe, recurrent laryngeal nerve, carina, esophagus, or spine, or there are secondary tumors in the same lung but a different lobe than the primary tumor
  

OR

• no more than 5 cm in the greatest dimension and have spread to mediastinal lymph nodes, which include subcarinalLocated just below the carina of the trachea, where it splits into the right and left mainstem bronchi nodes, near the lung with the primary tumor. They may or may not have grown into the main bronchus or the lung's inner lining, or have caused lung collapse or swelling.
  

Stage IIIB tumors are either:

• more than 5 cm in the greatest dimension and have spread to mediastinal lymph nodes, which include subcarinal nodes, near the lung with the primary tumor. Tumors have grown into the lung's outer lining or nearby sites, including the chest wall, phrenic nerve, or the heart's lining, or there are primary or secondary tumors in the same lobe; and/or tumors have grown in the diaphragm, mediastinum, heart or its major blood vessels, windpipe, recurrent laryngeal nerve, carina, esophagus, or spine, or there are secondary tumors in the same lung but a different lobe than the primary tumor
  

OR

• no more than 5 cm in the greatest dimension and have spread to the mediastinal or hilar nodes near the lung without the primary tumor, or to any supraclavicularSituated or occurring above the clavicle, or scalene, lymph nodes. They may or may not have grown into the main bronchus or the lung's inner lining, or have caused lung collapse or swelling.
  

Stage IIIC tumors are more than 5 cm in the greatest dimension and have spread to mediastinal or hilar nodes near the lung without the primary tumor, or to any supraclavicular, or scalene, lymph nodes. Tumors have grown into the lung's outer lining or nearby sites, including the chest wall, phrenic nerve, or the heart's lining, or there are primary or secondary tumors in the same lobe, and/or tumors have grown into the diaphragm, mediastinum, heart or its major blood vessels, windpipe, recurent laryngeal nerve, carina, esophagus, or spine, or there are secondary tumors in the same lung but a different lobe than the primary tumor.

Stage IV

Unlike the earlier stages of lung cancer, stage IV lung cancer has metastasized to distant parts of the body. The tumors may be of any size and may or may not have spread to lymph nodes.

Stage IV lung cancer is divided into two stages: stage IVA and stage IVB.^{4,5,6,7,8,10,11}

Stage IVA tumors may be of any size, may or may not have spread to any lymph nodes, and have metastasized, either from one lung into the other lung, into the lung's lining (and have formed secondary  nodules), into the heart's lining (and have formed secondary nodules), or into the fluid around the lungs or the heart; and/or tumors have spead to one site outside the chest area (e.g., adrenal gland or bones).

Stage IVB tumors may be of any size, may or may not have spread to any lymph nodes, and have metastasized to multiple sites outside the chest area (e.g., adrenal gland and bones).^{4,5,6,7,8,10,11}

Recurrence

Recurrent lung cancerLung cancer that has come back after a period of time during which the cancer could not be detected. The lung cancer may come back in the lung near the original tumor, in lymph nodes or in a distant organ. is lung cancer that has come back after treatment. If there is a recurrence, the cancer may need to be staged again ("restaged") using the system described above.⁸