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After someone is diagnosed with small cell lung cancer (SCLC), doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Doctors also use a cancer's stage when talking about survival statistics.
The stage of SCLC is based on the results of physical exams, biopsies, imaging tests, and any other tests that have been done (as described in Tests for Lung Cancer).
For treatment purposes, most doctors use a 2-stage system that divides SCLC into limited stage and extensive stage. For limited stage cancer, a person might benefit from more aggressive treatments such as chemotherapy combined with radiation therapy to try to cure the cancer. For extensive stage disease, chemotherapy alone is likely to be a better option to control (not cure) the cancer.
This means that the cancer is only on one side of the chest and can be treated with a single radiation field. This generally includes cancers that are only in one lung (unless tumors are widespread throughout the lung), and that might also have reached the lymph nodes on the same side of the chest.
Cancer in lymph nodes above the collarbone (called supraclavicular nodes) might still be considered limited stage as long as they are on the same side of the chest as the cancer. Some doctors also include lymph nodes at the center of the chest (mediastinal lymph nodes) even when they are closer to the other side of the chest.
What is important is that the cancer is confined to an area that is small enough to be treated with radiation therapy in one “port” or one treatment area. Only about 1 out of 3 people with SCLC have limited stage cancer when it is first found.
This describes cancers that have spread widely throughout the lung, to the other lung, to lymph nodes on the other side of the chest, or to other parts of the body (including the bone marrow). Many doctors consider SCLC that has spread to the fluid around the lung to be extensive stage as well. About 2 out of 3 people with SCLC have extensive disease when their cancer is first found.
A more formal system to describe the growth and spread of lung cancer is the American Joint Committee on Cancer (AJCC) TNM staging system, which is based on 3 key pieces of information:
Numbers or letters appear after T, N, and M to provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once the T, N, and M categories have been determined, this information is combined in a process called stage grouping, to assign an overall stage. For more information, see Cancer Staging.
In the TNM system, the earliest stage is stage 0 (also called carcinoma in situ, or CIS). The other main stages range from I (1) through IV (4). Some of these stages are broken down further with letters or numbers. As a rule, the lower the stage number, the less the cancer has spread. A higher number, such as stage IV, means cancer has spread more. And within a stage, an earlier letter (or number) means a lower stage.
The same TNM staging system is used for both SCLC and non-small cell lung cancer (NSCLC), although it’s generally not as important for SCLC. For more detailed information about this system, see Non-Small Cell Lung Cancer Stages. Staging with the TNM system can be complex, so if your health care team is using it, ask them to explain it to you in a way you understand.
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American Joint Committee on Cancer. Lung. In: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017: 431-456.
Araujo LH, Horn L, Merritt RE, Shilo K, Xu-Welliver M, Carbone DP. Ch. 69 - Cancer of the Lung: Non-small cell lung cancer and small cell lung cancer. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020.
Hann CL, Wu A, Rekhtman N, Rudin CM. Chapter 49: Small cell and Neuroendocrine Tumors of the Lung. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.
Last Revised: October 1, 2019