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The staging and prognosis of lung cancer

Staging lung cancer

The tests completed by your specialist work out how far the lung cancer has spread. This is known as staging, and it helps your health care team recommend the best treatment for you.

NSCLC is staged using the TNM system. TNM stands for tumour–nodes–metastasis. Each letter is assigned a number (and sometimes also a letter) to show how advanced the cancer is. This information may be combined to give the lung cancer an overall stage of 1, 2, 3 or 4.

Although the TNM system can be used for SCLC, doctors usually use a two-stage system:

Limited stage – Cancer is only on one side of the chest and in one part of the lung; nearby lymph nodes may also be affected.

Extensive stage – Cancer has spread widely through the lung, to the other lung, to lymph nodes on the other side of the chest or to other areas of the body.

T (tumour)indicates the size of the tumour and how far the tumour has grown into the lung; ranges from T1a (tumour is 1 cm or less) to T4 (tumour is more than 7 cm, or has grown into nearby structures, or there are two or more separate tumours in the same lobe of a lung)
N (nodes)shows if the tumour has spread to nearby lymph nodes; ranges from N0 (no spread) to N3 (cancer in lymph nodes on the opposite side of the chest, above the collarbone or at the top of the lung)
M (metastasis)shows if the tumour has spread to other parts of the body; ranges from M0 (no spread to distant parts of the body) to M1c (cancer has spread and formed more than one tumour in distant parts of the body, e.g. liver, bone)

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for anyone to predict the exact course of the disease. Instead, your doctor can give you an idea about the general outlook for people with the same type and stage of cancer.

To work out your prognosis, your doctor will consider:

  • your test results
  • the type and stage of lung cancer
  • the rate and extent of tumour growth
  • how well you and the cancer respond to treatment
  • other factors such as your age, fitness and overall health, and whether you’re currently a smoker.

Discussing your prognosis and thinking about the future can be challenging and stressful. It is important to know that although the statistics for lung cancer can be frightening, they are an average and may not apply to your situation. Talk to your doctor about how to interpret any statistics that you come across.

As in most types of cancer, the results of lung cancer treatment tend to be better when the cancer is found and treated early. Newer treatments such as targeted therapy and immunotherapy are effective in some people with advanced lung cancer and are bringing hope to those who have lung cancer that has spread. 

This information is reviewed by

This information was last reviewed in October 2020 by the following expert content reviewers: A/Prof Nick Pavlakis, President, Australasian Lung Cancer Trials Group, President, Clinical Oncology Society of Australia, and Senior Staff Specialist, Department of Medical Oncology, Royal North Shore Hospital, NSW; Dr Naveed Alam, Thoracic Surgeon, St Vincent’s Private Hospital Melbourne, VIC; Prof Kwun Fong, Thoracic and Sleep Physician and Director, UQ Thoracic Research Centre, The Prince Charles Hospital, and Professor of Medicine, The University of Queensland, QLD; Renae Grundy, Clinical Nurse Consultant – Lung, Royal Hobart Hospital, TAS; A/Prof Brian Le, Director, Palliative Care, Victorian Comprehensive Cancer Centre – Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, and The University Of Melbourne, VIC; A/Prof Margot Lehman, Senior Radiation Oncologist and Director, Radiation Oncology, Princess Alexandra Hospital, QLD; Susana Lloyd, Consumer; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Nicole Parkinson, Lung Cancer Support Nurse, Lung Foundation Australia.