There are two main types of lung cancer: non-small cell
lung cancer and small cell lung cancer. Each looks different under a microscope
and grows and spreads differently. But both types of lung cancer share the same staging system. Your doctor will consider the type and the stage of lung cancer
in determining the possible options for treatment.
Non-small cell lung cancer
Non-small cell lung
cancer is more common than small cell lung cancer. About 85% of all lung
cancers are non-small cell cancer. It generally grows
and spreads more slowly than small cell lung cancer.
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Adenocarcinoma. About 35% to 40% of lung
cancers are adenocarcinoma.1 This type often begins
near the outside surface of the lung and may vary both in size and how fast it
grows. Adenocarcinoma is likely to spread to lymph nodes and other organs. This
type is more common than other types of lung cancer in women, nonsmokers, and
Squamous cell carcinoma, also called epidermoid
carcinoma. About 25% to 35% of all lung cancers are squamous cell.1 This type usually begins in one of the larger airway tubes
(bronchi), generally grows more slowly than the other types of non-small cell
cancer, and may vary in size from very small to very large. Squamous cell
carcinoma may spread to nearby lymph nodes or to other
Large cell carcinoma. About 5% to 10% of all lung cancers
are large cell.2 This type often begins near the
surface of the lung and usually is large when diagnosed. Large cell carcinoma
is likely to spread to lymph nodes and other organs.
Small cell lung cancer
Small cell lung cancer is
less common than non-small cell lung cancer. About 15% of lung cancers are
small cell. This type of cancer grows very rapidly
and in most people has already spread to other organs in the body
by the time it is diagnosed.
The following stages may be used for small cell
Limited stage. Cancer is found only in one
lung and in nearby
Extensive stage. Cancer has spread (metastasized) outside the lung to other
tissues in the chest or to other parts of the body. This includes having a
Recurrent stage. Recurrent disease means that the cancer has
come back (recurred) after it has been treated. It may come back in the lungs
or in another part of the body. Recurrent small cell lung cancer has a poor
outcome, with most people living only 2 to 3 months after recurrence. A
pleural effusion is considered extensive stage in
small cell lung cancer.
Lung cancer staging
Both non-small cell lung cancer and small cell lung cancer may be classified into a number of
different stages, from Stage 0 to Stage IV.
This staging system is further defined by the extent of the
tumor, lymph node involvement, and metastasis (TNM). The primary tumor (T) is
staged in the following way:
T0. No primary tumor is
TX. Cancer cells are found in sputum
(mucus), but no tumor is found in the lung.
Tis (Tumor in situ). This type of lung cancer is called carcinoma in situ.
This means that the cancer is found in only one area of the lung and only in a
few layers of cells. It has not grown through the top lining of the
T1. The primary tumor is 3 cm (1.18 in.) or less. The cancer is
only in the lung, and healthy tissue is found around it.
T1a. The tumor is 2 cm (1 in.) or less.
T1b. The tumor is more than 2 cm (1 in.) but not more than 3 cm (1 in.).
T2. The tumor is larger than
3 cm (1.18 in.) but not more than 7 cm (3 in.). Or it involves the
main airways (bronchi) or has spread to the lining (pleura) around the lung.
T2a. The tumor is larger than 3 cm (1 in.) but not more than 5 cm (2 in.).
T2b. The tumor is larger than 5 cm (2 in.) but not more than 7 cm (3 in.).
T3. The tumor is larger than 7 cm (3 in.), the tumor is in the main bronchus, or the cancer has spread
The chest wall or the diaphragm below the
The area that separates the two lungs (mediastinum).
A separate tumor in the same lobe.
T4. The tumor is of any size, and the cancer has spread to
other organs in the chest, such as the heart, trachea, or
esophagus. Or the tumor has spread to another lobe on the same side of the chest.
After the tumor (T) is staged, the TNM system stages
lymph node involvement (N) to help determine the
treatment options at each stage. Lymph node involvement is staged in the
N0. No lymph node
N1. Cancer has spread to nearby
N2. Cancer has spread to lymph
nodes in the mediastinum.
N3. Cancer has
spread to lymph nodes on the other side of the chest from the primary tumor or
into the neck near the trachea.
The last part of staging lung cancer is to
determine whether cancer has spread (metastasized) to other parts of the body.
The TNM system stages metastasis (M) in the following way:
M1. Cancer has spread outside the lung in which it started.
M1a. The cancer has spread to the opposite lung or there is an abnormal amount of fluid with cancer cells, either in the lining of the lungs (malignant pleural effusion) or the heart (pericardial effusion).
M1b. The cancer has spread outside the lungs to other parts of the body.
The TNM staging system allows a doctor to
recommend the most effective treatment options and to discuss the long-term
outcome (prognosis) based on the type of tumor, the stage of the cancer, and
the person's age and overall health.
The stage and TNM class are
grouped in the following table.3
Lung cancer stages
Any T, any N, M1a
Any T, any N, M1b
Chesnutt MS, et al. (2008). Lung cancer. In SJ McPhee
et al., eds., Current Medical Diagnosis and Treatment,
47th ed., p. 1398-1404. New York: McGraw-Hill.
Chesnutt MS, et al. (2008). Pulmonary disorders. In SJ
McPhee et al., eds., Current Medical Diagnosis and Treatment, 47th ed., pp. 203-243. New York: McGraw-Hill.
American Joint Committee on Cancer (2010). Lung. In AJCC Cancer Staging Manual, 7th ed., pp. 253-270. New York: Springer.
Primary Medical Reviewer
Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer
Michael Seth Rabin, MD - Medical Oncology
May 27, 2010
WebMD Medical Reference from Healthwise
May 27, 2010
This information is not intended to replace the advice of a doctor.
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