Understanding Non-Small Cell Lung Cancer

The most common type of lung cancer, non-small cell lung cancer (NSCLC) includes squamous cell carcinoma, adenocarcinoma, and large cell carcinoma.

When identifying the stage of NSCLC, oncologists look at the size and extent of the tumor, if the lymph nodes are involved, and if it has spread to other parts of the body. Oncologists use the TNM staging system to classify this type of lung cancer.

Here's what the letters stand for in the TNM system:

• T tells how large a tumor is and whether it has grown into nearby structures.
• N tells whether the lymph nodes near the tumor are cancerous.
• M tells whether the cancer has spread (metastasized) to other organs in the body, such as your brain, bones, or liver.

Numbers are assigned to each of the T, N and M categories. Once your oncologist has determined your T, N and M categories, he or she uses this information in a process called stage grouping.

These are the stages of non-small cell lung cancer. Each TNM category has a number value from X to 4. It falls into one of these stages:

• Occult: This means you have cancer cells in your sputum (mucus from the lungs) or other lung fluids. At this stage, the tumor in your lungs cannot be seen. You may hear your doctor use these TNM terms for this stage: TX, N0, M0.
• Stage 0: In this stage, cancer is only in the cells lining your air passages and it has not invaded deeper into lung tissues or spread outside the lungs. Cancer at this stage is also called carcinoma in situ. You may hear your doctor use these TNM terms for this stage: Tis, N0, M0.
• Stage I: In this stage, you have cancer in your lung, and it may affect your airways (bronchi) or the lining outside your lung. Cancer found at this stage usually offers a good chance of survival. Stage I is divided into Stage IA and IB, based on the size and location of the tumor. For Stage IA, your doctor may use these TNM terms: T1, N0, M0. For Stage IB, your doctor may use these TNM terms: T2a, N0, M0.
• Stage II: In this stage, the cancer may have spread into surrounding tissue. You may have cancer in your lymph nodes within your lung on the same side the cancer is in. Stage II is divided into Stage IIA and IIB, based on the size and location of the tumor and whether it has spread to the lymph nodes. For Stage IIA, your doctor may use these TNM terms: T1, N1, M0 or T2a, N1, M0 or T2b, N0, M0. For Stage IIB, your doctor may use these TNM terms: T2b, N1, M0 or T3, N0, M0.
• Stage III: Stage IIIA and Stage IIIB are the two substages noted in Stage III. In Stage IIIA, the cancer may have spread to the organs or lymph nodes in the middle of the chest (mediastinum). Or it may have spread into a different lobe in the same lung. It may also have spread to lymph nodes behind your windpipe (trachea). For Stage IIIA, you may hear your doctor use these TNM terms: T1-T3, N2, M0 or T3, N1, M0 or T4, N0-N1, M0. In Stage IIIB, the cancer has spread to the lymph nodes above your collarbone on either side or to the lymph nodes on the other side of your chest. Or it has grown into the middle part of the chest or into a different lobe of the same lung, as well as into lymph nodes in the middle of the chest. For Stage IIIB, you may hear your doctor use these TNM terms: Any T, N3, M0 or T4, N2, M0.
• Stage IV: The cancer has spread to the other lung, into the fluid around the lung or heart, or to other distant organs in your body such as the liver or brain. You may hear your doctor use these TNM terms for this stage: Any T, any N, M1a-M1b.

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