Non-small cell lung cancer (NSCLC) affects everyone differently, and much of that depends on the stage of cancer. Staging helps describe how large the tumor is and how far the cancer has spread, details that can guide treatment decisions.

Knowing the stage of your cancer — as well as what symptoms to expect and what treatments might work best — can help you make informed decisions about your care every step of the way. In this article, we’ll explain each stage of NSCLC, including symptoms, treatment options, and outcomes.

Staging of Non-Small Cell Lung Cancer

NSCLC has five main stages — 0 through 4. Stages are sometimes written using Roman numerals, e.g., stage III for stage 3. To determine your stage, your doctor may need a biopsy (taking a small tissue sample) and imaging tests, such as:

• Chest X-ray
• Computed tomography (CT) scan
• Positron emission tomography (PET) scan

These tests can reveal characteristics of the main or primary tumor, including its size and whether cancer has spread to nearby lymph nodes or to other body parts — a process known as metastasis. Staging helps doctors choose the right type of treatment. It can also predict what symptoms you’re likely to experience and your prognosis (outlook).

Staging helps doctors choose the right type of treatment. It can also predict what symptoms you're likely to experience and your prognosis.

Stage 0 NSCLC

Stage 0 is the very beginning of NSCLC. The cancer cells are only on the surface of the lung’s lining and haven’t grown into deeper lung tissue. This stage is also called carcinoma in situ (CIS), which means “cancer in place.”

Symptoms

Most people with stage 0 NSCLC don’t feel sick or have obvious symptoms. Because of this, it’s rare to find stage 0 NSCLC early. Most stage 0 cases are discovered by chance during tests for another health issue.

Treatment Options

Because the cancer is still on the surface and hasn’t spread, treatment is often simple and very effective. Sometimes, a surgeon can remove just the small area of cancer during a procedure called a resection or a segmentectomy (removing a small part of the lung).

In other cases, less invasive methods might be used, such as:

• Laser therapy (a focused light to destroy cancer cells)
• Photodynamic therapy (PDT), which uses a light-sensitive drug and a laser
• Brachytherapy (a type of internal radiation that targets the tumor)

Prognosis

Stage 0 has the best outlook of all NSCLC stages. The five-year survival rate, which describes the number of people still alive five years after their diagnosis, is greater than 90 percent. In practical terms, this means moret han 90 percent of people diagnosed with stage 0 NSCLC are still alive five years after their diagnosis.

However, individual outcomes can vary widely, depending on factors such as overall health, tumor characteristics, access to care, and how well the cancer responds to treatment.

Stage 1 NSCLC

In stage 1 NSCLC, the tumor is still confined to one lung and hasn’t spread to nearby lymph nodes. These tumors are often minimally invasive adenocarcinomas, which means they’re starting to grow into the lung tissue, but only slightly.

Symptoms

Many people with stage 1 NSCLC feel fine and don’t notice symptoms. If symptoms do appear, they may include:

• A cough that persists or produces blood or mucus
• Mild chest pain
• Shortness of breath
• Fatigue
• Repeated lung infections

Because symptoms may be mild or not occur, stage 1 cancer is often found through routine screenings or a CT scan or chest X-ray done for another reason.

Treatment Options

Surgery is often used to treat the cancer at this stage. If the tumor is small, your doctor may perform a resection (removing just part of the lung) or lobectomy (removing the entire affected lobe). If surgery isn’t a good option for you, your doctor may recommend radiation therapy.

In some cases, your doctor may also recommend:

• Chemotherapy (cancer-killing drugs)
• Immunotherapy (treatment that helps your immune system fight cancer)
• Targeted therapy (drugs that attack specific cancer cell changes)

These may be given after surgery to help prevent the cancer from spreading or returning.

Prognosis

The prognosis for stage 1 NSCLC is good. According to the American Cancer Society and the Surveillance, Epidemiology, and End Results (SEER) database, the five-year survival rate for NSCLC that hasn’t spread outside the lung is around 65 percent.

Stage 2 NSCLC

At stage 2, the tumor is larger or has started growing into nearby parts of the lung, such as the airways or membranes (thin layers that line the lungs). The tumor may have reached nearby lymph nodes but not other organs.

Stage 2 is divided into two subgroups:

• Stage 2A — The tumor is about 4 to 5 centimeters wide (around the size of a lime).
• Stage 2B — The tumor may be up to 7 centimeters, blocking part of the airways, pressing on the chest wall, or growing into the main bronchus (a large breathing tube). It may also be smaller but has spread to nearby lymph nodes.

Symptoms

In stage 2 NSCLC, symptoms may become more noticeable and can include:

• New, worsening, or persistent cough, possibly with bloody mucus
• Shortness of breath
• Chronic (long-term) chest pain
• Frequent lung infections

Treatment

Surgery, often a lobectomy, is still a good option for many people with stage 2 NSCLC. After surgery, doctors usually recommend chemotherapy to kill any remaining cancer cells.

