Stage 1 lung cancer
The stage of a cancer tells you how big it is and whether it has spread. It helps your doctor decide which treatment you need. It can also give some idea of your outlook (prognosis).
Stage 1 is part of the number staging system. It uses the TNM system to divide cancers into stages. There are 4 stages of lung cancer, numbered from 1 to 4.
Stage 1 can be divided into 1A and 1B.
Stage 1A
There are 3 possible stages for stage 1A, namely stages 1A1, 1A2 and 1A3.
Stage 1A1 means:
- the cancer is a minimally invasive adenocarcinoma. Adenocarcinoma is a type of non small cell lung cancer
- the cancer is no more than 3cm at it’s widest part. It’s grown no further than 0.5cm into deeper lung tissue
- it has not spread to nearby lymph nodes
- it has not spread to distant parts of the body
Or stage 1A1 means:
- the cancer is 1cm or less at its widest part
- it has not grown into the membranes that surround the lungs (pleura)
- it has not grown into the main branches of the airways
- it has not spread to nearby lymph nodes
- it has not spread to distant parts of the body
Stage 1A2 means:
- the cancer is between 1cm and 2cm
- It has not grown into the membranes that surround the lungs (pleura)
- it has not grown into the main branches of the airways
- it has not spread to nearby lymph nodes
- it has not spread to distant parts of the body
Stage 1A3 means:
- the cancer is between 2cm and 3 cm
- it has not grown into the membranes that surround the lungs (pleura)
- it has not grown into the main branches of the airways
- it has not spread to nearby lymph nodes
- it has not spread to distant parts of the body
Stage 1B
Stage 1B means one or more of the following:
- the cancer is between 3cm and 4cm
- it is smaller than 4cm and has grown into the main airway of the lung (main bronchus)
- it is smaller than 4cm and has grown into the membrane covering the lung (visceral pleura)
- it is smaller than 4cm and has caused the lung to partly or completely collapse by blocking the airway or causing inflammation of the lung tissue (pneumonitis)
TNM stages
TNM stands for Tumour (T), Node (N) and Metastasis (M). The staging is different depending on the type of cancer you have.
The information below is an overview of the TNM staging for all types of cancer.
- T describes the size of the tumour (cancer)
- N describes whether there are any cancer cells in the nearby lymph nodes
- M describes whether the cancer has spread to parts of the body further away from where the cancer started
The doctor gives each factor (T, N and M) a number. The number depends on how far the cancer has grown or spread.
So, a very small cancer which hasn't spread to the lymph nodes or elsewhere in the body may be T1 N0 M0.
A larger cancer that has spread into the nearby lymph nodes and to another part of the body may be T3 N1 M1.
In the TNM staging system, stage 1A is the same as T1a-c, N0, M0.
Stage 1B is the same as T2a, N0, M0
Treatment
The stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on:
- your type of cancer (the type of cells the cancer started in)
- where the cancer is
- other health conditions that you have
The treatment for small cell lung cancer is different to the treatment for non small cell lung cancer.
Non small cell lung cancer
If you have surgery
If you are fit enough, you usually have surgery to remove
- part of your lung (a lobectomy, segmentectomy or wedge resection)
- all of the lung (pneumonectomy), depending on where the cancer is
Your fitness for surgery depends on your general health and how well you are likely to recover.
After surgery your doctor might offer you chemotherapy, 
or treatment with a . This lowers the chance of your cancer coming back. It is called adjuvant treatment.
If your surgeon is not able to remove all of your tumour, you might have radiotherapy after surgery.
If you're not having surgery
If you aren’t fit enough for surgery or you decide that you don't want to have it, you might have:
- radiotherapy - this is usually
stereotactic ablative body radiotherapy (SABR) . If you can’t have SABR, you might have conventional radiotherapy or radiotherapy that is divided into small doses and given more often, also known as continuous hyperfractionated accelerated radiotherapy (CHART) - chemotherapy after radiotherapy (adjuvant chemotherapy)
radiofrequency ablation
Small cell lung cancer
Chemotherapy followed by radiotherapy to the chest is the main treatment for small cell lung cancer if you are not well enough to have chemoradiotherapy.
If you are fit enough, you might have chemoradiotherapy. This means you have chemotherapy at the same time as radiotherapy. This is usually during your first or second cycle of chemotherapy.
Some people have surgery to remove all or part of the lung, especially in the early stage of cancer. But this is rare in small cell lung cancer. It is not usually possible to remove all of the cancer with surgery. After surgery, you have chemotherapy and possibly radiotherapy.
After you finish treatment, you might have radiotherapy to your head. This treatment is called (PCR). You have this because it is quite common for small cell lung cancer to spread to the brain. The radiotherapy aims to kill any cancer cells that may have already spread to the brain but are still too small to see on scans.
You might have prophylactic cranial radiotherapy for limited stage disease if:
- your chemotherapy or radiotherapy treatment has stopped your cancer growing
- you are well enough
