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How lung cancer stages determine treatment

Sarah Cannon - December 13, 2021

If you’re diagnosed with lung cancer, the stage of the disease will determine which treatments your doctor recommends. Typically, the earlier cancer is detected, the easier it is to treat. However, many people are living longer with advanced forms of lung cancer with better treatment options.

After determining what type of lung cancer you have (non-small cell lung cancer or small cell lung cancer), your doctor will tell you the disease’s stage. The stage, along with your overall health and lung function, will help your oncologist determine which treatment options are right for you. Staging can also help your physician give you a general prognosis, though every person responds differently to treatment.

What does lung cancer staging mean?

Lung cancer staging is determined by:

  • The size of the tumor
  • Where the cancer cells are found
  • If and where the cancer cells have spread

Oncologists use the TNM classification system to determine a cancer’s stage. TNM stands for:

  • T: Tumor location and size
  • N: Whether the lung cancer has spread to the lymph nodes near the lungs
  • M: Metastasis status, which determines if the cancer cells have spread to other parts of the body

Here’s a breakdown of what lung cancer treatment options are available based on the disease staging.

Stages of non-small cell lung cancer

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for 80 to 85% of lung cancer cases. It is staged from zero (0) to four (IV). The lower the number, the less the cancer has spread and, generally, the better the outlook.

  • Stage 0: This means the cancer cells are only found in the bronchus or top lining of the lung and have not spread elsewhere. This stage is usually curable with surgery alone. Sometimes, brachytherapy (internal radiation), laser therapy or photodynamic therapy are recommended as alternatives to surgery.
  • Stage I: This stage is categorized into stage IA or IB. At this stage, the cancer hasn’t spread to the nearby lymph nodes or elsewhere in the body. In many cases, only surgery is needed to treat stage I NSCLC. If the cancer has a higher risk of recurrence, your doctor may recommend chemotherapy after surgery. Sometimes, radiation therapy is used after surgery as well.
  • Stage II: This stage is classified into stage IIA or IIB and may be broken down into even more specific stages. In stage II, the tumor(s) may be larger than in stage I and/or have spread to the lymph nodes around the lungs. However, the cancer hasn’t spread to other organs. Surgery is usually the first treatment option for this stage, often followed by chemotherapy. Sometimes a second surgery or radiation therapy is needed.
  • Stage III: This stage is categorized into stage IIIA, IIIB or IIIC, depending on where the tumor is found, how big it is and where it has spread. Typically, in stage III, the lung cancer has spread to the lymph nodes in the chest between the lungs.
    • Treatment for stage IIIA often includes a combination of radiation therapy, chemotherapy and/or surgery.
    • Stage IIIB cancers can’t be removed with surgery, so chemotherapy and radiation therapy are typically recommended to patients with good overall health. Some people can be cured with this course of treatment. And in some cases, immunotherapy is used to keep the cancer from spreading.
  • Stage IV: This means the cancer cells have spread to the lining of the lung or other parts of the body, such as the brain or liver. Stage IV NSCLC can be difficult to cure. Treatments like radiation therapy, chemotherapy, surgery, targeted therapy and immunotherapy may prolong your life and improve your symptoms. Sometimes laser therapy or photodynamic therapy is used to manage symptoms. 

Stages of small cell lung cancer

Small cell lung cancer (SCLC) accounts for 10 to 15% of lung cancer cases. This type of cancer tends to be more aggressive than NSCLC, meaning it grows and spreads faster. It is categorized into two stages:

  • Limited stage: This means the cancer is only found in one lung or hasn’t spread to the nearby lymph nodes. Most people at this stage require chemotherapy. Some healthy individuals may be candidates for surgery. Sometimes radiation therapy to the chest is recommended if cancer is found in the nearby lymph nodes. Physicians also use radiation therapy to the head in some cases since the cancer eventually spreads to the brain in about half of SCLC cases. While chemotherapy and radiation will help shrink the tumor, SCLC often returns after treatment.
  • Extensive stage: This stage means the cancer has spread to the opposite lung or other organs. Approximately 70% of people with SCLC are diagnosed at the extensive stage. In this stage, chemotherapy and possibly immunotherapy are recommended to people in good health. If the disease responds well to this course of treatment, chest radiation may be the next treatment step.

Small cell lung cancer is difficult to treat and cure. For this reason, lung cancer clinical trials with newer treatment options may be a good fit for some patients. Talk to your oncologist about which options are right for you.

Learn more about lung cancer treatment at Sarah Cannon.

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