What stage is lung cancer when it is in the lymph nodes

Stages of Non-Small Cell and Small Cell Lung Cancer

Your doctor may strongly suspect you have lung cancer, or found you have it. The next step is to describe the cancer, such as the size of a tumor and if it has spread. This description is called the cancer stage. MSK’s thoracic (lung) surgeons, lung specialists, and radiologists will define your stage as quickly as possible. They will plan diagnostic procedures that will let them learn the stage of the cancer.

Table of Contents Show

Stages of Non-Small Cell and Small Cell Lung Cancer
Treatment Expertise for All Stages
The Role of Staging
TNM Classification
Non-small Cell Lung Cancer Stages
Small Cell Lung Cancer Stages
What is the survival rate for lung cancer that has spread to the lymph nodes?
Can lung cancer in lymph nodes be cured?
How long do you live when cancer spreads to lymph nodes?
What does it mean if lung cancer has spread to lymph nodes?

Staging is based on:

The size and location of the original tumor (also called the primary tumor)
Whether the cancer has metastasized (spread) to nearby lymph nodes
Whether the cancer has metastasized (spread) to other organs

Staging is an important step in choosing the best treatment for you. The stage of your cancer also helps doctors predict the outcome (result) of your treatment. To do this, we may recommend you have more tests, including imaging or biopsies.

Imaging tests to help learn the cancer stage include:

Computed tomography (CT) scans
Positron emission tomography (PET)/CT scans
Magnetic resonance imaging (MRI) of the brain

Doctors use the same staging system for both non-small cell and small cell lung cancer. Small cell lung cancer usually is diagnosed at a later stage than non-small cell lung cancer. It often is diagnosed at stage 3 or 4.

Stage 1

In stage 1, the tumor is only in the lung. It is bit small (4 centimeters or less). It has not spread to nearby lymph nodes or outside the chest. Most stage 1 tumors are treated with surgery.
We offer patients who cannot have surgery radiation therapy instead. Most stage 1 patients do not need chemotherapy, targeted therapy, or immunotherapy.

MSK’s experts were among the first to offer minimally invasive surgery to treat early-stage lung cancer. We now use this method with 8 out of 10 people who have stage 1 non-small cell lung cancer. Minimally invasive surgery uses small incisions (cuts) and few stitches, with less damage to nearby tissue.

Stage 2

In stage 2 lung cancer, there are larger tumors (more than 4 centimeters). Or, there are signs the cancer has spread to nearby lymph nodes, but not outside the lung. We usually treat stage 2 lung cancer with surgery, followed by chemotherapy and targeted therapies or immune therapies. We often offer patients who cannot have surgery chemotherapy and radiation instead.

Stage 3

In stage 3 lung cancer, there is cancer in lymph nodes of the chest further away from the lung. Or, there may be large tumors that spread to nearby lymph nodes. Most people with stage 3 cancer have several kinds of treatment. This includes some combination of chemotherapy, surgery, radiation, targeted therapies, and immune therapies.

Stage 4

In stage 4 lung cancer, there is cancer outside the chest cavity where it started. The most common areas are the other lung, bones, brain, and the adrenal gland (a gland on top of the kidneys). Treatment depends on the tumor. It can include chemotherapy, targeted or immune therapies, or a combination.

Treatment Expertise for All Stages

MSK led the way in setting the standard of care for treating every stage of cell lung cancer. Doctors everywhere follow best practices developed at MSK. For example, MSK led a large research study that showed the standard treatment for stage 1 non-small cell lung cancer should be a lobectomy. In this procedure, a complete lobe of the lung is removed. There are 3 lobes in the right lung and 2 in the left. MSK also helped determine the best time to give chemotherapy to people who have stage 2 and 3 cancer.

Advances made at MSK in 2021 offer new hope to people facing some of the most difficult and complex cancers. MSK researchers and doctors played a lead role in clinical trials that led to a new drug in 2021. The U.S. Food and Drug Administration (FDA) approved a drug that targets a protein, called KRAS, that fuels cancer growth. This protein may cause 1 out of 4 cases of lung cancers, but for decades it was considered “undruggable.” This treatment, called sotorasib (Lumakras™), is a new option for some people who have stage 3 or 4 non-small cell lung cancer.

