What is lung cancer?
Lung cancer is the third most common cancer in the UK¹ and it is also one of the most serious types of cancer. It begins when abnormal cells grow and multiply in an uncontrolled way to form a tumour in your lungs.
As with all cancers, the likelihood of survival is higher if lung cancer is caught in the early stages when it is most treatable. Treatment depends on the type, stage and grade of your lung cancer and your general health, and includes surgery, chemotherapy and radiotherapy.
How is lung cancer diagnosed?
You should see your GP if you have any lung cancer symptoms. They will assess your health, symptoms and breathing and may refer you to a specialist. There are a number of tests to help diagnose lung cancer symptoms including:
- Chest X-ray - usually the first test in diagnosing lung cancer. Lung tumours appear as a white-grey mass on an X-ray.
- CT scan of your chest – usually the second test. A chest CT scan creates detailed images of your lungs and other parts of your chest.
- PET–CT scan - may be performed if your CT scan shows you have early-stage cancer. It can display the location of active cancer cells.
- MRI scan – used to see if your lung cancer has spread to other parts of your lung or elsewhere in your body. Cross-section pictures of your body clearly show soft tissue.
- Bone scan – performed to see if lung cancer has spread to your bones.
- Bronchoscopy and biopsy - looks at the inside of your lung’s airways. A biopsy sample of cells are taken if any areas look abnormal.
- Endobronchial ultrasound scan (EBUS) - combines bronchoscopy with an ultrasound scan to see the inside of your airways and take a biopsy from your lymph nodes.
- Other biopsies
-Thoracoscopy - examines a particular area of your chest and takes tissue and fluid samples
-Mediastinoscopy - examines the area between your lungs at the centre of your chest and takes lymph node cell samples.
-Percutaneous lung biopsy – takes a biopsy using a needle inserted through your skin.
What are the stages of lung cancer?
After diagnostic and often further tests your doctors should be able to let you know the stage, type and grade of your cancer. This information helps plan your treatment and to give you information about the expected outcome for people with the same type and stage of cancer as you.
Lung cancer stages tell you how big your cancer is and whether it has spread from its origin. The type of cancer gives the cell type that the cancer started from. The grade shows how abnormal the cancer cells look compared to normal cells and indicates how quickly the cancer may grow.
Doctors use a number staging system or the TNM system to define your lung cancer stage.
Lung Cancer Stages using the Number Staging System
Stage 1 Lung Cancer – Early or Localised Lung Cancer
Stage 1 means your cancer is small and has not spread to your lymph nodes or other organs. Stage 1 cancer can be divided into 1A and 1B.
- Stage 1A is when your cancer is 3cm or smaller.
- Stage 1B is when your cancer is between 3cm and 4cm.
Stage 1 Lung Cancer Symptoms
There are often no symptoms of Stage 1 lung cancer. You may experience shortness of breath, coughing and hoarseness. It is important to see your doctor if you have any concerns.
Stage 2 Lung Cancer - Locally Advanced Lung Cancer
Stage 2 cancer is less than 5cm in size and may be growing into other parts of your lung, airway or surrounding areas outside your lung. Stage 2 can be divided into stages 2A and 2B.
- Stage 2A is when your cancer is 4 to 5cm and there are no cancer cells in any lymph nodes.
- Stage 2B is when your cancer is up to 5cm and there are cancer cells in the lymph nodes close to the affected lung.
Stage 2 Lung Cancer Symptoms
Symptoms you may notice at Stage 2 are coughing up blood, shortness of breath or wheezing, chest pain when breathing deeply and appetite and weight loss.
Stage 3 Lung Cancer – Locally Advanced Lung Cancer
Stage 3 cancers have not spread to other distant parts of your body. The stage is based on the size and number of tumours, which lymph nodes the cancer has spread to, and other areas it has spread to. Stage 3 can be divided into 3A, 3B and 3C.
- Stage 3A means the cancer is on one side of your body. Stage 3A cancer can be any size. It may have spread to other nearby areas or into your lymph nodes on the same side of your chest as your primary lung tumour. The cancer may have spread to your chest wall, phrenic nerve, membrane around the heart, diaphragm, the centre of your chest, your heart and its blood vessels, your trachea, the nerve that goes to your larynx voice box, your oesophagus, spinal bone or carina area.
