How Is Lung Cancer Treated by Stage?

Lung cancer is often staged using a number system, which begins at the occult stage (no tumor found), and then progresses from stages 0 to 4 with increasing severity.

Lung cancer can also be staged using the TNM system. It gives a score to each of its three components:

• Tumor: Scored from 0 to 4 with some subdivisions. This number increases if your tumor spreads or increases in size.
• Nodule: Scored from 0 to 3. This number increases if the cancer spreads through your lymph system.
• Metastasis: Scored either a 0 or 1 with some subdivisions. This number indicates whether cancer has spread from the initial site.

SCLC is sometimes divided into just two stages: limited and extensive.

Limited stage SCLC means the cancer is confined to just part of one lung, or it may have spread to the lymph nodes on the same side of your chest. Any further spread would be considered extensive.

At this stage, treatments can cure the cancer.

Your doctor will probably recommend surgery to remove the cancer if you are healthy enough for the procedure.

If surgery is not an option for you, other treatments might include:

• photodynamic therapy
• laser therapy
• brachytherapy (radiation)

Stage 0 lung cancer has a TNM stage of Tis (in situ) N0, M0.

Surgery is a common treatment for stage 1 lung cancer. Before surgery, you might receive:

• chemotherapy
• immunotherapy

After surgery, healthcare professionals will examine your removed tissue to learn more about your cancer. You can expect postoperative treatments. If your doctor believes not all the cancer was removed, they might recommend another surgery or radiation therapy.

If you have SCLC, you may also be treated with radiation therapy to the head because this type of cancer often spreads to the brain.

Stage 1 lung cancer includes TNM stages N0, M0 with any of the following T stages:

• T1mi
• T1a
• T1b
• T1c
• T2a

Surgery can treat stage 2 lung cancer if you’re healthy enough to safely go through the procedure.

Surgery for stage 2 lung cancer generally involves removing more lung tissue than for stage 1 lung cancer. It might include removing a full lung and lymph nodes.

Surgery may be proceeded or followed by a combination of chemotherapy, immunotherapy, and radiation.

If your cancer indicates certain genetic mutations, you might also take specialized medications as part of your treatment.

Stage 2 lung cancer includes the TNM stages:

• T2b or T3 with N0, M0
• T1a, T1b, T1c, T2a, or T2b with N1, M0

Stage 3 lung cancer may or may not be treatable with surgery. It depends on how far the cancer has spread.

If it’s treatable with surgery, you might receive chemotherapy, radiation, or immunotherapy before or after the surgery (or both). If surgery is not an option for you, these other treatments may still be used.

Stage 3 lung cancer includes TNM stages:

• T4, N0, M0
• T3 or T4 with N1, M0
• T1a, T2a, T2b, T2c, T3, or T4 with N2, M0
• T1a, T1b, T1c, T2a, T2b, T3, or T4 with N3, M0

If your doctor diagnoses stage 4 lung cancer, it means the cancer has already spread through your body. This makes treatment more difficult, but there are still some options.

Your doctor is likely to screen for genetic mutations before starting your treatment. If a genetic mutation is found, you can expect to begin targeted therapy.

You might be treated with chemotherapy, radiation, or immunotherapy. Your treatment plan might change depending on how your body responds to treatment. For some people, surgery may still be an option, but it’s less likely to cure the cancer at this stage.

Stage 4 lung cancer includes all TNM stages with an M score greater than 0.

Lung cancer can be cured in the earlier stages (or the limited stage for SCLC).

In stage 3, the cancer might be cured, or it might be controlled to where it stops growing. This is called remission. Stage 4 lung cancer (or extensive stage for SCLC) cannot be cured, but it can still be treated.

If you receive a lung cancer diagnosis, talk with your doctor right away about the goals of your treatment plan. Depending on your circumstances, your goal might be to cure the cancer or manage and relieve symptoms.

Relative 5-year survival rates depend on which type of lung cancer you have and whether it’s localized (N0, M0), regional (N greater than 0, M0), or distant (M greater than 0).

According to the American Cancer Society, the relative 5-year survival rates are:

One of the most important steps you can take if you receive a diagnosis of lung cancer is to quit smoking if you are a smoker. Your doctor can help you create a cessation plan that works for you.

If your cancer is advanced, you can consult with your doctor about participating in a clinical trial.

Your diagnosis, treatment plan, and results will be unique to your particular circumstances. Stage 4 lung cancer treatment generally focuses on easing symptoms and remaining comfortable.

Using the TNM stages, stage 4 lung cancer is any cancer that has an M score above 0. According to a 2017 research article, the median survival time for scores of M1a and M1b are 11.4 months, and for M1c it’s 6.3 months.

The goals, methods, and outcomes of your lung cancer treatments vary by stage.

Most treatments include surgery, if possible, supported by chemotherapy, immunotherapy, radiation, or targeted therapy.

Be sure to talk with your doctor about what you hope to achieve with treatment, and that your plan is appropriate for your goals.