Different stages of non-small cell lung cancer

After a diagnosis of lung cancer is made, a thorough examination is needed to determine if the cancer has spread in the lungs or has spread to other parts of the body.

The process of determining whether cancer cells have spread within the lungs or to other parts of the body is called staging. The information gathered during staging ultimately determines the stage of the disease. In order to plan treatment, it is important to know the stage. Some of the tests used to diagnose non-small cell lung cancer are also used for staging. (See the “Common Information” section.)

Other tests and procedures that may be used in staging include:

MRI (magnetic resonance imaging): A process that uses magnets, radio waves, and a computer to produce detailed pictures of a series of areas inside the body, such as the brain. This process is also called nuclear magnetic resonance imaging (NMRI).

CT scan (CAT scan): A process in which internal areas of the body, such as the chest, are scanned from different angles and made into a series of detailed image slices. These images are produced by a computer that is connected to an x-ray machine. A contrast agent may be administered orally or intravenously to make the tissue and organs more visible. This procedure may also be called computed tomography, computed tomography, or computed axial tomography.

PET scan (positron emission tomography): A method used to detect malignant cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein, and the PET scanner rotates around the body to image the part of the body that contains the glucose. In the image, the image is brighter because the malignant tumor cells are more active and take up more glucose compared to normal cells.

PET (positron emission tomography) scan; drawing shows patient lying on table that slides through the PET machine.<br />” src=”/page/web/media/CDR0000466545.jpg”><br />
<h6>Positron emission tomography (PET) scan. The patient lies on the operating table of the PET machine. The patient is immobilized with a headrest and a white band. A small amount of radioactive glucose (sugar) is injected into the patient’s vein, and the scanner photographs the areas of the body where the glucose is being used. Cancer cells take up more glucose than normal cells and therefore appear brighter in the image film. </h6>
<li>Bone scan:A test to check for the presence of rapidly dividing cells (such as cancer cells) in the bones. Trace amounts of radioactive material are injected into a vein and circulated through the bloodstream to reach the whole body. Radioactive material that collects in cancer lesions in the bones is detected by the scanner.
<li>Pulmonary function test (PFT):A test to see if the lungs are functioning well. It tests how much gas the lungs can hold and how quickly they can breathe in and out. It also measures how much oxygen is consumed and how much carbon dioxide is expelled when you breathe. This is also known as a lung function test.
<li>Bone marrow aspiration biopsy: A hollow needle is inserted into the hip bone or sternum to remove bone marrow, blood, and a small portion of bone. The pathologist looks at the bone marrow, blood, and bone under a microscope, looking for signs of cancer.
<p>Cancer spreads in the body in three ways. </p>
<p>Cancer can spread through the tissues, the lymphatic system, and the blood. </p>
<li>Tissue. Cancer spreads from the primary site into neighboring tissues.
<li>Lymphatic system. Cancer tissue invades the lymphatic system from the primary site. Cancer cells can spread to other parts of the body through the lymphatic vessels.
<li>Blood. Cancer tissue can invade the bloodstream from the primary site. Cancer cells can spread to other parts of the body through blood vessels.
<p>Cancer can spread from the primary site to other parts of the body. </p>
<p>Metastasis is the spread of cancer to other parts of the body. Cancer cells break away from the primary site (the primary tumor) and invade the lymphatic system or bloodstream. </p>
<li>Lymphatic system. Cancer tissue invades the lymphatic system and then forms a tumor in another part of the body through the lymphatic vessels (metastatic tumor).
<li>Blood. Cancerous tissue invades the bloodstream and then forms a tumor in another part of the body through the bloodstream (metastatic tumor).
<p>Metastatic tumors are the same type of tumor as the primary tumor. For example, if non-small cell lung cancer spreads to the brain, the cancer cells in the brain are actually still lung cancer cells. The disease would be called metastatic lung cancer, not brain cancer. </p>
<h6>Many cancer deaths are due to the spread of cancer cells from the primary tumor to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells move from where they first formed in the body to other parts of the body. </h6>
<p>The staging of non-small cell lung cancer is as follows:</p>
<p>Invisible (occult) stage</p>
<p>In the occult stage, the cancer cannot be detected by imaging or bronchoscopy. Cancer cells may be found in sputum or bronchial washings (a sample of cells taken from the airways leading to the lungs). The cancer cells may have spread to other parts of the body. </p>
<p>Stage 0</p>
<p>In stage 0, abnormal cells are found in the lining of the airways. These abnormal cells may become cancerous and spread to nearby normal tissue. stage 0 may be adenocarcinoma in situ (AIS) or squamous cell carcinoma in situ (SCIS). </p>
<p>Stage I</p>
<p>In stage I, cancer has formed. stage I is further divided into stage IA and stage IB. </p>
<li>Stage IA<img decoding=

