Cancer Stages 0 to IV Explained: What Your Stage Means
A cancer’s stage describes how large it is and how far it has spread. Most cancers are given a stage from 0 to IV (zero to four): stage 0 means abnormal cells that have not spread, and stage IV means the cancer has spread to distant parts of the body. For most solid tumors, the stage is worked out from three pieces of information called TNM — the Tumor, the lymph Nodes and Metastasis (distant spread). Your stage is one of the most important things your care team uses to plan treatment. If you have just been told your stage, it is normal to feel overwhelmed — this guide explains it step by step.
Quick Facts About Cancer Stages
- Stages run from 0 to IV; IV is the same as stage 4 (doctors use Roman numerals)
- There is no stage 5 in standard cancer staging
- Letters after a stage, like IIA or IIIB, split it into smaller groups
- Most solid tumors are staged with TNM: T (tumor), N (nodes), M (metastasis)
- Any cancer with distant spread (M1) is stage IV
- The rules differ for each cancer, so stage III breast cancer is not the same as stage III lung cancer
What Is Cancer Staging?
Cancer staging is a way of describing the size of a cancer and how far it has spread in the body. Staging is important because it helps your care team:
- Plan the best treatment
- Estimate the likely outcome (prognosis)
- Talk clearly with each other about your cancer
- Find clinical trials that may suit you
- Compare results of treatment across hospitals and studies
Key Terms
- Clinical stage: Based on exams, scans and biopsy before treatment
- Pathological stage: Based on tissue removed during surgery
- Post-treatment stage: Checked again after treatment given before surgery
- Restaging: Done if cancer comes back after treatment
Cancer Stage Chart: Stages 0 to IV at a Glance
This diagram shows how the stages build on each other. Each step up means the cancer is larger or has spread further.
General pattern only. Exact rules differ for each type of cancer.
| Stage | What it means | Typical TNM | Also called | Common treatment approach |
|---|---|---|---|---|
| Stage 0 | Abnormal cells that have not invaded nearby tissue (carcinoma in situ) | Tis N0 M0 | In situ, pre-invasive | Local treatment such as surgery |
| Stage I | Small cancer that has not spread to lymph nodes | T1 (sometimes T2) N0 M0 | Early stage, localized | Often surgery, sometimes with radiation or other treatment |
| Stage II | Larger cancer, or spread to a few nearby lymph nodes | T2–T3 N0, or T1–T2 N1, M0 | Early or locally advanced, depending on the cancer | Surgery plus chemotherapy, radiation or other treatment |
| Stage III | Cancer that has grown into nearby tissue and/or spread to more lymph nodes | T3–T4 and/or N1–N3, M0 | Locally advanced, regional | A combination of treatments |
| Stage IV | Cancer that has spread to distant organs or distant lymph nodes | Any T, any N, M1 | Metastatic, advanced, distant | Mainly whole-body (systemic) treatment, plus supportive care; sometimes surgery or radiation |
⚠️ Important
Stage groups differ by cancer type. For example, the same TNM code can be stage II in one cancer and stage III in another. Your care team, or your pathology report, gives your official stage. See our stage grouping tables for examples.
What Each Stage Means
Stage 0
Abnormal cells are present but have not grown into nearby tissue. This is often called carcinoma in situ (for example, ductal carcinoma in situ in the breast). Stage 0 is usually very treatable. Not every cancer type has a stage 0.
Stage I (stage 1)
The cancer is small and has not spread to lymph nodes or other parts of the body. It is often called early-stage or localized cancer.
Stage II (stage 2)
The cancer is larger, has grown deeper, or has spread to a small number of nearby lymph nodes. It has not spread to distant parts of the body.
Stage III (stage 3)
The cancer has grown into nearby tissue and/or spread to more lymph nodes, but not to distant organs. This is often called locally advanced cancer. Many stage III cancers are still treated with the aim of cure.
Stage IV (stage 4)
The cancer has spread to distant organs, such as the liver, lungs, bones or brain, or to distant lymph nodes. This is also called metastatic or advanced cancer. Stage IV is usually treated with medicines that work throughout the body. Some stage IV cancers can be controlled for many years, and a few can still be cured.
