Lung Cancer: Staging Presentation
How to Stage Lung Cancer
Lung cancer that originates within the lungs is referred to as primary lung cancer, while lung cancer that kicks off in other parts of the body, metastasizes and lodges into the lungs is a secondary type of lung cancer. Each type of lung cancer is managed in different ways depending upon the severity of the condition and preference of the patient. Proper diagnosis and management are essential in the treatment of lung cancer, and staging the disease is an important part of this.
Staging Lung Cancer through Simple Staging
Understand the simple staging process.Stages of cancer are used to define the size of cancer cells or tumors and indicate whether the condition has already metastasized to other parts of the body.
- Stages are used to provide information necessary for determining the proper management for the particular stage of cancer.
- Some health care practitioners utilize a very simple form of staging lung cancer (most specifically for small cell lung cancer) which separates the cancer into two stages.
Begin with the limited disease characterization.This stage is characterized by the development of cancer cells just within one side of the lungs, in the lymph nodes near the lungs or in the fluids surrounding the lungs (pleural effusion).
Categorize extensive disease.In this stage of lung cancer, the disease has already spread into the lymph nodes outside the lungs or into other organs of the body.
Staging Lung Cancer through the Number Staging System
Recognize Stage I lung cancer.Cancer cells are relatively small and are localized. No cancer cells are evident in any lymph nodes. This stage can be further broken down into:
- Stage IA. The size of tumor is up to 3 centimeter (1.2 in) only.
- Stage IB. Tumor size is between 3 to 5 centimeter (1.2 to 2.0 in). Cancer cells can be present in the main airway of the lung (bronchus) or in the membrane protecting the lung (pleura). The lung can also be partially collapsed.
Categorize Stage IIA lung cancer.In this stage, the tumor size can be within 5 to 7 centimeter (2.0 to 2.8 in) but cancer cells are not apparent in any lymph nodes.
- Alternatively, the tumor size may be 5 centimeter (2.0 in) or less but cancer cells are already seen in the lymph nodes near the affected lung.
- In whichever case, cancer cells may have spread into adjacent structures of the lungs like the bronchus or pleura. The lung may be partially collapsed as well.
Recognize signs of Stage IIB lung cancer.This stage can be characterized by the following manifestations:
- Tumor size is between 5 centimeter (2.0 in) and 7 centimeter (2.8 in), however cancer cells are already affecting the lymph nodes near the affected lung. Alternatively, the tumor size may be larger than 7 centimeter (2.8 in) but cancer cells are not evident in any lymph nodes.
- In other cases, this stage may mean that tumor size is larger than 7 centimeter (2.8 in) but has already spread to other areas of the body such as the chest wall, diaphragm, mediastinal pleura and parietal pericardium or the phrenic nerve.
- Cancer cells are larger than 7 centimeter (2.8 in) and are already affecting the main airway near the area where it divides to go into each lung.
- Cancer cells are taking part in the collapse of the lungs.
- Tumor can be in any size but there is more than one tumor in the same lobe of the lung.
Look for signs of Stage III lung cancer.This stage is characterized by the total collapse of the affected lung or an accumulation of mucus that causes inflammation. This stage is subdivided into:
- Stage IIIA. It can indicate variety of cases such as:
- Tumor is bigger than 7 centimeter (2.8 in) and has already spread into the lymph nodes near the lungs.
- Cancer cells already spread into the chest wall, diaphragm, or in the mediastinal pleura and parietal pericardium that covers the heart. Or in some instances, the cancer cells have spread into the lymph nodes near the main airway or in the middle of the chest on the same side of the damaged lung.
- Cancer cell can be any size but have spread into other major structures involving the chest, esophagus, heart, larynx, main blood vessel, spinal bone and trachea. They may also be evident in the lymph nodes near the affected lung. Or in some cases, cancer cells are already affecting more than one lobe of the same lung and may have spread into the lymph nodes near the damaged lung.
- Stage IIIB. This stage can denote:
- Cancer cells have spread into the lymph nodes on the opposite side of the affected lung. Or cancer cells are found in the lymph nodes at the center of the chest and have spread into other areas such as the chest wall, diaphragm, mediastinal pleura and parietal pericardium or in other major structures in the chest like the esophagus, heart, main blood vessel and trachea
- Stage IIIA. It can indicate variety of cases such as:
Categorize Stage IV lung cancer.This stage signifies that:
- Cancer cells are already affecting both lungs.
- Cancer cells have metastasized to other parts of the body like the liver or bones.
- Cancer cells are causing fluid accumulation in the heart (pericardial effusion) and lungs (malignant pleural effusion).
Staging Lung Cancer through the TNM Staging System
Understand what TNM stands for.TNM stands for Tumor, Node and Metastases.
Define the tumor.Defining the tumor involves describing the size of the tumor, as follows:
- T1: T1a. Tumor size is smaller than 2 centimeter (0.8 in) across and is contained within the lungs. T1b. Tumor size is between 2 centimeter (0.8 in) and 3 centimeter (1.2 in) across but it is still contained within the lungs.