Stage IA lung cancer. The tumor is only in the lung and is less than or equal to 3 cm in diameter. The cancer has not spread to the lymph nodes.

The tumor is only in the lung and is less than or equal to 3 cm in diameter. The cancer has not spread to the lymph nodes.

Stage IB

Stage IB lung cancer. The tumor is larger than 3 cm but not larger than 4 cm. The cancer has not spread to the lymph nodes; or the tumor is 4 cm or smaller. The cancer has not spread to the lymph nodes and one or more of the following are found: (a) the cancer has spread to the main bronchi but not yet to the ramus; and/or (b) the cancer has spread to the dirty pleura of the lung; and/or (c) a portion of the lung or the whole lung has developed atelectasis or pneumonia (inflammation of the lung)

Tumor is greater than 3 cm but not greater than 4 cm. The cancer has not spread to the lymph nodes.

Tumor is less than or equal to 4 cm and one or more of the following is found:

Cancer has spread to the main bronchi but has not spread to the ramus.

Cancer has spread to the innermost layer of the pleura in the superficial organ layer of the lung.

Part of the lung or the whole lung has expanded incompletely or developed pneumonia.

Cancer has not spread to the lymph nodes.

Stage II

Stage II is divided into stages IIA and IIB

Stage IIA

Stage IIA lung cancer. The tumor is larger than 4 cm but not larger than 5 cm. The cancer has not spread to the lymph nodes and one or more of the following may be found: (a) the cancer has spread to the main bronchi but not to the ramus; and/or (b) the cancer has spread to the dirty pleura of the lung; and/or (c) a portion of the lung or the whole lung has become atelectasis or there is pneumonia (inflammation of the lung).

Tumor is larger than 4 cm but not larger than 5 cm. The cancer has not spread to the lymph nodes and one or more of the following may be found:

The cancer has spread to the main bronchi but has not spread to the aorta.

Cancer has spread to the innermost layer of the dirty pleura on the surface of the lung.

Part of the lung or the whole lung has expanded incompletely or developed into pneumonia.

Stage IIB: Stage IIB lung cancer (1); drawing shows a primary tumor (5 cm or smaller) in the right lung and cancer in lymph nodes in the same lung Also shown are the trachea, main bronchus, pleura, and diaphragm.

Stage IIB lung cancer (1); drawing shows a primary tumor (5 cm or smaller) in the right lung and cancer in lymph nodes in the same lung Also shown are the trachea, main bronchus, pleura, and diaphragm.

Stage IIB lung cancer (1). The primary tumor is less than or equal to 5 cm and the cancer has spread to lymph nodes located on the same side of the chest as the primary tumor. The lymph nodes involved in the cancer are located in the lung or next to the bronchus.

The tumor is less than or equal to 5 cm and the cancer has spread to lymph nodes located on the same side as the primary tumor. The lymph nodes involved by the cancer are within the lung or next to the bronchus. In addition, one or more of the following may be found:

The cancer has spread to the main bronchus, but has not yet spread to the aorta.

Cancer has spread to the innermost layer of the dirty pleura on the surface of the lung.

Part of the lung or the whole lung has expanded incompletely or developed into pneumonia.

Stage IIB lung cancer (2). The cancer has not spread to the lymph nodes with one or more of the following: (a) primary tumor greater than 5 cm but not greater than 7 cm; and/or (b) one or more separate tumors in the same lung lobe as the primary tumor; the cancer has spread to any of the following: (c) chest wall and/or mural pleura, (d) phrenic nerve, and/or (e) mural layer of the pericardium.

The cancer has not spread to the lymph nodes and one or more of the following is found:

Tumor greater than 5 cm but not greater than 7 cm.

One or more separate tumors in the same lung lobe as the primary tumor.