You may also receive immunotherapy — medicine that helps your immune system attack cancer more effectively. Common immunotherapy drugs include:

• Atezolizumab (Tecentriq)
• Cemiplimab-rwlc (Libtayo)
• Durvalumab (Imfinzi)
• Nivolumab (Opdivo)
• Pembrolizumab (Keytruda)

Read more about immunotherapy for lung cancer.

If you can’t have surgery because of your overall health or other conditions, other treatments such as radiation therapy, chemotherapy, immunotherapy, or targeted therapy may be used instead — sometimes in combination.

Prognosis

Outcomes can depend on the size of the tumor, the type of treatment, and how well your body responds to the therapy. According to the National Cancer Institute, the five-year survival rate for stage 2 NSCLC is around 35 percent.

Apart from stage, the size of the tumor, the type of therapy, and how well your body responds to treatment can affect outcome.

Stage 3 NSCLC

In stage 3, the cancer has spread more deeply into the chest. Lymph nodes near the center of the chest, the opposite lung, or under the collarbone may be involved. The cancer may also have grown into nearby areas like the chest wall or major airways.

Stage 3 is divided into three subtypes — 3A, 3B, and 3C — based on how far the cancer has spread. Tumors may have reached the:

• Mediastinum (the space between the lungs)
• Bronchi (large airways)
• Membranes around the heart
• Diaphragm (the muscle that helps with breathing)
• Heart itself
• Major blood vessels
• Trachea (windpipe)
• Esophagus (food pipe)
• Spine

Symptoms

Lung cancer symptoms at this stage may include:

• Chest pain
• A deeper or bloody cough
• Trouble breathing
• Hoarseness (raspy voice)
• Back pain
• Difficulty swallowing or a feeling like food is stuck

Some people also get repeated bouts of bronchitis or pneumonia. Weight loss, lack of appetite, and fatigue are also more common at this stage.

Treatment

Treatment for stage 3 NSCLC usually involves a combination of therapies. Many people receive chemotherapy and radiation therapy together. If these treatments shrink the tumor enough, surgery may be recommended next.

Other people may receive immunotherapy or targeted therapy after initial treatment to help prevent cancer from returning. The type of treatment you receive will depend on the details about your tumor.

Some people may qualify for clinical trials, which test the safety and effectiveness of potential treatments. These studies may offer access to new drugs or inhibitors that target specific proteins. If you’re interested in learning more about clinical trials, talk to your healthcare team.

Prognosis

Stage 3 is considered an advanced stage of NSCLC. The five-year survival rate ranges from 9 percent to 37 percent, depending on how far the cancer has spread. While it’s harder to treat than earlier stages, new therapies may help people live longer and with a better quality of life.

Stage 4 NSCLC

Stage 4 is the most advanced stage of NSCLC. The cancer has metastasized beyond the lungs to other parts of the body, which may include the brain, bones, adrenal glands, and liver.

In addition to causing lung tumors, the cancer may show up in distant lymph nodes or cause fluid to build up around the lungs or heart. Also called metastatic NSCLC, stage 4 is divided into stages 4A and 4B, based on how far the cancer has spread.

Symptoms

Symptoms at stage 4 vary depending on where the cancer has spread. You may experience:

• Bone pain
• Headaches
• Swelling
• Shortness of breath
• A constant or worsening cough
• Fatigue (extreme tiredness that doesn’t improve with rest)
• Unexplained weight loss

If cancer has reached the brain, you might develop dizziness, seizures, vision changes, or memory problems.

Treatment

For stage 4 NSCLC, doctors may recommend targeted therapy for cancers with specific gene mutations (changes). For example, cancers with mutations in epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) genes may be treated with EGFR inhibitors or ALK inhibitors.

Immunotherapy, radiation therapy, and chemotherapy may also be used. Surgery usually isn’t recommended at this stage, but it may be done to relieve symptoms, such as removing a blockage or draining fluid from around the lungs or heart. In addition, working with a palliative care specialist can help relieve symptoms and improve quality of life.

Prognosis

While stage 4 is the most advanced stage, people are living longer than before thanks to newer, more effective treatments. The five-year survival rate ranges from about 8 percent to 37 percent, depending on how far the cancer has spread and how it responds to treatment. Regular follow-up with your oncology team can help you make the most informed decisions and explore all available options.

While stage 4 is the most advanced stage, people are living longer than before thanks to newer, more effective treatments.

Read more about how to prepare for stage 4 NSCLC.

Talk With Others Who Understand

MyLungCancerTeam is the social network for people with lung cancer and their loved ones. On MyLungCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with lung cancer.

What stage of NSCLC have you or your loved one been diagnosed with? Do you have any advice for someone recently diagnosed with the same stage about what to expect? Share your thoughts in the comments below, or start a conversation by posting on your Activities page.