What are the stages of lung cancer?

On a typical day seeing patients, Dr. Ahmed Salem, a pulmonologist with Sharp Community Medical Group and affiliated with Sharp Memorial Hospital, gets asked several questions about lung health. But one question comes up more than any other, particularly when discussing the complex subject of lung cancer.

“We get asked about the stages a lot,” Dr. Salem says. “Patients and their loved ones want to know what the staging means.”

These are important questions, especially considering how many people will face the challenge of lung cancer in their lifetimes. It’s the leading form of cancer death, with more than 125,000 Americans projected to die of the disease in 2024 and more than 234,000 cases estimated to be diagnosed.

Before staging

The first step in a lung cancer diagnosis is determining the type. After the diagnosis is confirmed, the care team will use imaging, such as CT scans, and tests, such as biopsies, to reveal key pieces of information that will be used to determine the stage, including:

• The size and location of the tumor

• Whether the cancer has spread to the lymph nodes around the lung and chest

• Whether the cancer has spread outside the lung to other organs

The stages of lung cancer

Once the care team has that information, they’ll assign a stage number to the patient’s lung cancer. This can help the patient more easily understand their diagnosis and prognosis. Staging also helps determine how the cancer will be treated.

• Stage 1: The cancer is small and has not spread.

• Stage 2: Tumors may be larger than Stage 1 or may have started to spread to the lymph nodes in the chest between the lungs.

• Stage 3: The cancer is large, or there is more advanced spread to the lymph nodes in the chest.

• Stage 4: The most advanced stage, at which the cancer has metastasized, which means it has spread beyond the lungs to other parts of the body

As with most forms of cancer, patients have significantly better odds of surviving the earlier the cancer is detected. However, Dr. Salem says that lung cancer presents significant challenges when it comes to early detection.

“It’s tricky because lung cancer isn’t something you really feel,” he says. “The lung is like a balloon, and if you have a small nodule, you likely won’t know or feel it. By the time you get symptoms, such as a cough or pain, you’re probably already at an advanced stage.”

The importance of screenings

Making sure people who are at significant risk of lung cancer get screened is a passion for Dr. Salem. “New studies show we can have success with earlier screening,” he says. “But we traditionally have not had the same success getting people into screenings for lung cancer as we have for breast and colon cancer.”

Dr. Salem points out that while 70 to 75% of those who are eligible get breast and colon cancer screenings, only 4.5% of those eligible get lung screenings.

“In San Diego, that number is even lower,” he says. “It is a standard of care that should be done for every patient that qualifies.”

People eligible for screening include:

• Those age 50 to 80

• A current smoker OR a person who has quit smoking within the last 15 years

• A person with a 20 pack-year history of smoking (a calculation that works out to smoking one pack per day for 20 years, two packs per day for 10 years, and so on)

Following staging

Accurate staging will help the care team develop a treatment plan. For Stages 1, 2 and 3, patients will be eligible for treatment with what doctors call “curative intent.”

“It’s what it sounds like — we are trying to cure the disease,” Dr. Salem says. “For Stage 1 and 2 cases, you’re going to see a thoracic surgeon who will try to cut out the cancer. Then there may be some kind of chemotherapy or immunotherapy to help ensure all the cancer cells are killed.”

Surgery may be appropriate for some Stage 3 patients, but often, radiation and chemotherapy are recommended instead. Radiation may also be used if a patient has Stage 1 or 2 cancer but cannot undergo surgery.

Upon reaching Stage 4, unfortunately, many cases cannot be cured. “We’re going to treat it and, hopefully, you’ll live longer and have less symptoms,” Dr. Salem says. “It’s about keeping people doing what they want to be doing and enjoying their quality of life for as long as possible.”

The development of new technology gives Dr. Salem optimism for the future of lung cancer treatment. Advancements, such as in robotics, allow doctors to detect, analyze and treat lung cancer more successfully than ever before.

“It’s exciting to see the impact we’re having in battling the leading form of cancer death,” said Dr. Salem. “Those are lives that are being saved.”

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