Overview of the Stages of Non-Small Cell Lung Cancer

If non-small cell lung cancer (NSCLC) is detected early enough, it can usually be treated successfully with surgery. If the disease moves outside your lungs (i.e. metastasizes), and spreads to other areas of your body, other forms of treatment will become necessary. These include radiation therapy, chemotherapy, and in some cases, drugs undergoing clinical trials.

The size of the tumor, and the extent to which it has metastasized is defined by stages. These stages offer a reliable gauge of your chances of survival. Below, we’ll explain the staging of non-small cell lung cancer, and describe the characteristics of each stage. We’ll also provide details regarding available forms of treatment along the way.

Stage 0 (Zero)

This stage is called “carcinoma in situ,” and is defined by abnormal cells that have developed in the air passages. It is not technically known whether the cells will evolve into cancer. However, following their detection, they are usually treated as such.

NSCLC is rarely caught this early because there are no noticeable symptoms. The abnormal cells are usually detected by accident during a routine examination. Following diagnosis, a wedge resection can usually be performed to address the disease.

Stage I

By this point, the abnormal cells have evolved into lung cancer, but remain localized to the lungs. It has not yet metastasized. If the tumor measures 3 centimeters or less, the disease is defined as Stage IA. If it is larger (though smaller than 5 centimeters), it is considered in Stage IB.

When symptoms present, they usually include a cough, bouts of pneumonia, and persistent fatigue. Surgery can be used in most cases to address the condition. In some surgical centers, a noninvasive form of lung cancer treatment called VATS (video-assisted thoracoscopic surgery) can be performed.

Stage II

When the cancer has spread to the lymph nodes or the main bronchus, the disease is said to be in Stage II. Here, again, staging is split into two phases, each categorized by size. In Stage IIA, the tumor is 3 centimeters or less. In Stage IIB, it is between 3 and 5 centimeters.

NSCLC usually presents coughing (often accompanied by blood), chest pain, difficulty breathing, and recurring infections. It is still possible to cure the disease through surgery, though your doctor may also recommend chemotherapy. If the tumor’s position precludes surgery, chemotherapy may be combined with radiation therapy.

Stage III

By this stage, metastasis has resulted in the disease spreading outside the lungs. Staging is once again defined in two phases, though tumor size is no longer a factor. Stage IIIA is characterized by tumors that have reached distant lymph nodes near the chest bone. It may have also spread to the bronchus and chest wall. In stage IIIB, the cancer might have invaded the heart, trachea, and esophagus.

Symptoms during stage IIIA are the same as those during the previous stage, though they are generally more pronounced. By stage IIIB, the disease may cause hoarseness, and make it difficult to swallow.

Lung cancer surgery is often done in IIIA, but as an adjunct treatment to chemotherapy. In IIIB, the disease is considered “inoperable,” which means surgery alone cannot eliminate it. Chemotherapy and radiation therapy are administered, and drugs in clinical trials are usually considered.

Stage IV

This is the last stage of non-small cell lung cancer. By this point, the disease may have spread to the brain, kidneys, liver, or other organs, including the opposite lung. Symptoms are similar to previous stages, but are now more pronounced and in the case of pain, has spread to other areas of the body. Loss of appetite and weight loss are common.

Surgery can usually be performed to remove tumors from the lungs, but chemotherapy is the primary form of treatment. Radiation therapy can also be used, but its usefulness is limited.

Because treatment for non-small cell lung cancer is governed by the size of the tumor (in early stages) and the disease’s spread, staging is critical. If you notice any of the symptoms described above, consult your physician.

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