What is the difference between stage 1 and stage 4 cancer?
Stage 1 cancer is small and still in the place where it started. Stage 4 cancer has spread to distant parts of the body. Stage 1 is often treated with surgery or radiation to remove or destroy the tumor, while stage 4 usually needs treatment that reaches the whole body, such as chemotherapy, hormone therapy, targeted therapy or immunotherapy.
Stage Letters (A, B, C) and Roman Numerals
- Roman numerals: I, II, III and IV are simply 1, 2, 3 and 4. “Stage IV” and “stage 4” mean exactly the same thing.
- Letters after the stage: Many cancers split a stage into smaller groups, such as IIA, IIB and IIC, or IIIA, IIIB and IIIC. Within the same stage, A is usually less extensive than B or C. Some cancers also add numbers, such as IA1 or IIIC2.
- No stage 5: Standard cancer staging stops at IV. If you see a 5, it is probably a grade (for example Grade Group 5 in prostate cancer), not a stage.
- “Stage A” on its own: A letter-only stage usually comes from a different system, such as Binet stage A for chronic lymphocytic leukemia, or the older Dukes A for bowel cancer. See other staging systems.
How TNM Maps to a Stage
For most solid tumors, doctors first describe three things and then combine them into one stage. This page gives the overview; our TNM staging reference explains every code (including TX, T0, NX, why MX is no longer used, the c, p, y and r prefixes, and worked examples such as T2 N1 M0).
T - Primary Tumor
Size and local growth of the main tumor:
- TX: Cannot be assessed
- T0: No sign of a primary tumor
- Tis: Carcinoma in situ
- T1–T4: Larger and/or growing further
N - Lymph Nodes
Whether cancer is in nearby lymph nodes:
- NX: Cannot be assessed
- N0: No cancer in nearby nodes
- N1–N3: More nodes or further spread
M - Metastasis
Whether cancer has spread to distant parts of the body:
- M0: No distant spread found
- M1: Distant spread (always stage IV)
The old code MX is no longer used. Why?
TNM to Stage: Rough Guide
Pick T, N and M values to see the stage group they usually fall into. This is a learning tool only — the real rules depend on the cancer type.
How Staging Is Done
Staging Tests and Procedures
Common Staging Workup
1. Physical Exam
Checking the tumor and nearby lymph nodes
2. Imaging Scans
CT, PET or MRI scans to look for the tumor and any spread
3. Biopsy
A tissue sample checked under the microscope — see biopsy
4. Blood Tests
Tumor markers and organ function tests
5. Surgical Staging
Looking directly at the tumor and nodes during surgery (if needed)
Types of Staging
- Clinical staging (cTNM): Based on exams, scans and biopsies before treatment
- Pathological staging (pTNM): Based on surgery and examining the removed tissue
- Post-treatment staging (ycTNM or ypTNM): After chemotherapy, radiation or other treatment given before surgery
Waiting for staging results can be hard. Staging often takes a few weeks, because several tests may be needed before your team can give you a complete picture. It is fine to ask your team what tests are planned and when you will get results.
Staging for Different Cancers
Each cancer type has its own staging rules. Some also use extra information, such as grade, blood markers or biomarkers, or use a different system altogether. Find staging details for your cancer:
Solid Tumors (TNM)
- Breast cancer staging (TNM plus grade and receptor status)
- Lung cancer staging (AJCC Version 9)
- Colorectal cancer staging
- Prostate cancer staging (TNM plus PSA and Grade Group)
- Stage 4 cancer: what it means
- Prognosis and survival rates explained
- Lung cancer
- Colorectal cancer
- Bladder cancer (includes stage 0a and 0is)
- Kidney, pancreatic, stomach and esophageal cancer
TNM Plus Extra Factors
- Prostate cancer: TNM plus PSA and Grade Group (Gleason)
- Melanoma: tumor thickness (Breslow) sets the T category
- Thyroid cancer: age at diagnosis also counts
- Testicular cancer: blood tumor markers are included
Gynecologic Cancers
FIGO staging, which closely matches TNM
- Ovarian cancer
- Cervical and endometrial (womb) cancer
Blood Cancers and Brain Tumors
- Lymphoma: Ann Arbor / Lugano stages I–IV
- Leukemia (CLL): Rai (0–IV) or Binet (A–C)
- Myeloma: ISS / R-ISS stages I–III
- Brain tumors: WHO grade 1–4 rather than stage
For how these systems compare with TNM, see TNM vs other staging systems.
