Stages of Lung Cancer

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Cancer is categorized into stages that describe the size of the tumor and how far the cancer has spread. These stages help physicians better understand the best treatment options. Lung cancer is divided into two main types: non-small cell lung cancer and small cell lung cancer, and each has its own staging system.

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Non-Small Cell Lung Cancer Stages

Non-small cell lung cancer (NSCLC) is assigned an overall stage of I, II, III or IV (stage 1, 2, 3 or 4) with stage I being the least advanced and stage IV being the most advanced. The stages may be further subdivided based on more precise features of the cancer. Here are details about what each stage means:

Stage I (1)

The cancerous tumor is only in the lung and has not spread to any lymph nodes.

Stage II (2)

The cancer may have spread to nearby lymph nodes or grown into nearby structures but is still localized, meaning it hasn’t spread to distant parts of the body.

Stage III (3)

The cancer has spread to lymph nodes in the chest or other nearby tissues or organs.

Stage IV (4)

The cancer has spread to other parts of the body.

Small Cell Lung Cancer Stages

For small cell lung cancer (SCLC), the staging system is different from NSCLC:

Limited stage

This means the cancer is on one side of your chest and involves one region of your lung, your mediastinum (area between your lungs) as well as lymph nodes.

Extensive stage

This means the cancer has spread outside your lungs to other parts of your body.

Why Staging is Important

Accurate staging is one of the most important parts of lung cancer treatment because it helps your physicians choose the most appropriate therapy for you (and can help you avoid ineffective therapy).

The Fred Hutch Cancer Center lung cancer team has a methodical and scientific approach to lung cancer staging that allows many patients to have more aggressive therapy with a goal of curing their disease, even when this may not have seemed possible based on initial evaluations.

Lung Cancer Stages FAQ

X-rays provide a basic image of your lungs, but they can’t always convey what the size, location or spread of the cancer may be. Therefore, to determine the stage of your disease, you may need scans, such as a CT scan, magnetic resonance imaging (MRI) scan, positron emission tomography (PET) scan, bone scan and brain scan.

You may also have a minimally invasive procedure called mediastinoscopy. During this procedure, a tiny, narrow lighted scope is inserted through a very small incision in your neck so the physician can examine the tissues in your chest. Your physician may want to do biopsies of lymph nodes or any abnormal appearing areas.

The TNM staging system is a method used to describe:

  • The size of the tumor (T)
  • Whether cancer has spread to nearby lymph nodes (N)
  • Whether or not it has metastasized (M), which means it has spread to other distant parts of the body

By considering these factors, physicians are able to assign a stage, which guides them in making treatment recommendations.

There is no one-size-fits-all when it comes to recommending treatments for cancer patients, because each person is different. However, there are some treatments that are more common than others when it comes to stage and cancer type.

Non-Small Cell Lung Cancer

  • Stages 0, I, and II: Surgery is generally recommended to remove the tumor. This may be combined with chemotherapy or radiation in some cases.
  • Stage III: Treatment often includes a combination of chemotherapy, radiation and sometimes immunotherapy.
  • Stage IV: Treatment usually focuses on systemic therapies (treatments that work throughout your entire body) such as targeted therapy and immunotherapy.

Small Cell Lung Cancer

  • Limited stage: Usually treated with a combination of chemotherapy and radiation followed by immunotherapy.
  • Extensive stage: Typically treated with chemotherapy, often along with immunotherapy. Radiation is sometimes utilized. Tarlatamab, a novel immunotherapy, was approved in May 2024 by the U.S. Food and Drug Administration.

Emerging treatments for advanced lung cancer include new immunotherapy drugs that enhance the body’s own ability to attack cancer and targeted therapies that fight specific genetic mutations in cancer cells, like EGFR mutations. Clinical trials are also exploring novel drug combinations and precision medicine approaches tailored to a patient’s unique type of cancer.

While Stage IV lung cancer is considered advanced, there are some treatments that can help manage the disease and improve quality of life. Therapies like immunotherapy and targeted therapy can help shrink tumors, relieve symptoms and extend survival.