This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science
This page was updated on April 29, 2022.
Stage 3 cancer is sometimes referred to as locally advanced cancer. It occurs when cancer has grown or spread locally, but has not been found in distant locations.
Stage 3 cancer is more advanced than stage 2 because either the tumor is larger or the cancer has spread to lymph nodes or nearby tissue.
Patients whose cancer has advanced to stage 3 may consider a second opinion to confirm their diagnosis and explore new treatment options.
Stage 3 cancer is considered advanced. In this stage, the tumor may have grown to a specific size, the cancer may consist of multiple tumors, and/or the cancer may have spread to adjacent lymph nodes, organs or tissue. In some cases, stage 3 cancers may be considered metastatic cancers, meaning they may have spread beyond their organ of origin.
Many stage 3 cancers have multiple subcategories, usually designated as stages 3A, 3B and 3C. These subcategories are often determined by the size of the tumors, whether multiple tumors are present and the degree to which the cancer has spread locally.
Liquid cancers, or blood cancers, such as leukemia, lymphoma or multiple myeloma, are staged differently than most other cancers because they may not always form solid tumors. Liquid cancers may be staged by a variety of factors, including:
In stage 3 breast cancer, the tumor may also be quite large at this stage, possibly extending to the chest wall and/or the skin of the breast. Cancer cells may be found in nearby lymph nodes.
In stage 3 lung cancer, the cancer has spread from the lungs to the lymph nodes and/or to nearby structures and organs, such as the heart, trachea and esophagus.
The cancer is in tissues near the prostate. It also may have reached the seminal vesicles, the glands that secrete components of semen.
The cancer has grown into the intestine wall and may have entered the muscle. The cancer may have spread to nearby lymph nodes and/or into nearby organs or tissues.
The cancer cells have spread to nearby lymph nodes, but not to distant organs.
Grade 3 and stage 3 cancer are not the same. Staging and grading cancer use different criteria to evaluate treatment options.
Staging is an important factor in determining cancer treatment options, since it establishes the tumor’s size and spread within the body. Staging is used for most cancers, but not all. Cancers in and near the brain, for example, don’t use a defined staging system because their likelihood of spreading is low.
In general, cancer falls within stages 1 through 4. Some types may be stage 0, meaning there are cancerous cells in a layer of tissue, but they haven’t grown or spread.
Most cancers are staged using some form of the TNM system. Doctors may also use the TNM system to help determine the extent of certain cancers in each stage. The TNM system stands for:
Some cancers, especially liquid cancers, are staged using different established protocols. The Binet and Rai systems, for example, are used to stage certain types of leukemia. Cancers of the female reproductive system, such as cervical cancer and ovarian cancer, are staged using the FIGO staging system, designed by the International Federation of Gynecology and Obstetrics (FIGO).
Regardless of the system used, the first step for doctors staging cancer is to gather information about it. Some tests or procedures that may be involved as the care team is staging the patient's cancer include:
Grading is sometimes also a part of the staging process, depending on the type of cancer. Staging indicates the extent of the cancer. Grading, on the other hand, looks at the cancer cells specifically and uses them as clues to predict the cancer’s pace of growth. Low-grade tumors tend to grow slowly, and high-grade tumors tend to grow more rapidly. Grading especially informs treatment options in breast cancer, prostate cancer and brain tumors.
After a tumor biopsy or surgery, a sample of the cancerous tissue is sent to a lab. If cancer cells are found, a pathologist compares them to normal tissue cells. If they look similar, the cancer is low-grade. If they structurally appear very different, the tumor is high-grade. Sometimes, the pathologist won’t be able to determine the grade. Other times, the grade may be right in the middle (intermediate)—neither low nor high. The cancer grade is part of how the care team stages cancer and determines the patient's prognosis.
When it comes to grading, tumors generally may be referenced in the following ways.
Cancers of the central nervous system (CNS) are graded rather than staged. Grade 3 brain and spinal cancers are considered fast-growing and may have invaded nearby tissues.
In general, regimens for stage 3 cancers typically start with either surgery or treatment to shrink the tumor before surgery, such as chemotherapy, radiation, or a combination of both.
The first step is typically either chemotherapy or surgery.
Called neoadjuvant chemotherapy, because it’s given before other treatment, this may help shrink a tumor enough that breast-conserving surgery (BCS) is possible. If it doesn’t shrink enough, the patient may need a mastectomy (removal of full breast) instead. HER2-positive cancers may also be treated with targeted drugs before surgery.
After surgery, depending on the type of breast cancer, treatment may continue with radiation. Chemotherapy and/or targeted drugs may be part of the patient's treatment plan after surgery as well.
This is highly dependent on how large the tumor is and which lymph nodes are affected. Generally, treatment begins with chemotherapy and/or radiation. The patient may have chemotherapy and radiation at the same time, or may have them one after another. Surgery may follow this treatment if the care team thinks the remaining cancer may be successfully removed. After surgery, additional chemotherapy and/or radiation may be part of the treatment plan.
If chemotherapy, radiation or surgery aren’t appropriate options, immunotherapy drugs may be.
The approach for stage 3 prostate cancer tends to be radiation therapy and hormone therapy. In some cases, surgery may be an option, with radiation and/or hormone therapy afterward. Clinical trials may also be an option.
People who are older or have complex health problems may opt to only have hormone therapy or radiation therapy as a less aggressive treatment option. Even with stage 3 prostate cancer, holding off on treatment and sticking with regular observation may be an option sometimes.
Stage 3 colon cancer is most commonly treated with surgery to remove the cancer and repair the colon, followed by chemotherapy. Ask the care team about any appropriate clinical trials.
Treatment for stage 3 rectal cancer is most often the opposite: It begins with chemotherapy and radiation at the same time (chemoradiation) to shrink the cancer and prepare for a successful surgery. Once the cancer is removed through surgery, about six months of chemotherapy typically follows.
First-line treatment for stage 3 melanoma tends to be surgery. Since stage 3 melanoma involves cancer spreading into the lymph nodes, surgery removes the primary tumor itself, any “in-transit” tumors under the skin and the affected lymph nodes. Afterward, radiation, targeted therapy or immunotherapy may be options that the care team recommend to lower the chance of recurrence.
For melanoma that cannot be removed with surgery, treatment options include immunotherapy, targeted therapy and chemotherapy. Clinical trials may also be an option.
Cancer survival rates are projected using several criteria, including:
The patient's care team will provide a prognosis after evaluating these factors. Many patients with stage 3 cancer live for years.
Patients may be overwhelmed with organizations offering support, or may be confused about eligibility or how to enroll. Though some of these support options happen outside of the care team’s facility, speak openly with them about what kind of support is needed and any questions to start.
Stay connected with the care team: The care team knows the patient and the battle ahead. They also know which resources have been helpful for other patients, and which resources they may be able to offer. They know that factors such as stress, nutrition and sleeping problems affect the patient's health. They’re there to help patients get what they need.
Lean on friends and family: Interactions with friends and family may be different when a cancer diagnosis is involved. Odds are that the patient's support system wants to help, but they may not know how to help unless the patient shares that information. Don’t be afraid to ask for help, whether it’s company on the ride to an appointment or help with household chores.
Look for support groups: Patients with stage 3 cancer are joining a host of others who have walked a similar path. Participating in a support group may help patients feel more connected and understood. The American Cancer Society has tools to help patients find resources for cancer support.