What Your Stage Says About Outlook
In general, cancers found at an earlier stage have a better outlook than those found later. But stage is only one part of the picture, and survival numbers vary a lot between cancer types — so we do not give one set of figures for all cancers here. Cancer statistics are often reported using three broad groups:
Localized
Cancer is only in the place where it started. Mostly matches stages I and some II.
Regional
Cancer has spread to nearby tissue or lymph nodes. Mostly matches some stage II and stage III.
Distant
Cancer has spread to distant parts of the body. Matches stage IV.
For figures that apply to your situation, see the page for your cancer type and ask your care team, who can take your own details into account.
Things That Affect Outlook Besides Stage
- Cancer type and subtype
- Tumor grade and biomarkers (such as hormone receptors or gene changes)
- Your age and general health
- How the cancer responds to treatment
- Access to specialist care
Restaging and Recurrence
Your original stage stays the same on your record, even if the cancer later shrinks, grows or comes back. Doctors may stage the cancer again to:
- See how well treatment is working
- Plan more treatment
- Check a suspected recurrence
A new assessment is written with a prefix: y after treatment given before surgery (for example ypT1 N0), and r when cancer comes back (for example rT2 N1 M0). See TNM prefixes for more.
Types of Recurrence
- Local recurrence: Cancer comes back in the same place
- Regional recurrence: Cancer comes back in nearby lymph nodes or tissue
- Distant recurrence: Cancer comes back in distant organs (metastatic)
Frequently Asked Questions
Most cancers are staged from 0 to IV. Stage 0 means abnormal cells that have not spread. Stages I to III describe cancer that is still in its original area or nearby lymph nodes, with higher numbers meaning a larger cancer or more spread. Stage IV means the cancer has spread to distant parts of the body.
Yes. Doctors write stages with Roman numerals, so stage IV and stage 4 mean exactly the same thing: the cancer has spread to distant parts of the body.
No. Standard cancer staging stops at stage IV. If you see a 5 on a report, it is probably a grade, such as Grade Group 5 in prostate cancer, which describes how abnormal the cells look rather than how far the cancer has spread.
They split a stage into smaller groups. For example, stage III may be divided into IIIA, IIIB and IIIC. Within the same stage, A usually means less extensive disease than B or C. The exact meaning depends on the cancer type.
T (tumor), N (lymph nodes) and M (metastasis) are combined into one stage using a table for each cancer type. For example, T1 N0 M0 is usually stage I, and any cancer with M1 is stage IV. Our TNM staging page explains every code in detail.
The stage given at diagnosis stays on your record, even if the cancer later shrinks, grows or comes back. Doctors may stage it again to check the current situation, using the prefix y after treatment given before surgery or r for cancer that has come back.
In general, a higher stage means more advanced cancer and a less favorable outlook. But this is not always true for each person. Some stage IV cancers respond very well to treatment, and some early-stage cancers can be aggressive. Cancer type, grade, biomarkers and your general health all matter.
Stage describes the size of the cancer and how far it has spread. Grade describes how abnormal the cancer cells look under a microscope, which gives a clue to how fast they may grow. Both are important, but they tell you different things.
Most solid tumors use TNM staging. Blood cancers (leukemia, lymphoma and myeloma) and brain tumors use different systems, and gynecologic cancers often use FIGO stages, which closely match TNM.
Sometimes. Stage IV is usually treated mainly with medicines that work throughout the body, but surgery may be used to remove the main tumor, relieve symptoms, or remove a small number of areas of spread in certain situations. Your care team can tell you whether it is an option for you.
Related Resources
Medical Disclaimer: Staging information is general and may not apply to your situation. Always talk with your oncology team about your own stage and what it means for your treatment and outlook.