Lung cancer is the second most common cancer in men and women. There are two types: Non-small-cell lung cancer (NSCLC) and small-cell lung cancer. NSCLC is more common and mostly affects the cells on the surface of your lung's airways.
Early-stage NSCLC is when cancerous cells in your lungs haven’t spread through the body, says Heather Wakelee, MD, deputy director of the Stanford Cancer Institute.
Typically, early-stage cancer is easier to treat and your chances for survival are higher. Here’s what you need to know.
Types of NSCLC
Different kinds of cancer cells trigger NSCLC, and each looks different under a microscope. The cells also grow and spread in your body in different ways. Depending on the type, your doctor will come up with a treatment plan to target your specific type of cancer.
The most common types of NSCLC are:
Squamous cell carcinoma. It’s the cancer that forms in the thin, flat cells lining the inside of your lungs. This is also called epidermoid carcinoma.
Large cell carcinoma. Cancer that may begin in several types of large cells.
Adenocarcinoma: This type forms in the cells that line the alveoli, tiny air sacs in your lungs.
Other types include:
- Adenosquamous carcinoma
- Sarcomatoid carcinoma
- Salivary gland carcinoma
- Carcinoid tumor
- Unclassified carcinoma
What Are the Causes and Risk Factors?
A risk factor is anything that raises your chances of getting cancer. For NSCLC, risk factors can include:
- Smoking tobacco currently or in the past
- Secondhand smoke exposure
- Radon exposure
- Asbestos exposure
- Certain dietary supplements with beta-carotene
- Arsenic in drinking water
- Previous lung cancer diagnosis or lymphoma
- Air pollution
- Exposure to other cancer-causing chemicals like uranium, silica, and coal products
- COPD or pulmonary fibrosis
Experts are also looking at the link between smoking marijuana and lung cancer. Because marijuana smoke has tar and other cancer-causing chemicals just like cigarettes, it could up your risk for lung cancer.
Symptoms of NSCLC
If you have early-stage NSCLC, you may not have any symptoms or think something not as serious is causing them.
“There's a couple of ways that it's either usually found accidentally, like a patient has a scan for another reason -- maybe they were in a car accident,” says Conor Steuer, MD, an assistant professor in the department of hematology and medical oncology at Emory University School of Medicine.
NSCLC symptoms can include:
- A new cough or one that seems to be getting worse
- Coughing up blood or blood-stained mucus
- Pain in your chest, ribs, or shoulder
- A rough, scratchy throat or voice
- Weight loss
- Difficulty swallowing
- Swelling in your face or neck veins
- Lung infections like pneumonia or bronchitis that don’t get better or keep coming back
- A nodule spotted on an X-ray
If you notice any of these symptoms, let your doctor know as soon as possible.
How Is Early NSCLC Diagnosed?
Your doctor may recommend lab and imaging tests. If you have a history of smoking tobacco, you may also need regular lung cancer screening to detect the cancer early.
- Chest X-ray to check for abnormalities
- CT scan to show more clear and detailed pictures of your lungs
- MRI to show any changes in your chest wall, diaphragm, and lungs and surrounding areas
- PET scan to help your doctor find out exactly what type of cancerous cells are growing from your neck to thighs
If your doctor suspects lung cancer, they may do a biopsy. This involves taking a sample of the affected tissue or lymph node to check under a microscope.
For those who are high risk, doctors will recommend a lung cancer screening every year. You’re considered high risk if you:
- Have a 20 pack-year or more smoking history
- Smoke now or have quit within the past 15 years
- Are between 50 and 80 years old
- Have a nodule spotted on an X-ray
A pack year is the number of cigarette packs you smoke per day for 1 year. Talk to your doctor if you think you qualify for a yearly lung screening. Most insurance plans and Medicare can help pay for them.
How Is Early NSCLC Staged?
Your doctor will look at the tumor location and size in a process called staging. It’s an important step that helps the doctor figure out your treatment plan.
