Let's Talk About Lung Cancer Stages

有一个压倒性的amount of info that comes at you right after hearing the words, “You have lung cancer.” It’s hard to digest it all, that’s for sure. But there is one thing that’s super-important to tune into—and that’s learning your lung cancer stage. This information dictates treatment options and helps direct decision-making. When you’ve just been diagnosed, though, it’s hard to know a stage I from a stage IV. Start by consulting our easy-to-digest guide to lung cancer staging, right here.

Lung Cancer Stages

我们的专业面板

We went to some of the nation’s top experts in lung cancer to bring you the most up-to-date information possible.

雅各布沙滩，M.D.

Thoracic Medical Oncologist and Instructor in Medicine

Dana-Farber Cancer Institute and Harvard Medical School

Boston, MA

Elisabeth Dexter, M.D.

Thoracic Surgeon and Quality Assurance Officer for the Department of Thoracic Surgery

Roswell Park Comprehensive Cancer Center

Buffalo, NY

Josephine (Joy) Feliciano, M.D.

医疗肿瘤科医生，肿瘤学助理教授

The Johns Hopkins University School of Medicine

巴尔的摩，MD

To Recap, What Is Lung Cancer?

Lung cancer refers to a mutation in the DNA of a single cell or cells in your lungs that causes cells to begin growing abnormally. When these cells replicate, that DNA glitch does as well. After enough of these abnormal cells develop, they may cluster together, forming a mass or tumor in your lungs. And boom: Lung cancer.

由于肿瘤的增长，肺癌构成了特殊的挑战，它会使氧气供应到剩余的健康肺组织，最终摧毁它。这makes it difficult to breatheand also challenging to circulate oxygen from the lungs throughout the body.

Whilemost cases of lung cancer are caused by smoking cigarettes，从未吸烟的人也可以发展这种癌症。肺癌是美国的第二次常见的癌症类型，每年有超过235,000人诊断出来。如果您开发肺癌，您通常具有两种类型中的一种：非小细胞肺癌（NSCLC）的较慢增长或更快地扩散的小细胞肺癌（SCLC）。

How Is Lung Cancer Type Determined?

In order to zero in on which type of lung cancer (small cell or non-small cell) you have, your care team will review your symptoms, blood tests, and imaging tests. Imaging tests determine whether your lung cancer has spread. Various combos of tests can be done and often include:

• Computed tomography (CT) scan:A combination of x-rays taken from different angles allows a computer to generate a three-dimensional image of organs and tissues inside your body.

• Positron emission tomography (PET)orintegrated PET–CT scan:After you receive a small dose of a radioactive drug, known as a tracer, the scan machine follows as it travels through your body. Tissues with higher metabolic rates, such as tumors, absorb more of the tracer, which then appears on the scan.

• Bone scan(generally if a PET–CT isn’t available)

• 你的胸部和/或大脑的MRI

这些测试以及可能是最微创活组织检查程序，让您的医生破译您拥有的肺癌类型。从那里，您的医生将决定疾病的程度（您的阶段）和最佳治疗课程。即使症状在治疗过程中改善，肺癌的阶段也总是相同。

非小细胞肺癌如何分阶段？

There are a few different ways non-small cell lung cancer (NSCLC) is staged. The first, from the National Cancer Institute, is based on the SEER (Surveillance, Epidemiology, and End Results) database. This method defines lung cancer stage based on how far it has spread.

• Localized:你的肺癌没有在肺部外面涂抹。

• Regional:您的癌症在肺部外面蔓延到附近的胸部内的组织或淋巴结。

• 遥远：你的癌症已经蔓延到你身体中的其他器官，如你的大脑或你的其他肺部。

第二常见的分期系统来自于我erican Joint Committee on Cancer and the International Association for the Study of Lung Cancer. Known as the TNM (Tumor, Nodes and Metastasis) classification system, in this method, your lung cancer is assigned a letter or number to describe the following:

• T:这refers to the size and location of original tumor.

• N:这references nearby lymph nodes involvement.

• M:这stands for metastasis status or which, if any, organs your cancer has spread to.

Next, your care team attaches a number after T, N and M to provide more details about each factor. Higher numbers mean the cancer is more advanced.

For instance, a T number or “score” is derived from the original tumor’s size, plus the location and size of any additional tumors. Scores range from TX (no tumor can be measured) to T4 (tumor is more than 7 centimeters in diameter or a tumor of any size that invades the trachea, esophagus, or other specific organ). Making matters even more complicated, T scores can also include a secondary letter which notes things like the size of specific tumor features.

