With an Explanation of Symptom Progression
The stages of lung cancer range from 0 to 4 based on how advanced the cancer is. Lower numbers are less advanced and have a higher survival rate. Higher stages are more advanced and have a lower survival rate. Pre Cancerous Colon Polyps
There are different lung cancer classification systems based on the type of cancer. Information used in staging lung cancer includes the size of the main tumor, cancer in the lymph nodes, and the spread of cancer to other areas of the body.
The lung cancer staging system lets oncologists (cancer specialists) effectively communicate with and about the patient, make accurate treatment decisions, and determine the course of the disease.
This article will review the stages of types of lung cancer, including life expectancy and survival rates at each stage. It will review the symptoms and treatment options for each lung cancer stage and how quickly it progresses.
Different types of lung cancer use different staging systems. The two main types of lung cancer are non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). There is also a type of cancerous tumor that can develop in the lungs called a carcinoid tumor. Characteristics of each include:
Non-small cell lung cancers are staged on a traditional 0 to 4 system based on the size of the tumor, its presence in the lymph nodes, and its spread to other organs.
Most cancers, including NSCLC, use a version of the TNM staging system. This system takes into account these three main factors:
The other main factor that impacts the stage of NSCLC is the type of cells the cancer has come from. The three most common kinds of non-small cell lung cancer are:
Most NSCLCs are diagnosed at stage 3 or 4. According to the National Cancer Institute’s SEER (Surveillance, Epidemiology, and End Results) database, only 26% of lung and bronchus cancers are diagnosed early, with more than half (53%) of cases found after it has already spread to other body parts (metastasized).
Small cell lung cancers use a different staging system. This system only has two stages.
Limited SCLC is on just one side of the chest but can be present in both the lung and lymph nodes. These cancers are confined to an area small enough to be treated with radiation through just one port.
About one-third of people with SCLC are classified as limited-stage. They will typically benefit from more aggressive treatment options like chemotherapy combined with radiation to try to cure the cancer.
Extensive SCLC is typically spread over a larger area—widespread within one side of the chest or on both sides. The cancer may also have spread to lymph nodes above the collar bone, on the other side of the chest, or in the middle of the chest. Cancer may have spread to the fluid around the lung or other body parts and organs.
Extensive-stage SCLC is more advanced, so treatments aim to control the spread of cancer instead of cure it. This would typically involve chemotherapy alone. Two-thirds of small cell lung cancers are classified as extensive stage.
Carcinoid lung cancers may grow very slowly and are less likely to spread to other body parts than other lung cancers. The staging system used for lung carcinoid tumors is a version of the TNM staging system published by the American Joint Committee on Cancer (AJCC) in 2018, includes:
Stage 0 non-small cell lung cancer is the most curable stage of this common lung cancer. Stage 0 is when cancer cells are found only in the topmost layer of cells in the airway lining. They haven't spread deeper into the airway nor are they found in any lymph nodes or other body parts.
Early lung cancers typically have very few symptoms. Most lung cancers do not have symptoms until they spread outside the lungs. This makes it challenging to catch lung cancers early.
Treatment for stage 0 NSCLC typically involves surgery without chemotherapy or radiation. Usually, the small section of the lung that is cancerous is removed using a segmentectomy (removal of a segment of the lung) or wedge resection (removal of a wedge-shaped area of the lung). These treatments should be enough to cure stage 0 NSCLC.
Alternatives to surgery include photodynamic therapy (a light-sensitizing drug and bright light is used to kill cancer cells), laser therapy, or brachytherapy (internal radiation).
It is not often that lung cancers are caught at stage 0. If they are, it’s usually because you’re getting scanned for another reason or getting screening for being high risk. If it is completely removed, stage 0 NSCLC is curable and should not recur, indicating a high survival rate is likely.
Stage 1 non-small cell lung cancer is divided into the following stages:
Stage 1 NSCLC is typically treated with surgery to remove the area of the lung with the primary tumor. The surgeon will also check the lymph nodes and the space between the lungs for cancer.
Certain factors may make stage 1 NSCLC more likely to return after surgery. In these cases, the person may get additional treatment with chemotherapy and possibly immunotherapy after surgery.
If analysis of the removed portion of the lung after surgery suggests that there may have been cancer left behind, you may need another surgery or radiation.
Immunotherapy with Opdivo (nivolumab) is another option for larger tumors. It is used along with chemotherapy before surgery. Additional therapy after surgery might be needed depending on what is found at the time of surgery.
People with serious health problems who can’t have surgery may get radiation therapy, including stereotactic body radiation therapy (which delivers precise and intense doses of radiation to the cancer site) or radiofrequency ablation treatment (radio waves apply heat to destroy tissues).
About 26% of adenocarcinomas of the lung and bronchus are found at the localized stage. The localized stage is the National Cancer Institute’s SEER database equivalent to stage 1 or stage 0 cancers. These cancers have not spread beyond the tissue or organ they started in (the primary site).
The five-year relative survival rate for people diagnosed with localized lung adenocarcinoma between 2013 and 2019 was 73.3%. That means nearly 3 out of every 4 people who were diagnosed with stage 1 or 0 adenocarcinoma NSCLC during this period were still alive five years later. For all NSCLCs, the survival rate for localized cancers is 65%.
