To classify how much lung cancer has spread beyond the lungs, you go through a process called lung cancer staging. Lung cancer staging is an important part of developing an effective treatment plan—the stage of cancer predicts how well it will respond to different treatments.
At Penn Medicine Lancaster General Health, we thoroughly and accurately stage cancers using advanced diagnostic tests and procedures. Then our lung cancer team works together to determine the best treatment plan for your diagnosis.
Lung Cancer Staging: Why Choose Penn Medicine Lancaster General Health?
Our team includes experienced doctors who subspecialize in lung cancer. This special expertise means they have the training and knowledge to identify tumor characteristics that affect different treatment approaches.
But they don’t operate on an island. During a weekly Thoracic Tumor Board, these medical and radiation oncologists, thoracic (chest and lung) surgeons, pathologists (lab specialists) and pulmonologists (lung specialists) review patient cases together. They share perspectives and come to a consensus about the best treatment plan.
While you may only see one or two doctors, be assured you have nearly a dozen subspecialists weighing in on your care. Lung cancer staging at Penn Medicine Lancaster General Health also includes:
- Gold standard staging: Staging often involves checking nearby lymph nodes for signs of cancer. Lymph nodes are usually the first place that lung cancers spread. While removing around 10 lymph nodes is the gold standard, less than half of all patients in Pennsylvania have this many removed. By contrast, almost all our patients have the recommended number of lymph nodes removed for staging.
- Latest treatments: Once we settle on the diagnosis and lung cancer stage, all patients are screened to see if they are eligible for one of our lung cancer clinical trials. These trials give them early access to cancer treatment breakthroughs before they are widely available.
- Oncology nurse navigator: From the moment we suspect lung cancer, our lung cancer nurse navigator is there to guide you. Your nurse navigator helps you coordinate visits, answers your questions and attends appointments with you when possible. This caregiver provides an extra layer of support and helps you overcome any issues that arise during your care. Meet our lung cancer team.
- Warm, peaceful setting: The Ann B. Barshinger Cancer Institute was designed with your comfort in mind. A 12-foot-high, 34-foot-long vertical garden and friendly faces greet you at the door. This “living wall” encourages healing and serenity as you spend time here, as does our meditation pavilion, soothing colors and floor-to-ceiling windows that provide natural light and landscaped views.
How We Stage Lung Cancer
To accurately stage lung cancer, we consider your:
- Physical exam
- Biopsy results
- Imaging tests, such as CT scans
We offer several types of biopsies to gain information about the cancer, including:
- Tissue biopsy: Surgeons remove a tissue sample from the tumor, so pathologists can examine it under a microscope and analyze the unique characteristics of the cancer cells. This process can also help determine if the cancer will respond to immunotherapy.
- Liquid biopsy: In this groundbreaking test developed at Penn Medicine, pathologists analyze a blood sample for genetic changes in cancer cells. Finding certain changes might make you eligible for targeted therapy for lung cancer. Targeted therapies are often more successful and have fewer side effects than treatments like chemotherapy.
Non-Small Cell Lung Cancer (NSCLC) Stages
To stage non-small cell lung cancer, doctors use the American Joint Committee on Cancer’s TNM staging system. This system details:
- Size and spread of the main tumor (T)
- The lymph nodes (N) involved
- If and where the cancer has metastasized (M), or spread, to other parts of the body
Doctors then give each letter a number to further describe the cancer:
- Stage I: The cancer is only in the lungs.
- Stage II: The cancer is in the lungs and has started to spread to nearby lymph nodes.
- Stage III (locally advanced NSCLC): The cancer is in the lungs and lymph nodes in the chest. Stage III has two subtypes:
- Stage IIIA: The cancer has spread to lymph nodes on the same side of the chest as the main tumor.
- Stage IIIB: The cancer has spread to lymph nodes on the other side of the chest or by the collarbone.
- Stage IV (advanced disease): Stage IV lung cancer is in both lungs or has spread to fluid around the lungs or other parts of the body, such as the liver, bones or brain.
Small Cell Lung Cancer (SCLC) Stages
Small cell lung cancer often spreads more aggressively than non-small cell lung cancer. That’s why it’s usually diagnosed after it has spread beyond the lungs. Doctors use a two-stage system to stage small cell lung cancer:
- Limited stage: The cancer is in the lungs and may have spread to the mediastinum (area between the lungs) or to lymph nodes by the collarbone.
- Extensive stage: The cancer has spread to other distant areas of the body. Stage 4 small cell lung cancer would be considered extensive stage.