Cancer has spread to any of the following sites.

Mural pleura

chest wall

phrenic nerve

Outer pericardial tissue

Stage III

Stage III is divided into stages IIIA, IIIB, and IIIC

Stage IIIA

Stage IIIA lung cancer (1). The tumor is 5 cm or smaller, and the cancer has spread to lymph nodes located on the same side of the chest as the primary tumor. The lymph nodes involved in the cancer are located around the trachea or aorta (not shown), or at the division of the trachea and bronchi. In addition, one or more of the following may be found: (a) the cancer has spread to the main bronchus but not to the aorta; and/or (b) the cancer has spread to the mural pleura; and/or (c) a portion of the lung or the whole lung has become atelectatic or has pneumonia (inflammation of the lung).

The tumor is less than or equal to 5 cm and the cancer has spread to the lymph nodes located on the same side as the primary tumor. The lymph nodes involved in the cancer are located around the trachea or aorta, or at the division of the trachea and bronchi. In addition, one or more of the following may be found:

The cancer has spread to the main bronchus, but has not yet spread to the aorta.

Cancer has spread to the innermost layer of the dirty pleura on the surface of the lung.

Part of the lung or the whole lung is incompletely expanded or has developed pneumonia.

Stage IIIA Lung cancer (2). The cancer has spread to the lymph nodes located on the same side of the chest as the primary tumor. The lymph nodes involved in the cancer are in the lungs or near the bronchi. In addition, one or more of the following may be found: (a) tumor larger than 5 cm but not larger than 7 cm; and/or (b) presence of one or more separate tumors in the same lobe of the lung as the primary tumor; cancer has spread to any of the following: (c) chest wall and/or mural pleura, (d) phrenic nerve, and/or (e) mural layer of the pericardium.

Cancer cells have spread to lymph nodes located on the same side of the chest as the primary tumor. The lymph nodes involved in the cancer are in the lungs or near the bronchi. One or more of the following were also found:

The tumor was larger than 5 cm, but not larger than 7 cm.

One or more separate tumors in the same lung lobe as the primary tumor.

Cancer has spread to any of the following sites.

Mural pleura

chest wall

phrenic nerve

the outer pericardial tissue

Stage IIIA lung cancer (3); drawing shows (a) a primary tumor (larger than 7 cm) in the left lung and (b) separate tumors in a different Also shown is cancer that has spread to the (c) trachea, (d) carina, (e) esophagus, (f) breastbone, (g) diaphragm, ( h) heart, and (i) the aorta and vena cava.

Stage IIIA lung cancer (3). The cancer may have spread to the lymph nodes located on the same side of the chest as the primary tumor. The lymph nodes involved in the cancer are in the lungs or near the bronchi. One or more of the following are also found: (a) primary tumor larger than 7 cm; and/or (b) one or more separate tumors on a lobe of the lung different from the primary tumor; and/or the tumor, regardless of size, has spread to (c) the trachea, (d) the ramus, (e) the esophagus, (f) the sternum or spine, (g) the diaphragm, (h) the heart, (i) to or from the great vessels (aorta or vena cava), or the recurrent laryngeal nerve (not shown).

Cancer may have spread to lymph nodes located on the same side of the chest as the primary tumor. The lymph nodes involved in the cancer are in the lungs or near the bronchi. One or more of the following were also found:

The tumor was larger than 7 cm.

One or more separate tumors on a lobe of the lung different from the primary tumor.

Tumor, regardless of size, with cancer that has spread to

Trachea.

tracheal bullae

esophagus

Sternum or spine

Diaphragm

Heart

major blood vessels (aorta or vena cava) leading to or from the heart

Laryngeal nerve (larynx).

Stage IIIB

Stage IIIB lung cancer (1). The primary tumor is less than or equal to 5 cm in diameter and the cancer has spread to the lymph nodes located above the clavicle in the chest on the same side as the primary tumor or to any lymph node located in the chest opposite the primary tumor. In addition, one or more of the following may be found: (a) the cancer has spread to the main bronchus but not to the ramus; and/or (b) the cancer has spread to the dirty pleura; and/or (c) a portion of the lung or the whole lung has developed atelectasis or there is pneumonia (inflammation of the lung).