- T2: Tumor size is between 3 centimeter (1.2 in) and 7 centimeter (2.8 in) across or it can grow into the main bronchus more than 2 centimeter (0.8 in) below the area where it divides to enter each lung. Or in others, the tumor has developed into the inner lining of the chest cavity or it can take part into the collapse of the lungs. T2a: T2 tumors that are 5 centimeter (2.0 in) or smaller in size. T2b: T2 tumors that are larger than 5 centimeter (2.0 in) in size.
- T3: Tumor size is larger than 7 centimeter (2.8 in) or has developed into other body structures such as the central lining of the chest cavity, chest wall, diaphragm, and pericardium. The tumor may contribute to the total collapse of the lungs. Or more than one tumor is present in the same lobe of the lung.
- T4: The tumor may be apparent in other structures such as the esophagus, heart, major blood vessels, mediastinum, nerve that controls the voice box, spinal bone and trachea. Or more than one tumor is affecting one lobe of the same lung.
Categorize the node.Categorizing the node determines whether the cancer cells have spread into the lymph nodes near the lungs.
- N0: Cancer cells are not found in any lymph nodes.
- N1: Cancer cells are visible in the lymph nodes close to the affected lung.
- N2: Cancer cells are present in the lymph nodes in the middle of the chest but on the same side as the damaged lung. Cancer cells may also affect the lymph nodes below the area wherein the windpipe branches off to each lung.
- N3: Cancer cells affect the lymph nodes on the opposite side of the affected lung or develop in the lymph nodes in the collar bone and the top of the lung.
Define the metastases.This indicates whether the cancer cells have already spread into other parts of the body.
- MO: No evident signs that cancer cells have spread into the opposite lobe of the affected lung or to any other parts of the body.
- M1: M1a: Cancer cells are present in both lungs. The fluids around the lungs and heart also contain cancer cells. M1b: Cancer cells have already spread to other parts of the body like the bones and liver.
Understanding Lung Cancer
Understand that lung cancer can be classified into types.Lung cancer can be classified into a number of different types based on the appearance of cancer cells under a microscope
Define non-small cell lung cancer.Eighty percent (80%) of lung cancers fall under this category. It can be further subdivided into:
- Adenocarcinoma:A type of lung cancer that is commonly experienced by women and non-smokers. It forms in the mucus-producing glands of the lungs.
- Bronchioloalveolar carcinoma:A very unusual type of lung cancer that develops near the air sacs of the lungs.
- Large-cell undifferentiated carcinoma:A type of lung cancer that grows quickly near the outer edges or surface of the lungs.
- Squamous cell carcinoma or epidermoid carcinoma:The most common type of lung cancer that usually affects the male population. It develops in the lining of bronchial tubes.
Know what small cell lung cancer is defined as.Small cell lung cancer accounts for the remaining 20% of lung cancer incidents. It is comprised of small cells that reproduce abruptly and develop into large tumors that can spread throughout the body. Most cases are caused by smoking.
Be aware of what can cause lung cancer.Normally, all cells in the body undergo a systematic process of growth, division and death (apoptosis). Any breakdown of this orderly process usually indicates the formation of cancer cells. These cancer cells develop when a programmed death of cells do not push through but instead continues to grow and divide. This phenomenon leads to the build up of abnormal cells that mature uncontrollably. Lung cancer is typically associated with:
- Carcinogens:Inhalation of carcinogenic substances usually leads to the development of lung cancers. Carcinogens are substances that are capable of damaging DNA thus promoting cancer. Examples include: arsenic, asbestos, compounds in car exhaust fumes, radiation (gamma and x-rays), sun, tobacco. Exposure to these carcinogens triggers the formation of free radicals that can damage body cells and affect their normal function and process of division.
- Genes:Some cases of lung cancer are attributed to familial genetic predisposition to the disease. Certain individuals can inherit the disease if it runs within their family, while others can be born with specific genetic mutations for lung cancer that can progress later in life. Genetic predisposition can directly cause lung cancer or it can increase an individual’s risk for lung cancer.
- An unrestrained growth of abnormal cells that affects either one or both sides of the lungs is referred to as lung cancer. Lung cancer commonly develops in the cells that line the air passages. This abnormal growth of cells can abruptly divide resulting in the build up of tumors. As these tumors start to expand and become abundant, they can interfere with lung function, especially with the supply of oxygen to the bloodstream.
- Tumors that stay intact in one place and do not spread to other adjacent areas are called “benign tumors”. However there are types of tumors that can spread to other parts of the body through the bloodstream or the lymphatic system which are termed “malignant tumors”.
Sources and Citations
- Crosta, P. (2009, October 1). What Is Lung Cancer? In medicalnewstoday.com. Retrieved from
- Cancerresearchuk.org (n.d.). More about staging for lung cancer. Retrieved from
- Swierzewski, S. (2011, May 20). Lung Cancer Treatment According to Stages.
Video: Stage 1 and Stage 2 Lung Cancer
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