Stages of Non-Small Cell Lung Cancer

Cancer stage describes the extent of cancer in the body, such as the size of the tumor, whether it has spread, and how far it has spread from where it first formed. It is important to know the stage of non-small cell lung cancer to plan the best treatment.

There are several staging systems for cancer that describe the extent of the cancer. Non-small cell lung cancer staging usually uses the TNM staging system. The cancer may be described by this staging system in your pathology report. Based on the TNM results, a stage (I, II, III, or IV, also written as 1, 2, 3, or 4) is assigned to your cancer. When talking to you about your diagnosis, your doctor may describe the cancer as one of these stages. 

Learn about tests to stage non-small lung cell cancer. Learn more about Cancer Staging.

The following stages are used for non-small cell lung cancer:

Occult (hidden) stage non-small cell lung cancer

In the occult (hidden) stage, cancer cannot be seen by imaging or bronchoscopy. Cancer cells are found in sputum or bronchial washings (a sample of cells taken from inside the airways that lead to the lungs). Cancer may have spread to other parts of the body.

Stage 0

In stage 0, abnormal cells are found in the lining of the airways. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 may be adenocarcinoma in situ (AIS) or squamous cell carcinoma in situ (SCIS).

Stage I (also called stage 1) non-small cell lung cancer

In stage I, cancer has formed. Stage I is divided into stages IA and IB.

• Stage IA:

  The tumor is in the lung only and is 3 centimeters or smaller. Cancer has not spread to the lymph nodes.

• Stage IB:

  The tumor is larger than 3 centimeters but not larger than 4 centimeters. Cancer has not spread to the lymph nodes.

  or

  The tumor is 4 centimeters or smaller and one or more of the following is found:

  • Cancer has spread to the main bronchus, but has not spread to the carina.
  • Cancer has spread to the innermost layer of the membrane that covers the lung.
  • Part of the lung or the whole lung has collapsed or has developed pneumonitis.

  Cancer has not spread to the lymph nodes.

Stage II (also called stage 2) non-small cell lung cancer

Stage II is divided into stages IIA and IIB.

• Stage IIA:

  The tumor is larger than 4 centimeters but not larger than 5 centimeters. Cancer has not spread to the lymph nodes and one or more of the following may be found:

  • Cancer has spread to the main bronchus, but has not spread to the carina.
  • Cancer has spread to the innermost layer of the membrane that covers the lung.
  • Part of the lung or the whole lung has collapsed or has developed pneumonitis.
• Stage IIB:

  The tumor is 5 centimeters or smaller and cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus. Also, one or more of the following may be found:

  • Cancer has spread to the main bronchus, but has not spread to the carina.
  • Cancer has spread to the innermost layer of the membrane that covers the lung.
  • Part of the lung or the whole lung has collapsed or has developed pneumonitis.

  or

  

  Cancer has not spread to the lymph nodes and one or more of the following is found:

  • The tumor is larger than 5 centimeters but not larger than 7 centimeters.
  • There are one or more separate tumors in the same lobe of the lung as the primary tumor.
  • Cancer has spread to any of the following:
    • the membrane that lines the inside of the chest wall
    • the chest wall
    • the nerve that controls the diaphragm
    • the outer layer of tissue of the sac around the heart

Stage III (also called stage 3) non-small cell lung cancer

Stage III is divided into stages IIIA, IIIB, and IIIC.