同时，N个分数可以从NX（无节点无法评估）到N3（数量越高，含有癌症的节点）。并且M分数包括MX（不能测量转移），M0（癌症没有传播），M1（癌症已经扩散）。

还有一种肺癌分期方法，很可能是你最熟悉的方法。

What Does Stage l to Stage IV Non-Small Cell Lung Cancer Mean?

The TNM system is an effective and super-detailed way for your care team to understand your lung cancer stage, but it’s also pretty complicated for the average patient to digest. In the end, TNM is really more useful to your care team than you. Because of that, your T, N, and M scores will be tallied and synthesized to a more concise, simplified, overall stage. These stages utilize the Roman numerals from I to IV, with stage IV (4) being the most advanced stage of lung cancer.

而且因为没有任何东西就像你想要的那样简单，阶段仍然可以用字母细分。（稍后更多。）这是一种简化版本的摇摆：

• Stage I:Cancer is only in one lung.

• Stage II:Cancer is in one lung and nearby lymph nodes.

• Stage III:癌症在一个肺部，位于胸部或锁骨上方的节点中。

• 第四阶段：癌症已经蔓延到肺部，肺周围的液体，或身体中的另一个器官。

The above is an abridged version. Let’s take a closer look at how lung cancer gets placed into these different categories.

阶段I非小细胞肺癌

除了肿瘤小而仅存在于一个肺中，阶段肺癌意味着您的癌症没有传播到任何淋巴结并没有转移。大约25％的NSCLC在I阶段诊断出I.S阶段的阶段患者：

• Stage IA:Your tumor is no more than 3 centimeters in greatest dimension.

• Stage IB:你的肿瘤在最大的尺寸之间的3-4厘米之间，生长在你的主要支气管（气道进入肺部）或胸膜（肺衬里）或也可能导致部分或全肺塌陷或导致肺炎（肺组织炎症）。

II阶段非小细胞肺癌

仍然是一个小肿瘤，只在一个肺部，II阶段肺癌仍未蔓延到其他器官，但可能已达到淋巴结。大约8％的NSCLC患者在这个阶段被诊断出来。有两个阶段II肺癌的子类别。

• Stage IIA:Your tumor is larger than 4 centimeters in greatest dimension, but no more than 5. There is no lymph node involvement. In addition, your lung cancer may have also spread to your main bronchus and/or the pleura. You may also experience a partial or full lung collapse or pneumonitis.

• Stage IIB:There are two definitions for IIB. Either the cancer has not spread to any lymph nodes and hits one or more of the following notes:

  1. Your tumor is 5-7 centimeters in greatest dimension.

  2. One or more tumors are located in the same lobe.

  3. Your cancer has spread to either your pleura, chest wall, the phrenic nerve that controls the diaphragm, and/or the pericardium sac around the heart.

或

• Stage IIB:The tumor is no more than 5 centimeters in greatest dimension and has spread to nearby lymph nodes on the same side of the chest as the tumor. In addition, your lung cancer has spread to either the main bronchus or the pleura and/or you experience a partial or full lung collapse and/or develop pneumonitis.

III阶段非小细胞肺癌

所有阶段III阶段肺癌都蔓延到胸部中间的淋巴结，但仍然没有向身体的距离部位转移。有些人将III阶段肺癌称为“当地先进”。在这个阶段诊断出约27％的肺癌患者。

Stage III has three subtypes and multiple criterium for each (it’s complicated, we know):

• Stage IIIA:Your tumor measures 5 centimeters in greatest dimension or smaller and the only lymph node involvement is on the same side of the chest as the original tumor. At the same time, your lung cancer may or may not have spread to the main bronchus and/or your pleura, and you may or may not experience a whole or partial lung collapse or develop pneumonitis.

或

• Stage IIIA:唯一的淋巴结参与是胸部的同一侧作为主要肿瘤。Also, one or more of the following is true:

  1. Your tumor is larger than 5 centimeters in greatest dimension, but less than 7.

  2. One or more tumors are located in the same lobe.

  3. Your cancer has spread to your pleura, the chest wall, the phrenic nerve, or the pericardium sac.

或

• Stage IIIA:唯一的淋巴结参与是胸部的同一侧作为主要肿瘤。此外，其中一个或多个是真的：

  1. Your tumor measures larger than 7 centimeters in greatest dimension.

  2. One or more tumors are located in a different lobe than the primary tumor

  3. Your tumor is any size and has spread to either the trachea, carina (ridge of cartilage in the trachea), esophagus, breastbone or backbone, diaphragm, heart, aorta, vena cava or the nerve that controls your larynx.

