Non-Small-Cell Lung Cancer: Treatment by Stage

After your lung cancer is diagnosed, the doctor will run tests to find out the size of the tumor and whether the cancer has spread to other parts of the body. This process is called staging. Knowing the stage of your disease is crucial because it will help you and your doctor choose the best course of treatment.

Here’s a look at the options for each stage. Keep in mind that no one can say for sure how your cancer will respond. Every person is different, and so is every cancer. Your doctor will make changes along the way to find what works best.

STAGE 0

How It’s Defined

The cancer is only in the lining of your airways.

Treatments

Surgery: If your health is good overall, surgery is probably all you need. Depending on where the tumor is, your surgeon will suggest one of these procedures:

  • Wedge resection: Cut out the tumor and a small amount of normal lung tissue
  • Segmental resection (segmentectomy): Take out the part of the lung where the tumor is located.
  • Sleeve resection: Remove a lobe of the lung and a part of the airway.
  • Lobectomy: Cut out an entire lobe of the lung. (The right lung is divided into three lobes; the left lung has two lobes.) Most surgeons prefer this option since it offers the best chance for cure.
  • Pneumonectomy: Take out the entire lung. This might sound extreme, but you can live a normal life with only one lung.

Photodynamic therapy (PDT): This process uses a drug called a photosensitizer and a certain type of light to create a form of oxygen that kills nearby cells. It can help shrink tumors without the side effects of other drugs. If you have stage 0 cancer, this could cure it.

Brachytherapy: This involves planting radioactive pellets into the cancer or a nearby airway. The implant can be short-term or permanent. If that’s the option, don’t worry -- the radiation will weaken over time. This too, can sometimes cure stage 0 cancer.

STAGE I

How It’s Defined

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In stage 1A, the tumor is no larger than 3 centimeters (about 1 1/4 inches) across and hasn’t spread to any other tissues or lymph nodes. In stage 1B, it's 3-5 centimeters and has spread to the main bronchus or the lung's lining, or both.

Treatment Options

Surgery: If you’re in good health, surgery may be all you need. Based on the tumor’s size and placement and how well your lungs work, your surgeon may suggest one of these procedures.

  • Sleeve resection
  • Segmentectomy or wedge resection (for tumors smaller than 2 centimeters across)
  • Lobectomy

Chemotherapy: With any of these surgeries, nearby lymph nodes are also removed to see if the cancer has spread. If your medical team feels your cancer could come back, they’ll probably suggest you get chemo after surgery to destroy any leftover cancer cells. You might hear this called adjuvant chemotherapy. You could take a chemo drug by mouth or get it in a vein.

Radiation: If you’re not healthy enough for surgery, your doctor may go with this therapy. It uses powerful, high-energy X-rays to kill cancer cells. You may hear the doctor call it external radiation.

STAGE II

How It’s Defined

The tumor is between 3 and 7 centimeters across, or it has spread to your lymph nodes, or both.

Treatment Options

Chemotherapy: Your doctor may want to do chemo (sometimes paired with radiation) before surgery to shrink the tumor. He might call this neoadjuvant chemotherapy. Even if your doctor doesn’t find cancer cells during surgery, he might suggest chemo afterward just in case cancer cells were left behind.

Surgery: If you’re healthy enough, the doctor will likely recommend one of the following:

  • Lobectomy
  • Sleeve resection
  • Pneumonectomy

After surgery, your doctor will check the tissue he removed for cancer cells at the edges. If so, you may need another operation to remove more cancer cells.

Radiation: If you’re not healthy enough for surgery, you may get radiation instead.

STAGE III

How It’s Defined

Cancer is found in the lung and in the lymph nodes in the middle of the chest. Stage III has two subtypes:

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STAGE IIIA

How It’s Defined

If the cancer has spread only to lymph nodes on the same side of the chest where it began, it’s called stage IIIA.

Treatment Options

Chemotherapy and radiation: If you can stand the side effects, treatment usually starts with chemo. It might be combined with radiation.

Surgery: If you’re healthy enough and your doctor thinks there’s a good chance he can remove any cancer that remains, he may suggest surgery. In some cases, it may be his first choice of treatment. It’s often followed by chemotherapy and sometimes radiation. The type of surgery depends on size and location of the tumor, how far the cancer has spread into the lymph nodes, and whether you’ve had surgery before.

STAGE IIIB

How It’s Defined

The cancer has spread to lymph nodes near the opposite lung or in your neck. These cancers can’t be completely removed by surgery.

Treatment Options

Chemotherapy with radiation: Again, treatment depends on your overall health and how you can handle the treatments. If you’re in fairly good health, chemo and radiation might improve your condition.

Radiation or chemotherapy: If you can’t handle the combo treatment, you’ll probably get radiation therapy alone. Chemo by itself is less common.

Clinical trials: These cancers can be difficult to treat, so you may want to think about taking part in a clinical trial of newer treatments.

STAGE IV

How It’s Defined

The cancer has spread to both lungs, to fluid in the area surrounding the lungs, or to other organs.

Treatment Options:

Chemotherapy and radiation: A cancer that’s spread to distant sites in your body can be hard to cure. As long as you’re in fairly good health and can handle the side effects, treatments like chemotherapy and radiation can ease your symptoms and help you live longer.

Targeted therapy: A test can tell your doctor if your cancer will respond to one of these new treatments. These drugs only attack cancer cells and do little damage to healthy cells nearby. They don’t work for everyone, and some are still in trial phase and not on the market yet. If there’s one that might work for you, your doctor can help you find out more about how to get into a clinical trial.

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Photodynamic therapy: Doctors use light to kill cancer cells and shrink tumors.

Stent: Lung tumors that have grown into an airway can cause trouble breathing or other problems. Your doctor inserts a hard silicone or metal tube called a stent into the airway to hold it open.

WebMD Medical Reference Reviewed by William Blahd, MD on May 31, 2016

Sources

SOURCES:

American Cancer Society: “How is non-small cell lung cancer staged?”

American Cancer Society: “Surgery for non-small cell lung cancer.”

The Society of Thoracic Surgeons: “Lung/Thoracic Surgery.”

American Cancer Society: “Treatment choices by stage for non-small cell lung cancer.”

Penn Medicine: “Photodynamic Therapy (PDT).”

American Cancer Society: “Radiation therapy for non-small cell lung cancer.”

McElnay, P. Journal of Thoracic Disease, May 6, 2014.

UpToDate: “Patient Information: Non-small cell lung cancer treatment; Stage I to III cancer (Beyond the Basics)."

American Cancer Society: “Targeted Therapies for non-small cell lung cancer.”

National Cancer Institute: “General Information About Non-Small Cell Lung Cancer (NSCLC)," "NCI Dictionary of Cancer Terms."

Annals of Thoracic Medicine: “Bronchial Stents.”

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