Diagnosis

I’ve Just Been Diagnosed… What’s Next?

Your doctor will order a series of tests that are designed to help determine the stage, or to what extent, the cancer may have spread. This information will help your doctor decide whether surgery, radiation, chemotherapy or a combination of these treatments is appropriate for you.

Some of the tests you may need include:

  • CT scans (computed tomography) of the brain, chest, abdomen and pelvis.
  • MRI scans (magnetic resonance imaging).
  • Bone scans which include a radioisotope injected into a vein that then travels through the bloodstream and collects only in bone areas where tumor cells may lay hidden.
  • PET scans (positron emission tomography) are special types of x-rays that may detect the spread of the cancer into other organ sites.
  • Blood tests may also be ordered to check your blood count or liver enzymes.

Staging of Non-Small Cell Lung Cancer

Physicians use the American Joint Commission on Cancer (AJCC) system to stage non-small cell lung cancer. This system also is referred to as the TNM system, named for tumor extent, nodal amount and presence of metastases.

In general, there are five stages ranging from stage 0 to stage IV. Some of these stages are subdivided into A and B subcategories. The higher the stage number, the more extensive the lung cancer is.

Typically, surgery is reserved for individuals with stages I – III. Stage 0 is an unusual stage of lung cancer because no lesions are identified on imaging tests but are found by a collection of cells from a sputum sample or from a procedure involving a bronchoscopy (a procedure in which a physician uses a bronchoscope to look at the tissues of the lung). Stage IV designates that cancer has spread to distant areas of the body and, for this reason, surgery would not be helpful in most cases.

Stages I – III are divided into A and B subclasses:

Stage IA – Tumor is 3 centimeters or smaller.

Stage IB – Tumor larger than 3 centimeters or has spread to main bronchus and is at least 2 centimeters from the point where the trachea branches into the left and right main bronchi or has spread to the innermost layer of the lung or partly blocks the bronchus.

Stage IIA – Tumor meets criteria for stage IA but has spread to the nearby lymph nodes on the same side of the chest where the tumor is located.

Stage IIB – Meets the same criteria for Stage IB but also has spread to the nearby lymph nodes on the same side of the chest where the tumor is located.

Stage IIIA – This stage indicates that a lung tumor has invaded the chest wall or the lining around the heart, main bronchus, pleura, and/or lymph nodes located in the center of the chest or the diaphragm.

Stage IIIB – Meets the same criteria as Stage IIIA but the tumor has spread to lymph nodes on the opposite side of the lung from where the tumor mass is located or the tumor has invaded the lining of the pleura.

Stage IV – Cancer cells have spread to other organs or parts of the body.

Small Cell Lung Cancer Staging

There are only two stages for small cell lung cancer: limited and extensive.

Limited stages indicate that the cancer involves only one of the lungs and/or nearby lymph nodes.

Extensive stage indicates that cancer has spread outside of the lung into other areas of the body.