• Stage IIIA:

  The tumor is 5 centimeters or smaller and cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are around the trachea or aorta, or where the trachea divides into the bronchi. Also, one or more of the following may be found:

  • Cancer has spread to the main bronchus, but has not spread to the carina.
  • Cancer has spread to the innermost layer of the membrane that covers the lung.
  • Part of the lung or the whole lung has collapsed or has developed pneumonitis.

  or

  

  Cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus. Also, one or more of the following is found:

  • The tumor is larger than 5 centimeters but not larger than 7 centimeters.
  • There are one or more separate tumors in the same lobe of the lung as the primary tumor.
  • Cancer has spread to any of the following:
    • the membrane that lines the inside of the chest wall
    • the chest wall
    • the nerve that controls the diaphragm
    • the outer layer of tissue of the sac around the heart

  or

  

  Cancer may have spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus. Also, one or more of the following is found:

  • The tumor is larger than 7 centimeters.
  • There are one or more separate tumors in a different lobe of the lung with the primary tumor.
  • The tumor is any size and cancer has spread to any of the following:
    • the trachea
    • the carina
    • the esophagus
    • the breastbone or backbone
    • the diaphragm
    • the heart
    • the major blood vessels that lead to or from the heart (aorta or vena cava)
    • the nerve that controls the larynx (voice box)
• Stage IIIB:

  The tumor is 5 centimeters or smaller and cancer has spread to lymph nodes above the collarbone on the same side of the chest as the primary tumor or to any lymph nodes on the opposite side of the chest as the primary tumor. Also, one or more of the following may be found:

  • Cancer has spread to the main bronchus, but has not spread to the carina.
  • Cancer has spread to the innermost layer of the membrane that covers the lung.
  • Part of the lung or the whole lung has collapsed or has developed pneumonitis.

  or

  

  The tumor may be any size and cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are around the trachea or aorta, or where the trachea divides into the bronchi. Also, one or more of the following is found:

  • There are one or more separate tumors in the same lobe or a different lobe of the lung with the primary tumor.
  • Cancer has spread to any of the following:
    • the membrane that lines the inside of the chest wall
    • the chest wall
    • the nerve that controls the diaphragm
    • the outer layer of tissue of the sac around the heart
    • the trachea
    • the carina
    • the esophagus
    • the breastbone or backbone
    • the diaphragm
    • the heart
    • the major blood vessels that lead to or from the heart (aorta or vena cava)
    • the nerve that controls the larynx (voice box)
• Stage IIIC:

  The tumor may be any size and cancer has spread to lymph nodes above the collarbone on the same side of the chest as the primary tumor or to any lymph nodes on the opposite side of the chest as the primary tumor. Also, one or more of the following is found:

  • There are one or more separate tumors in the same lobe or a different lobe of the lung with the primary tumor.
  • Cancer has spread to any of the following:
    • the membrane that lines the inside of the chest wall
    • the chest wall
    • the nerve that controls the diaphragm
    • the outer layer of tissue of the sac around the heart
    • the trachea
    • the carina
    • the esophagus
    • the breastbone or backbone
    • the diaphragm
    • the heart
    • the major blood vessels that lead to or from the heart (aorta or vena cava)
    • the nerve that controls the larynx (voice box)

Stage IV (also called stage 4) non-small cell lung cancer

Stage IV is divided into stages IVA and IVB.

• Stage IVA:

  The tumor may be any size and cancer may have spread to the lymph nodes. One or more of the following is found:

  • There are one or more tumors in the lung that does not have the primary tumor.
  • Cancer is found in the lining around the lungs or the sac around the heart.
  • Cancer is found in fluid around the lungs or the heart.
  • Cancer has spread to one place in an organ not near the lung, such as the brain, liver, adrenal gland, kidney, bone, or to a lymph node that is not near the lung.
• Stage IVB:

  Cancer has spread to multiple places in one or more organs that are not near the lung.

Non-small cell lung cancer can recur (come back) after it has been treated.

Recurrent non-small cell lung cancer is cancer that has come back after it has been treated. If non-small cell lung cancer comes back, it may come back in the brain, lung, chest, or in other parts of the body. Tests will be done to help determine where the cancer has returned. The type of treatment for non-small cell lung cancer will depend on where it has come back.

Learn more in Recurrent Cancer: When Cancer Comes Back. Information to help you cope and talk with your health care team can be found in the booklet When Cancer Returns.