Abnormal cells are found in the innermost lining of the airways. These abnormal cells may become cancerous and spread into nearby normal tissue. Stage 0 is also called adenocarcinoma in situ (AIS) or squamous cell carcinoma in situ (SCIS).
Understanding Lung Cancer
Learn more about how lung cancer is diagnosed and the stages so you can make informed decisions about your care.
Diagnosing Lung Cancer
Early Detection with HOA’s Lungs for Life Program
Lung cancer often develops without noticeable symptoms in its early stages, making proactive screening crucial for individuals at high risk. At HOA, our Lungs for Life Program offers a comprehensive lung cancer screening approach, including low-dose CT (LDCT) scans, which have been proven to detect lung cancer earlier and improve outcomes.
If you have a history of smoking or other lung cancer risk factors, our team provides proactive monitoring for lung nodules and a dedicated cancer navigator to guide you through the screening and follow-up process. Talk to your doctor to see if lung cancer screening is right for you.
More About Lung Cancer Screening
Our team at HOA guides patients through every step of the diagnostic process, offering access to advanced imaging, biopsies, and pathology services to ensure a precise diagnosis.
Tests Used for Lung Cancer Diagnosis
Lung cancer is often detected during imaging for another condition, such as a routine chest X-ray, or when patients seek medical attention for persistent symptoms like a chronic cough, shortness of breath or chest pain.
A chest x-ray is usually the first step in detecting signs of cancer that suggest further testing is needed. Blood and sputum tests tell whether cancer is present by looking for tumor markers in the blood. If there are any signs that lung cancer is present, a biopsy is the next step.
A fine-needle aspiration (FNA) lung biopsy is performed using a CT scan, ultrasound, or another imaging tool to locate abnormal tissue or fluid in the lung. A thin biopsy needle is inserted through a small incision into the abnormal tissue or fluid to retrieve a sample and send it to the laboratory. A pathologist then views the sample under a microscope to look for cancer cells. Afterward, a chest x-ray is done to make sure no air leaks from the lung into the chest.
Biopsy results are the final determination of whether cancer is present and the type of lung cancer. The tissue sample may also be sent for biomarker testing if non-small cell lung cancer is diagnosed.
Other Tests to Determine if Cancer Has Spread Outside of the Lungs
It’s important to know if cancer has spread outside the lungs to lymph nodes or other areas of the body. Your lung cancer doctor will perform several tests to determine the extent of the tumor, also known as staging. These tests can include:
- Imaging scans such as a PET/CT scan to look for cancer, even before it develops a tumor, Bronchoscopy or thoracoscopy to look inside the mouth, knows, esophagus, lungs, and nearby lymph nodes.
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Thoracentesis to check the fluid lining around the lungs for cancer cells.
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Bone scan to see if cancer has developed in the bones.
Stages of Lung Cancer
Knowing the stage of lung cancer helps physicians recommend the best treatment plan for the patient and even predict the prognosis (chances of survival).
Staging Non-Small Cell Lung Cancer
Non-small lung cancer may require additional tests and procedures to determine the stage or extent of cancer, these include:
- Lymph node biopsy
- Mediastinoscopy: This surgical procedure examines the lymph nodes between the lungs for abnormal areas. An incision is made at the top of the breastbone to insert a thin, tube-like instrument with a light, a lens for viewing, and a tool to remove samples.
- Anterior mediastinotomy: A surgical procedure to look at the organs and tissues between the lungs and between the breastbone and heart for abnormal areas. This is also called the Chamberlain procedure.
Stages of Non-Small Cell Lung Cancer
There are five stages for non-small cell lung cancer: stage 0 (zero), then stages I through IV (1 through 4).
Stage 0 (Carcinoma in Situ) Non-Small Cell Lung Cancer
Stage I Non-Small Cell Lung Cancer
Cancer has formed. Stage I is divided into stages IA and IB:
- Stage IA: The tumor is located within the lung only and is 3 centimeters or smaller.
- Stage IB: The cancer has not spread to nearby lymph nodes or distant parts of the body.One or more of the following applies:
- The tumor is larger than 3 centimeters.
- Cancer has spread to the main bronchus of the lung and is at least 2 centimeters from the carina (where the trachea joins the bronchi).
- Cancer has spread to the membrane's innermost layer covering the lungs.
- The tumor partly blocks the bronchi or bronchioles, and part of the lung has collapsed or developed pneumonitis (inflammation of the lung).
Stage II Non-Small Cell Lung Cancer
Stage II is divided into stages IIA and IIB:
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Stage IIA Non-Small Cell Lung Cancer: The tumor is larger than 4 centimeters but not larger than 5 centimeters and has not spread to nearby lymph nodes or distant parts of the body. The cancer has one or more of the following features:
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It has grown into the main bronchus but is not into the carina.
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The tumor has grown into the membranes surrounding the lungs.
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The tumor is partially clogging the airways.
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Stage IIB (1) Non-Small Cell Lung Cancer: The tumor is larger than 3 centimeters but not larger than 5 centimeters across. Cancer has also spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are within the lung and/or around the area where the bronchus enters the lung. The tumor has one or more of the following features:
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It has grown into the main bronchus but is not in the carina.
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It has grown into the membranes surrounding the lungs.
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It is partially clogging the airways.
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OR
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Stage IIB (2) Non-Small Cell Lung Cancer: The tumor is larger than 5 centimeters but not larger than 7 centimeters across. The cancer has not spread to nearby lymph nodes or distant parts of the body. The tumor has one or more of the following features:
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It has grown into the chest wall, the inner lining of the chest wall, the phrenic nerve that controls the diaphragm, or membranes of the sac surrounding the heart.