The tumor is less than or equal to 5 cm in diameter, and the cancer has spread to the lymph nodes above the clavicle in the chest on the same side as the primary tumor or to any lymph node in the chest opposite the primary tumor. In addition, one or more of the following may be found:

The cancer has spread to the main bronchus, but has not yet spread to the ramus.

Cancer has spread to the innermost layer of the dirty pleura on the surface of the lung.

Part of the lung or the whole lung has expanded incompletely or developed into pneumonia.

Stage IIIB lung cancer (2). The tumor can be any size, and the cancer has spread to lymph nodes located on the same side of the chest as the primary tumor. The involved lymph nodes are located around the trachea or aorta (not shown), or at the division of the trachea and bronchi. In addition, one or more of the following were found: (a) one or more separate tumors in the same or different lobe of the lung as the primary tumor; and/or (b) the cancer had spread to the following sites: the chest wall or mural pleura, the recurrent laryngeal nerve, the trachea, the ramus, the esophagus, the sternum or spine (not shown), the septum, the phrenic nerve, the heart, the great vessels entering and leaving the heart (aorta or vena cava), or the pericardium .

The tumor can be any size, and the cancer has spread to lymph nodes located on the same side of the chest as the primary tumor. The involved lymph nodes are located around the trachea or aorta (not shown), or at the division of the trachea and bronchus. In addition, one or more of the following were found:

Separate tumors in one or more of the same or different lung lobes as the primary tumor

Cancer has spread to any of the following sites.

Mural pleura

chest wall

phrenic nerve

the outer pericardial tissue

Trachea.

tracheal ramus

Esophagus

Sternum or spine

Diaphragm

Heart

major blood vessels (aorta or vena cava) leading to or from the heart

Laryngeal nerve (larynx).

Stage IIIC

Stage IIIC lung cancer. The tumor can be any size, and the cancer has spread to the lymph nodes above the clavicle in the chest on the same side as the primary tumor or to any lymph node located in the chest opposite the primary tumor. In addition, one or more of the following were found: (a) one or more separate tumors in the same or different lobe of the lung as the primary tumor; and/or (b) the cancer had spread to the following sites: chest wall or mural pleura, recurrent laryngeal nerve, trachea, rongeur, esophagus, sternum or spine (not shown), septum, phrenic nerve, heart, large blood vessels entering or leaving the heart (aorta or vena cava), or pericardium wall layer.

The tumor can be any size, and the cancer has spread to lymph nodes above the clavicle on the same side of the chest as the primary tumor or to any lymph node located on the chest opposite the primary tumor. In addition, one or more of the following have been found:

Separate tumors in one or more of the same or different lung lobes as the primary tumor

Cancer that has spread to any of the following sites.

Mural pleura

chest wall

phrenic nerve

the outer pericardial tissue

Trachea.

tracheal ramus

Esophagus

Sternum or spine

Diaphragm

Heart

major blood vessels (aorta or vena cava) leading to or from the heart

Laryngeal nerve (larynx).

Stage IV

Stage IVA is divided into stages IVA and IVB

Stage IVA

Stage IVA lung cancer. The tumor can be any size, and the cancer may have spread to the lymph nodes. One or more of the following are found: (a) one or more tumors in the lung without a primary tumor; and/or (b) cancer cells are found in a pleural or pericardial effusion, or a cancerous lesion in the pleura or pericardium; and/or (c) cancer cells have spread to a single organ or tissue not adjacent to the lung, such as the brain, adrenal glands, kidneys, liver, or bone, or to lymph nodes not adjacent to the lung.

The tumor can be any size, and the cancer may have spread to the lymph nodes. One or more of the following are found:

One or more tumors in the lung without a primary tumor.

Cancer cells found in the pleura or pericardium

Cancer cells can be found in the body fluid surrounding the lung or heart.

Cancer cells have spread to organs or tissues not adjacent to the lungs, such as the brain, liver, adrenal glands, kidneys, bones, or lymph nodes not adjacent to the lungs

Stage IVB

Cancer cells have spread to multiple parts of one or more organs that are not adjacent to the lung Multiple sites in organs that are not adjacent to the lungs, such as the brain, adrenal glands, kidneys, liver, lymph nodes in distant segments, or bone.

Cancer has spread to multiple sites in one or more organs not adjacent to the lung