Lung cancer staging is an integral part in knowing what your treatment options are. Typically, cancers that are an earlier stage are easier to treat but many people are able to live a long time with advanced-stage disease.

Key Points

Lung cancer staging means finding out:
- Where the lung cancer cells are located.
- The size of the lung cancer tumor.
- If and where the lung cancer has spread.
Lung cancer staging helps determine what treatment options you have.
Staging gives some information about lung cancer prognosis but does not predict how long you will live.

The Role of Staging

After determining your type of lung cancer, staging is the next step in the lung cancer diagnosis process. Your team will use results from tests and tissue samples to determine your lung cancer stage. Staging helps determine your recommended treatment plan.

Lung cancer staging also is used to discuss the general outlook for your recovery. This is sometimes called a lung cancer prognosis. Doctors can estimate prognosis based on the experiences of other people with the same type and stage of cancer. Keep in mind that no one knows for sure how your cancer will respond to treatment. Every person is different. No doctor can accurately predict the life expectancy of an individual with lung cancer.

TNM Classification

Three factors are used to determine lung cancer stage (sometimes referred to as the TNM classification system). The stage of your lung cancer is determined by a combination of all of these factors.

T – Tumor size and location
N – Regional lymph node involvement. Lymph nodes are small ball-shaped immune system organs distributed throughout the body. It is important to know whether the lung cancer has spread to the lymph nodes around the lung.
M – Metastasis status. Metastasis status refers to which organs the cancer has spread.

Non-small Cell Lung Cancer Stages

Non-small cell lung cancer stages range from one to four, usually expressed in Roman numerals (0 through IV). The lower the lung cancer stage, the less the cancer has spread and the better the prognosis.

Stage 0 (carcinoma/tumor in-situ) non-small cell lung cancer is an early stage of lung cancer that is only in the top lining of the lung or bronchus and has not spread.

Stage I non-small cell lung cancer (NSCLC) is divided into two sub-stages, 1A and 1B, based on the size of the tumor. In Stage I NSCLC, the cancer has not spread to the lymph nodes or other parts of the body.

Stage II non-small cell lung cancer is divided into stage IIA and IIB, with each stage then broken into additional sections, depending on the size of the tumor, where it is found, and whether or not the cancer has spread to the lymph nodes. These tumors may be larger than those in stage I and/or have begun to spread to nearby lymph nodes. The cancer has not spread to distant organs.

Stage III lung cancers are classified as stage IIIA, IIIB or IIIC, depending on the size and location of the tumor and how far it has spread. Most commonly the cancer has spread to the lymph nodes in the mediastinum (the area in the chest between the lungs).

Stage IV non-small cell lung cancer (NSCLC) is the most advanced form of lung cancer. In stage IV, the cancer has metastasized, or spread, to the lining of the lung or other areas of the body.

Small Cell Lung Cancer Stages

Small cell lung cancer is described using two stages: limited and extensive.

Limited stage lung cancer is only in one lung with or without spread to the lymph nodes in the mediastinum (area in the chest between the lungs).

Extensive stage lung cancer has spread to tissue outside of the originally affected lung like the opposite lung or distant organs.

Page last updated: October 28, 2021

What is the survival rate for lung cancer that has spread to the lymph nodes?

For regional NSCLC, which means the cancer has spread outside of the lung to nearby lymph nodes, the 5-year survival rate is about 35%. When cancer has spread to distant parts of the body, called metastatic lung cancer, the 5-year survival rate is 7%.

Can lung cancer in lymph nodes be cured?

Cancers that recur in the lymph nodes between the lungs are usually treated with chemo, possibly along with radiation if it hasn't been used before. For cancers that return at distant sites, chemo, targeted therapies, and/or immunotherapy are often the treatments of choice.

How long do you live when cancer spreads to lymph nodes?

A patient with widespread metastasis or with metastasis to the lymph nodes has a life expectancy of less than six weeks. A patient with metastasis to the brain has a more variable life expectancy (one to 16 months) depending on the number and location of lesions and the specifics of treatment.

What does it mean if lung cancer has spread to lymph nodes?

Or stage 3B means that your cancer has spread into the lymph nodes in the centre of the chest. The lung tumour is more than 7cm or it has spread into a major structure in your chest such as: the heart. the wind pipe (trachea)