Stage 1 lung cancer

About staging

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.

TNM stages

The TNM system describes:

• the size of the primary tumour (T)

• whether the cancer has spread to the lymph nodes (N)

• whether the cancer has spread to another part of the body (M)

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 T1mi-T1a N0 M0.

A larger cancer that has spread into the nearby lymph nodes and to another part of the body may be T3-T4 N1 M1.

In the TNM staging system, stage 1A is the same as one of the following:

• T1mi-T1a, N0, M0

• T1b N0 M0

• T1c N0 M0

Stage 1B is the same as:

• T2a N0 M0

Find out about TNM staging for lung cancer

Stage 1A

There are 3 possible stages for stage 1A, namely stages 1A1, 1A2 and 1A3.

Stage 1A1

Stage 1A1 (T1mi-T1a) 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 the cancer:

• is 1cm or less at its widest part

• has not grown into the membranes that surround the lungs (pleura)

• has not grown into the main branches of the airways

• has not spread to nearby lymph nodes

• has not spread to distant parts of the body

Stage 1A2

Stage 1A2 (T1b, N0, M0) 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

Stage 1A3 (T1c N0 M0) 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 any other part of the body

Stage 1B

Stage 1B (T2a N0 M0) means the cancer is between 3cm and 4cm.

Or the cancer is 4cm or less with one or more of the following features:

• it involves the inner lining of the chest cavity (the visceral pleura)

• it involves the main airway (the main bronchus) but does not involve the area where the bronchus divides to go into each lung (carina), or part or all of the lung has collapsed or is blocked due to inflammation

• it has not spread to lymph nodes

• it has not spread to any other part of the body

Treatment

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, you may have extra treatment to reduce the chance of the cancer coming back. This is called adjuvant treatment. You might have chemotherapy. Or you may have targeted cancer drugs or immunotherapy.

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​

Read about treatments for lung cancer

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 for limited stage small cell lung cancer. This means you have chemotherapy at the same time as radiotherapy. Limited stage small cell lung cancer means the cancer is contained in a single area on one side of the chest. 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 ​prophylactic cranial irradiation​ (PCI). 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

Read about lung cancer treatments

Other stages of lung cancer

• Stage 2

• Stage 3

• Stage 4

• Limited and extensive disease (for small cell cancer)

• TNM staging