- Stage 3B means that the cancer has spread to your lymph nodes in the centre or opposite side of your chest from the affected lung or your neck or above your collarbone. It may have also spread to your chest wall, diaphragm or the layers that cover your heart or into a major structure in your chest such as your heart, trachea, oesophagus or main blood vessel.
- Stage 3C means the cancer has spread into the lymph nodes in the centre of your chest on the opposite side from the affected lung, or at the top of your lung on the same or opposite side, or above your collar bone, or there is more than one tumour in more than one lobe of the same lung. The cancer may also have spread into your phrenic nerve and/or parietal pericardium, or into one of these areas: diaphragm, mediastinum, heart, a major blood vessel, trachea, the recurrent laryngeal nerve, oesophagus, spinal bone or carina.
Stage 3 Lung Cancer Symptoms
At Stage 3 you may have noticeable symptoms, such as a new and persistent cough or a more frequent cough that produces blood. You might feel short of breath and wheezy when breathing, pain in your chest area, bone pain and headaches, have a hoarser voice or unexplained weight loss.
Stage 4 Lung Cancer – Metastatic, Advanced or Secondary Lung Cancer
Stage 4 means that your lung cancer has spread. It is divided into stage 4A and 4B.
- Stage 4A means that you have cancer in both lungs, or in the covering of your lung or your heart, or in the fluid around your lungs or heart. Alternatively, stage 4A can mean that the cancer has spread to your lymph nodes outside your chest or to another part of your body such as your liver or bone.
- Stage 4B is when the cancer has spread to several areas in one or more organs.
Stage 4 Lung Cancer Symptoms
Your symptoms at Stage 4a can include fatigue and disinterest in previous pursuits, severe pain and discomfort, shortness of breath and difficulty breathing, a persistent cough, bleeding and reduced appetite. You may also feel or experience bone pain or fractures, headaches, brain seizures, vision problems, nausea, bloating and jaundice. Symptoms vary depending on the area your cancer has spread to.
Lung Cancer Stages using the TNM Staging System
- T – Is the size of your tumour. It is usually a number between 1 and 4 where 1 is a small cancer and 4 is a larger or more advanced cancer./li>
- N – Describes if the cancer has spread to your lymph nodes. It is a number between 0 and 3 where 0 means there are no cancer cells in the lymph nodes and 3 indicates more lymph nodes are affected by cancer.
- M – Is used to define if the cancer has spread to another part of your body. It is known as metastatic or secondary cancer. Cancer is assigned a 0 or 1 with 0 meaning the cancer has not spread to other parts of your body and 1 meaning it has spread.
Types of lung cancer
The type of lung cancer is determined by the cell type your cancer started in. If your cancer began in your lung, it is called primary lung cancer. If it has spread to your lungs from another part of your body it is secondary lung cancer.
There are different types of primary lung cancer that are divided into two main groups:
- Small Cell Lung Cancer (SCLC) – makes up about 15% of primary lung cancers.
- Non-Small Cell Lung Cancer (NSCLC) – accounts for approximately 85% of primary lung cancers.
Is the staging method the same for the primary types of lung cancer?
NSCLC is staged using the number staging or TNM systems. SCLC can be staged using a simplified staging system with just two stages:
- limited disease – cancer has not spread beyond the lung
- extensive disease – cancer has spread beyond the lung
Limited and extensive disease staging is becoming less common as more is learnt about SCLC. Doctors now use the number staging and TNM systems more often for SCLC.
Grades of lung cancer
Grading divides cancer cells into groups based on how they look under the microscope compared with normal cells. It provides an indication of the likely speed and spread of growth of your cancer. The grading system for most lung cancers is:
Grade 1 – low grade. The cells look similar to normal cells. They tend to be slow-growing and less likely to spread than higher-grade cancer cells.
Grade 2 - moderate or intermediate-grade. The cancer cells look more abnormal and are faster growing and more likely to spread.
Grades 3 and 4 - high-grade or poorly differentiated. The cancer cells look very different from normal cells and tend to grow quickly and are more likely to spread.
We're here to help
The staging systems, types and grades of cancer cells can seem complicated. We advise you to ask your lung cancer specialist any questions you have about your lung cancer stages to ensure you fully understand your situation and the best course of treatment for you.
Our Ramsay hospitals have the latest technology, experienced specialists, caring support staff and comfortable surroundings to diagnose, stage and treat lung cancer. We know that you will want to have all the required tests as soon as possible and these are all available without waiting at Ramsay Health Care UK.