• Stage IIIB:被认为是IIIB肺癌，您的肿瘤尺寸最大或更小的尺寸为5厘米，在胸部对面的淋巴结中出现为您的主要肿瘤或在与您的主要肿瘤相同的腰口上方，以及一个或一个或以下内容是真的：

  1. Your lung cancer may have spread to the main bronchus and/or the pleura.

  2. You may have experienced a full or partial lung collapse or developed pneumonitis.

或

• Stage IIIB:Your lung cancer tumor can be any size and it’s spread to nodes on the same side of the chest as your main tumor. Also, one or more of the following is found:

  1. 一个或多个肿瘤可以在相同或不同的叶片中发现而不是主要肿瘤。

  2. Your lung cancer has spread to your pleura, chest wall, phrenic nerve, pericardium sac, trachea, carina, esophagus, breastbone, backbone, diaphragm, heart, aorta, vena cava or the nerve that controls the larynx.

• Stage IIIC:The lung cancer tumor may be any size and has spread to either the lymph nodes above your collarbone on the same side of your chest as your primary tumor or it spread to the nodes on the opposite side of your chest. In addition, either or both may be true:

  1. One or more tumors can be found in the same or a different lobe as your primary tumor.

  2. Your lung cancer has spread to your pleura, chest wall, phrenic nerve, pericardium sac, trachea, carina, esophagus, breastbone or backbone, diaphragm, heart, aorta, vena cava or the nerve that controls the larynx.

Stage IV Non-Small Cell Lung Cancer

At this stage, your lung cancer tumors can be any size. They’ve now metastasized (spread) to distant parts of the body. Lymph nodes may or may not be involved. This stage is often referred to as “advanced disease” and about39 percent of NSCLC patients在这一阶段被诊断出来。有两种亚型s:

• Stage IVA:Here, your lung cancer has spread either from one lung into the other lung, the pleura, the pericardium sac; and/or tumors have spread to one site outside the chest.

• Stage IVB:Your lung cancer has spread to multiple sites outside the chest area, such as your bones and adrenal gland.

关于什么Carcinoma in Situand Occult Lung Cancer?

There are two other stages of NSCLC that are not included in the Roman numeral roundup. First, there’s Stage 0, which is carcinoma in situ (CIS). This is considered a pre-cancer because it’s found only in the top layer of cells that line your air passages, without reaching into the layers below (when it officially becomes lung cancer). About 50 percent of CIS lesions eventually turn into cancer.

The second type is occult (or hidden) lung cancer. Here, the main tumor either cannot be assessed or cancer cells are detected in a sample of your sputum (a mix of saliva and mucus), but the cancer itself cannot be found with other testing. The 5-year survival rate for occult lung cancer is up to 85%. About 12% of people with NSCLC are diagnosed at an unknown or occult stage.

What Are the Stages of Small Cell Lung Cancer?

While both SEER and the TNM staging system are used for NSCLC, they are generally not used for small cell lung cancer. The reason: The vast majority of SCLC are already metastasized when diagnosed. Because of this, most physicians will use a pared down staging system that divides SCLC into just two stages: limited stage and extensive stage.

有限阶段小细胞肺癌

Here, the disease is confined to the side of your chest where your cancer started, but still could metastasize to same-side lymph nodes or other parts of the same-side lung. One in three people with SCLC is diagnosed with limited stage.

Extensive-Stage Small Cell Lung Cancer

In extensive-stage, the disease has spread throughout the lung where cancer originated. It can be found in the other lung, lymph nodes on the other side of your chest, or other areas of the body including your bone marrow. (If your cancer has spread to the fluid around your lungs, some physicians will place your lung cancer in this stage, too.) About 67% of SCLC are diagnosed at this stage.

Without a doubt, the different staging systems and complex breakdowns within each system is confusing. But there is a reason for the seemingly endless permutations of stages, letters, and numbers. The better your doctor is able to zoom in on exactly where your cancer is, how big, and how far it has spread, the more accurate your treatment will be, raising the odds of a healthy recovery.

Meet Our Writer

Holly Pevzner

Holly Pevzner specializes in creating health, nutrition, parenting and pregnancy content for a variety of publications, such asEatingWell,Family Circle,Parents, andReal Simple. Before becoming a full-time writer, Holly held senior staff positions atPrevention,Fitness, andSelfmagazines, covering medical health and psychology. She was also a contributing editor atScholastic Parent & Childmagazine. She resides with her family in Brooklyn, New York.

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