6th January 2022

Understanding the stage of your lung cancer and treatment options

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Getting diagnosed with your lung cancer stage is a terrifying and overwhelming time. There is so much to get your head around and, understandably, you will feel fearful about the future.  

When you are first diagnosed, one of the first things your doctors will need to do is stage your lung cancer. Staging is a way of describing and assessing the extent of your lung cancer. The stage of your cancer can determine what treatments are available to you. 

How is your lung cancer stage accessed. 

The stage system, known as the TNM system stands for:  

  • – Tumour
  • – Nodes
  • – Metastasis

Once the cancer has been lettered, it will be linked with numbers that reflect how large the tumour is and how much it has spread.  

Tumour size will be described 1 to 4 depending on its size. Nodes, which is lymph nodes will be scaled from 0 to 3. If your N score is 0 this means, there is no evidence of cancer in your lymph nodes, when numbered 1 to 3 this indicates the cancer has spread to the lymph system, and with that how much and how far it has spread.  

Metastasis is scaled on how and where your lung cancer has spread in the body. This scale ranges from 0 – no metastases through to 1c where there are extensive metastases. 

This international standard will be used to explain your lung cancer and the Multi-Disciplinary Team looking after you will use this to plan treatment with you. 

Determining the stage for lung cancer is complicated but your doctors will explain it as it applies to you using the 4 stage system. 

What does the stage of your lung cancer mean? 

The stage of your lung cancer often gives a combined result of numbers and letters which identify the extent of a person’s cancer. This can generally be grouped into one of the following four stages:  

  • – Stage 1 means the cancer is small and in one localised area of the lung. 

This includes the subgroups IAI, IA2, IA3 and IB.  

  • – Stage 2 or 3 cancers are larger and may have spread to surrounding tissues. There may be cancer cells in the lymph nodes, locally advanced.  

This includes subgroups 2A, 2B, 3A and 3C. 

  • – Stage 4 means the cancer has spread to another part of the body, secondary or metastatic cancer. 

This includes subgroups 4A and 4B. 

1Based on the International Association for the Study of Lung Cancer’s 8th Edition of the TNM Classification for Lung Cancer (www.iaslc.org

Treatment choices for the stage of your lung cancer

Treatment options for your lung cancer stage

Once the stage of your lung cancer has been determined, you will be offered treatment. The options for treatment will vary depending on the stage of your cancer, your general fitness and any other health conditions.  

Your lung cancer will be investigated through a number of tests, these may include:  

  • – Blood tests 
  • – CT scans 
  • – MRI scans 
  • – PET scans 
  • – Biopsy 

For more information, please download our Managing your Diagnosis pack here.  

Alongside the tests, your medical team will discuss with you your health, fitness and views on what matters to you in terms of your treatment. 

Generally, lung cancers Stage 1 to 111b are assessed as potentially curable. The options that might be relevant to you include:  

  • – Surgery  
  • – Radiotherapy with curative intent  
  • – Combinations of radiotherapy and chemotherapy  
  • – Surgery and chemotherapy.  

Where you have combinations of treatments your clinician may call this “multi-modality” therapy.  

During your diagnosis that determines the stage of your lung cancer, a sample of your cancer will be tested to identify if you have a genetic mutation driven tumour. This may mean that you are able to receive a targeted therapy as part of your treatment.  

These treatments have been found to be effective for specific subtypes of lung cancer. For more information on targeted therapy, download our online guide. 

Adjusting to diagnosis can be difficult and you may have a lot of information to make sense of and decisions to consider.  

There are many sources of help including your: 

  • – Lung Cancer Nurse Specialist 
  • – Clinical team 
  • – Our Ask the Nurse service  

You can also download booklets from our website ranging from diagnosis to treatment and access our Lung Cancer Connect service that includes interviews with clinicians and people with experience of lung cancer.