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There are two or more separate tumor nodules in the same lung lobe.
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Stage III Non-Small Cell Lung Cancer
Lung cancers are categorized as stage IIIA, IIIB, or IIIC. The stage is dependent on the size of the tumor and which lymph nodes the cancer has spread to. Stage III cancers have not spread to other distant parts of the body.
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Stage IIIA (1) Non-Small Cell Lung Cancer: The cancer has spread to the lymph nodes on the same side of the chest as the primary lung tumor. The tumor has one or more of the following features:
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The tumor is 5 centimeters or smaller.
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It has grown into the main bronchus but is not in the carina.
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It has grown into the innermost layer of the membrane that covers the lung.
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It is partially clogging the airways.
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OR
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Stage IIIA (2) Non-Small Cell Lung Cancer: The cancer has also spread to lymph nodes within the lung and/or around the area where the bronchus enters the lung. These lymph nodes are on the same side as the cancer. The tumor has one or more of the following features:
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It is larger than 5 centimeters but not larger than 7 centimeters across.
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It has grown into the chest wall, the inner lining of the chest wall, the phrenic nerve, or the membranes of the sac surrounding the heart.
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There are two or more separate tumor nodules in the same lung lobe.
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OR
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Stage IIIA (3) Non-Small Cell Lung Cancer: The cancer may or may not have spread to lymph nodes within the lung and/or around the area where the bronchus enters the lung. Any affected lymph nodes are on the same side of the chest as the primary cancer. The tumor has one or more of the following features:
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It is larger than 7 centimeters across.
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It has grown into the space between the lungs and heart, large blood vessels near the heart, trachea, esophagus, voice box, diaphragm, backbone or breastbone, or the carina.
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There are two or more separate tumor nodules in different lobes of the same lung.
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Stage IIIB (1) Non-Small Cell Lung Cancer: The cancer has spread to lymph nodes near the collarbone and/or has spread to lymph nodes on the other side of the body from the primary tumor. The tumor has one or more of the following features:
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It is larger than 3 centimeters but not larger than 5 centimeters across.
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It has grown into the main bronchus but is not within the carina.
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It has grown into the innermost layer of membrane that surrounds the lungs.
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It is partially clogging the airways.
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OR
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Stage IIIB (2) Non-Small Cell Lung Cancer: The cancer has spread to lymph nodes around the carina or in the space between the lungs. These lymph nodes are on the same side as the main lung tumor. The tumor has one or more of the following features:
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There are two or more separate tumor nodules in the same lobe of a lung.
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It has grown into the space between the lungs and heart, large blood vessels near the heart, trachea, esophagus, voice box, diaphragm, backbone, breastbone, or carina.
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Stage IIIC Non-Small Cell Lung Cancer: The cancer has spread to lymph nodes near the collarbone and/or has spread to lymph nodes on the other side of the body from the main tumor. The tumor has one or more of the following features:
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Two or more separate tumors may be in the same lobe or a different lobe of the lung with the primary tumor.
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It has grown into the chest wall, its inner lining, the phrenic nerve, the membrane surrounding the heart, large blood vessels near the heart, the trachea, esophagus, diaphragm, the breastbone or backbone, or the carina.
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Stage IV Non-Small Cell Lung Cancer
Stage IV NSCLC is categorized as either stage IVA or IVB. Cancer can be any size and may or may not have grown into nearby structures or spread to the lymph nodes.
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Stage IVA Non-Small Cell Lung Cancer: The tumor has one or more of the following features:
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One or more tumors in the lung do not have the primary tumor.
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The cancer has spread to the other lung.
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Cancer cells are found in the fluid around the lung or heart.
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Cancer has spread to one place in an organ or tissue, not near the heart.
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Stage IVB Non-Small Cell Lung Cancer: The cancer has spread to multiple places in one or more organs, not near the lungs. It has grown as more than one tumor outside the chest, such as to distant lymph nodes and/or to other organs such as the liver, bones, or brain.
Small Cell Lung Cancer Staging
The results of the tests for diagnosis will indicate the type of lung cancer, how large it is, where it’s located in the lung(s), and if it has spread to other areas of the body. Based on this, a stage is determined which will also impact the types of treatments available to the patient.
Small cell lung cancer stages fall into two categories:
- Limited-Stage Small Cell Lung Cancer: In limited-stage small cell lung cancer, the cancer is found only in one lung, the tissues between the lungs, and/or nearby lymph nodes.
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Extensive-Stage Small Cell Lung Cancer: In extensive-stage small cell lung cancer, cancer has spread outside of the lung in which it began or to other parts of the body.
There is another, more formal system — the TNM system — to describe the stage of lung cancer, but SCLC is almost always staged as a limited or extensive stage.
Find a Lung Cancer Specialist in the Syracuse Area
At Hematology-Oncology Associates of CNY, we are committed to providing expert, patient-centered lung cancer care to the Central New York region. Our multidisciplinary team of specialists ensures that each patient receives a personalized treatment plan based on the latest advancements in lung cancer care. Our cancer centers offer care for patients throughout Central New York, specifically in the Syracuse area, including Camillus and all of Onondaga County; in Auburn, and the rest of Cayuga County; in Oneida County, including Utica, Oneida and Verona; in Watertown, and throughout Oswego County. We also offer second opinions on diagnosis and treatment plans for lung cancer. Take the time to evaluate your options and choose the cancer care team you feel most comfortable with.
Source: American Cancer Society, National Cancer Institute.
