Diagnosis & Staging
I’ve received a lung cancer diagnosis. What’s next?
Once you’ve completed diagnostic testing, your doctor will review the results with you. If your doctor confirms a diagnosis of lung cancer, additional tests may be used to learn more about the disease to determine the stage of cancer and help determine the best treatment plan for you. Cancer staging can be complex, so ask your doctor to explain it to you in detail since it can help determine which treatment is best and can help predict prognosis. Be sure to ask questions if there’s anything you don’t understand.
TNM Staging
The stage of cancer is based on a combination of factors, which include the size and location of the tumor, and whether it has spread to any lymph nodes and/or other parts of the body. TNM staging is based on 3 key pieces of information:
- Tumor: How large is your tumor and has it grown into other body structures?
- Nodes: Has your cancer spread to the lymph nodes?
- Metastasis: How far has your cancer spread? Has the cancer reached other organs, such as the brain, bones, adrenal glands, liver or the other lung?
Letters and numbers are used with T, N, and M to give more details, and a higher number indicates that the cancer is more advanced. After T, N, and M categories have been confirmed, these details are grouped to determine an overall stage. Staging may be done twice, since additional details may be confirmed after surgery.
T Scores
Tumor: How large is your tumor and has it grown into other body structures?
| Tis | Tumor is only in the top layers of cells lining the air passages. Known as in situ. |
| T1 | Tumor is ≤3 cm. |
| T2a | Tumor is > 3 cm but no larger than 4 cm. Tumor may have grown into the inner lining of the lung/main airway and/or caused the lung to swell or collapse |
| T2b | Tumor is > 4 cm but no larger than 5 cm. Tumor may have grown into the inner lining of the lung/main airway and/or caused the lung to swell or collapse |
| T3 | Tumor may have one or more of the below:
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| T4 | Tumor may have one or more of the below:
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N Scores
Nodes: Has your cancer spread to the lymph nodes?
| N0 | Cancer hasn’t spread to any lymph nodes |
| N1 | Cancer has spread to lymph nodes in the lung |
| N2 | Cancer has spread to lymph nodes in the middle of the chest (next to the lung) and/or below the windpipe |
| N3 | Cancer has spread to lymph nodes in the middle of the chest (near the other lung), in the other lung and/or near the collarbone |
M Scores
Metastasis: How far has your cancer spread? Has the cancer reached other organs, such as the brain, bones, adrenal glands, liver or the other lung?
| M0 | Cancer has not spread far |
| M1a | Cancer has spread far within the chest |
| M1b | Cancer has spread to one place beyond the chest |
| M1c | Cancer has spread to more than one place beyond the chest |
Stages of lung cancer
| Cancer stage | TNM scores |
| 0 | Tis, N0, M0 |
| 1A | T1, N0, M0 |
| 1B | T2a, N0, M0 |
| 2A | T2b, N0, M0 |
| 2B | T3, N0, M0 T1, N1, M0 T2, N1, M0 |
| 3A | T3, N1, M0 T4, N0, M0 T4, N1, M0 T1, N2, M0 T2, N2, M0 |
| 3B | T3, N2, M0 T4, N2, M0 T1, N3, M0 T2, N3, M0 |
| 3C | T3, N3, M0 T4, N3, M0 |
| 4A | Any T, Any N, M1a Any T, Any N, M1b |
| 4B | Any T, Any N, M1c |
SCLC Staging
Although the TNM staging system may be used for small cell lung cancer (SCLC), your healthcare team may also use the Veterans Administration (VA) system, which divides SCLC into two stages. Limited stage is cancer that’s found on only one side of the chest, might have reached lymph nodes on that same side, and can be treated with a single radiation field. Extensive stage is cancer that has spread widely throughout the lung, to the other lung, or other body parts (e.g. bone marrow).