“The primary way that we stage tumors is with a CT scan, and a CT scan is actually going to accurately gauge the majority of patients who have lung cancer,” says Russell Hales, MD, director of the Thoracic Oncology Multidisciplinary Program at Johns Hopkins Medicine.
Your doctor will figure out the stage of your cancer using three key criteria called TNM:
- Tumor (T). How big is the tumor and where is it?
- Nodes (N). Is the cancer in nearby lymph nodes?
- Metastasis (M). How far has the cancer spread from its original spot?
- Stage 0: Cancer cells are in the lining of your airways.
- Stage I: A small tumor is in only one lung. The cancer hasn't spread to lymph nodes.
- Stage II: A large tumor is in one lung, or the cancer has spread to nearby lymph nodes.
- Stage III: Cancer in one lung has spread to farther lymph nodes or into nearby structures.
- Stage IV: Cancer has spread to both lungs, to fluid around the lungs, or to other parts of the body, such as bones and other organs.
Early-stage NSCLC usually includes stage I and stage II. And your doctor can subdivide these two based on the specific size and location of the tumor.
Stage I is usually divided into stage IA and IB. Stage II is subdivided into stage IIA and IIB.
Stage IA. The cancer is only in the tumor stage and has not spread to the lymph nodes. There are three types:
- Stage IA1: the tumor is 1 centimeter (cm) or smaller, or not very invasive
- Stage IA2: Larger than 1 cm but not larger than 2 cm
- Stage IA3: Larger than 2 cm but not larger than 3 cm
Stage IB. The tumor has one or more of these features:
- The tumor is larger than 3 cm but not larger than 4 cm.
- The tumor is found on the bronchus (the air passage that splits into the lung) and not larger than 4 cm.
- The tumor has grown into the pleura, which are the membranes surrounding your lung, and is less than 4 cm.
- The tumor is partially blocking the airway and is less than 4 cm.
Stage IIA. It has one out of the following four features and hasn’t spread to the lymph nodes:
- It is larger than 4 cm but not larger than 5 cm.
- It has grown on the bronchus and is more than 4 cm but less than 5 cm.
- The tumor has grown into the visceral pleura and is larger than 4 cm but not larger than 5 cm across.
- The tumor is partially blocking the airway and is more than 4 cm but less than 5 cm.
Stage IIB. It’s possible to have stage IIB if your tumor is less than 3 cm but has spread to the lymph nodes. The affected lymph nodes and cancer are on the same lung, and the cancer hasn’t spread to other parts of your body.
It’s also considered stage IIB if has spread to the lymph nodes and has one or more of the following:
- The tumor is larger than 3 cm but not larger than 5 cm across.
- It has grown into a main bronchus or the pleura and isn’t larger than 5 cm.
- It’s partially clogging the airways but isn’t larger than 5 cm.
If you have two or more tumors in the same lung but the cancer hasn’t spread to the lymph nodes, doctors will also stage this as stage IIB.
What Are the Treatment Options?
There are several. They include:
- Surgery to remove part of the affected lung
- Chemotherapy or radiation to kill cancer cells
- Targeted therapy to see if you have a specific gene that’s triggering your cancer
- Immunotherapy to help your immune system fight the cancer
Things to Be Aware Of
If you’ve been diagnosed with early NSCLC, the outlook is good and there are several options for treatment. But it’s important to stay on top of your follow-up screenings after you complete treatment. That’s because there’s always the chance of your lung cancer coming back.
Sometimes lung cancer comes back in the same place or shows up somewhere else in the body. If it does, it’s most likely to come back within 5 years of treatment. Hales says lifestyle changes like eating lots of fruits and vegetables and regular exercise may help keep this from happening.
“The No. 1 thing that a patient can do to improve their outcome is to stop smoking, and that's not only going to help them recover, but help them be more healthy,” Hales says. “It has been associated with a lower risk of recurrence, and it also may decrease the chance of the patient developing other primary lung cancers unrelated to the one that they initially had.”