Lung Cancer Stages

This first stage of lung cancer means that abnormal cells or cancer have only developed inside the lining of air passages in the lungs; they haven’t spread further into other lung tissues or other areas of the body. At stage 0, you may not have any symptoms, and this stage of lung cancer is often only found during an imaging test like a lung cancer screening.

If your team finds early-stage lung cancer on an imaging test, many of our locations offer specialized clinics to coordinate your care and connect you with treatment. The primary treatment for stage 0 lung cancer is surgery or endobronchial therapies, which help remove or destroy the cancer cells while preserving healthy lung tissue.

The two types of stage 0 lung cancer are:

• Adenocarcinoma in situ: The abnormal cells are still “in place” where they started in the lining of the lung’s glandular tissue.
• Squamous cell carcinoma in situ: The abnormal cells are still “in place” where they started in tissues that line the respiratory tract.

Stage 1 lung cancer includes small-sized tumors located in only one lung. The cancer has not spread to any of the regional lymph nodes or anywhere outside of the lung. You may start to have symptoms, such as shortness of breath, a persistent cough, coughing up blood or blood-stained mucus.

With our dedicated cancer programs, we’ll help you coordinate all your treatments so you can access the care you need. Surgery is the primary treatment for stage 1A and 1B lung cancer, but in some cases, radiation is used. In stage 1B, chemotherapy and targeted therapy may be recommended following your surgery.

• Stage 1A: The tumor is less than or equal to 3 centimeters in size. In this substage, it does not involve a membrane around your lung (the visceral pleura) and does not involve the main bronchus.
• Stage 1B: A few factors may place your cancer in stage 1B:
  • The tumor is between 3 and 4 centimeters in size.
  • In this substage, smaller tumors that involve the visceral pleura have grown into the main bronchus.
  • The tumors may have caused changes in the lung due to obstruction of your airway.

At stage 2, lung cancer has started to grow, and it may have spread to nearby lymph nodes. Your symptoms could include a cough, bronchitis or pneumonia that doesn’t go away. Other symptoms include weight loss, coughing blood, chest pain, hoarse voice, shortness of breath, wheezing or tiredness.

Your care team will work with you to plan your care, which could include several treatment options. Surgery is often still used at this stage, but chemotherapy and immunotherapy may also be recommended before or after surgery. In some situations, targeted therapy and radiation therapy may be offered. Our lung cancer experts will guide you through the entire process.

• Stage 2A: Stage 2A lung cancer includes tumors greater than 4 centimeters but not more than 5 centimeters. In this substage, cancer hasn’t spread to the nearby lymph nodes but may involve the main bronchus or the tissue surrounding the lung and may have caused changes in your lung due to obstruction of the airway.
• Stage 2B: A few factors may place your cancer in stage 2B:
  • In some cases, the tumor is up to 5 centimeters and has spread to nearby lymph nodes in the chest. It may have also spread to the main bronchus or tissue surrounding the lung, obstructing the airways.
  • Your cancer may also be stage 2B if the original tumor is between 5 and 7 centimeters but doesn’t involve the nearby lymph nodes.
  • You may also have this stage of disease if you have more than one tumor in the same part of the lung—even if the tumors are smaller in size— or if the cancer has reached areas outside the lungs, such as the chest wall, the outside lining of the heart or a nerve near the lungs that controls the diaphragm.

Stage 3 lung cancer has spread into the lymph nodes, other lobes in the same lung or nearby tissues or organs in the chest. You may experience similar symptoms to stage 1 and stage 2 lung cancer, as well as symptoms in other organs affected by the cancer.

Your care team may still be able to remove some stage 3 tumors. However, the cancer may have spread too much for surgery to be beneficial. Based on your specific tumor and substage, your stage 3 lung cancer treatment could include chemotherapy, radiation therapy or immunotherapy. You may also have access to innovative research and clinical trials to give you even more options. 

• Stage 3A: This substage is applied in a few different cases:
  • The tumor is less than 5 centimeters and has spread to certain areas of lymph nodes in the chest. It may have also spread to the main bronchus or to the membranes that surround the lung or has caused changes in the lung due to obstruction of the airway.
  • The original tumor is between 5 and 7 centimeters and cancer is found in the nearby lymph nodes.
  • Any sized tumor has grown to the chest wall and involves the nearby lymph nodes, or the tumor involves the nearby lymph nodes and either the sac surrounding the heart or a nerve.
  • The original tumor is more than 7 centimeters, one other tumor has formed in a different lobe of the same lung, or the cancer involves other tissues in the chest like the windpipe (trachea) or esophagus.
• Stage 3B: The following cases would be categorized as stage 3B:
  • A tumor of less than 5 centimeters is found in lymph nodes on the other side of your chest or above the collarbone.
  • The original tumor is more than 5 centimeters, or there are other tumors in the same lung and cancer is found in the lymph nodes in the center of the chest.
  • The cancer has reached the chest wall, the sac around the heart or the nerve that controls the diaphragm (phrenic nerve) or a nerve that controls the vocal cords (recurrent laryngeal nerve).
• Stage 3C: The cancer has spread to the lymph nodes in the other lung or past the collarbones and the original tumor measures more than 5 centimeters. It’s also considered stage 3C when a tumor of any size involves the chest wall, sac around the heart or specific nerves, or there is a secondary tumor in the same lung.

Stage 4 lung cancer is the most advanced type of lung cancer. Also known as metastatic lung cancer, it may have spread to the opposite lung or distant parts of the body. During this stage, there is a wide range of symptoms, including a cough, coughing up blood, chest pain, shortness of breath, loss of appetite, weight loss, fatigue, weakness, headaches and pain.

Treatments for metastatic lung cancer focus on managing symptoms and slowing the growth of the cancer. Surgery isn’t usually an option at this stage, but your treatment options may include chemotherapy, immunotherapy, targeted therapy or clinical trials.

• Stage 4A: In this substage, the cancer may have spread into the other lung, formed in the fluid and lining surrounding the heart or lungs, or cancer is found in a distant location like the liver, bones, adrenal gland or brain.
• Stage 4B: This is the most advanced substage of metastatic lung cancer. The cancer has spread with multiple tumors found outside the lung, including the liver, bones, adrenal gland or brain.

Along with medical treatments, you’ll have access to numerous services that support you and help you navigate this stage of cancer. You don’t have to walk through your stage 4 lung cancer journey alone.