Stage 2 non-small cell lung cancer is larger tumors that may have spread within the lung area or to one or more lymph nodes, as follows:
Most early-stage lung cancers do not have symptoms. Lung cancer symptoms that may crop up for stage 2 and other early-stage cancers include:
Treatment for stage 2 NSCLC includes surgery, which might consist of removing the whole lung and any lymph nodes that may have cancer.
After surgery, the tissues removed are checked for cancer. If some were left behind, you may need another surgery and then treatment with a combination of chemotherapy, immunotherapy, and radiation.
Chemo and/or immunotherapy may be recommended after surgery even if they believe all of the cancer was removed.
For larger tumors, treatments before surgery may include immunotherapy with Opdivio and chemotherapy. People who can’t have surgery may only get radiation.
Stage 3 non-small cell lung cancers have spread to more lymph nodes and further areas within the chest cavity. They may also be larger. These stages include:
Treatment of stage 3 lung cancers includes a mix of radiation, chemotherapy, and surgery. Immunotherapy with Opdivo, Keytruda (pembrolizumab), Imfinzi (durvalumab), or Libtayo (cemiplimab), or targeted treatment with Tagrisso (osimertinib) may be an option for some stage 3 lung cancers.
These cancers can be hard to treat, so taking part in a clinical trial of newer treatments may be a good option for some people.
About 19% of adenocarcinomas of the lung and bronchus are found at the regional stage. The regional stage is the National Cancer Institute’s SEER database equivalent to stage 2 or stage 3 cancers. These cancers have spread to lymph nodes and other tissues within the organ they developed in but have not spread to far reaches of the body.
The five-year survival rate for people diagnosed with regional lung adenocarcinoma between 2013 and 2019 was 46.4%. That means about half of people who were diagnosed with stage 2 or stage 3 adenocarcinoma NSCLC during this period were still alive five years later. For all NSCLCs, the survival rate for regional cancers is 37%.
Stage 4 non-small cell lung cancers are the most advanced and have the worst survival rate. Stage 4 lung cancers are challenging to cure. These cancers can be any size and may be present in any number of lymph nodes in any part of the body.
The defining trait of stage 4 lung cancers is that they’ve spread beyond the lungs to other organs. They include:
When lung cancer spreads to other parts of the body, it leads to more detectable symptoms, such as:
Treatment for stage 4 lung cancers can include surgery, chemotherapy, targeted therapy, multiple immunotherapy options, radiation therapy, photodynamic therapy, or laser therapy. These treatments are intended to help you live longer and relieve symptoms.
Genetic analysis of the tumor before any treatment can refine treatment choices, including the use of targeted treatments, including:
About 51.9% of adenocarcinomas of the lung and bronchus are found at the distant stage. The “distant” stage is the National Cancer Institute’s SEER database equivalent to stage 4 cancers. These cancers have spread to far away lymph nodes and other organs.
The five-year survival rate for people diagnosed with distant lung adenocarcinoma between 2013 and 2019 was 11%. That means 11 out of 100 people who were diagnosed with stage 4 adenocarcinoma NSCLC during this period were still alive five years later. For all NSCLCs, the survival rate for distant cancers is 9%.
Early-stage lung cancer usually refers to stages 1, 2, and 3A NSCLC and limited-stage SCLC.
Factors influencing the success of these treatments include the tumor's location, how much it has grown or spread, and where it is located in the lung—other factors like proteins the cancer is making or the genetic changes that may also play a role.
What options are suitable for your cancer depends a lot on the size of the tumor, its location, what lymph nodes it has spread to, how healthy you are, and how treatment progresses.
How quickly cancer moves from one stage to the next depends on a variety of factors and varies from person to person. There are several ways in which lung cancer progresses.
One important factor in lung cancer progression is the type of cancer. Small cell lung cancers can spread early, even from a very small primary tumor. Non-small cell cancers vary in their growth rates.
Treatment for late-stage lung cancer, including stage 3B and stage 4 lung cancers, is determined by multiple factors. The treatment for your cancer is likely to be determined by your desires as much as where and how far the cancer has spread, whether the cancer cells have certain gene or protein changes, and your overall health.
Your health, treatment goals, and how you react to treatments play a significant role in what treatments are tried for late-stage lung cancer.
Cancer doctors classify lung cancer from stages 0 to 4 based on how large it is and how it has spread. Types of lung cancer use different staging systems. An oncologist determines the cancer's stage by its size, lymph nodes, and spread. Also significant are the type of cancer and any protein or gene changes.
Non-small cell lung cancers (NSCLC) include adenocarcinomas, squamous, and large cell carcinomas. Oncologists stage small cell lung cancers (SCLC) as a limited or extensive stage. Carcinoid tumors of the lung follow a basic TNM staging system based on tumor size, lymph node involvement, and metastasis.
The distinct stages of NSCLC have varying survival rates and treatment approaches. A surgeon could cure stage 0 NSCLC. But an oncologist would treat advanced NSCLC with a mix of:
Factors influencing treatment success include where the tumors are and how early they're found.
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By Jennifer Welsh Jennifer Welsh is a Connecticut-based science writer and editor with over ten years of experience under her belt. She’s previously worked and written for WIRED Science, The Scientist, Discover Magazine, LiveScience, and Business Insider.
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