Stage II Non-Small-Cell Lung Cancer: What to Know

Medically Reviewed by Paul Boyce, MD on November 04, 2023
Written by Maya Kroth
5 min read

Stage II lung cancer is when your doctor finds one or more tumors, but only in one lung. The cancer may or may not have spread to the nearest lymph nodes. But it hasn’t reached distant sites like your bones or other organs.

Depending on the size of your tumor and the location of any affected lymph nodes, your cancer can be either localized or regional. Doctors often can remove stage II cancer with surgery.

Some 85% of lung cancers are non-small-cell lung cancers (NSCLC). A rarer but more aggressive kind is called small-cell lung cancer. The numbered stages are used mostly with the more common NSCLC.

Doctors divide stage II lung cancer into two more detailed subtypes. The evaluation relies on three main criteria, called TNM:

  • Tumor (how big and where it is)
  • Nodes (Is the cancer in nearby lymph nodes?)
  • Metastasis (how far the cancer has spread to other parts of the body)

Stage IIA. The cancer is only in your lung. The tumor is bigger than 4 centimeters (about the size of a walnut) but not larger than 5 centimeters (the size of a lime). In addition, one or more of the following are true:

  • Your cancer is in your main airway (bronchus).
  • The cancer is in the membrane that covers your lung.
  • Part of all of your lung has collapsed.
  • Your lung is inflamed (pneumonitis).

Stage IIB. This is the more advanced phase of stage II. It’s defined a couple of different ways. Your tumor may still be no bigger than 5 centimeters. But the cancer also may be in your lymph nodes near your lung or your airway. Or, your tumor hasn’t spread to your lymph nodes. But your doctors find one of the following:

  • Your tumor size ranges from larger than 5 centimeters to 7 centimeters.
  • You have more than one tumor in the same area (lobe) of the lung as your main tumor.
  • The cancer has reached your chest wall or its membranes, or the nerves connected to your diaphragm, or the outer layer of the sac around your heart.

 

Most lung cancers are not diagnosed until they’re past stage II. That’s partly because this cancer grows fast and because you may not notice any signs until the disease turns serious. But symptoms may include:

Some stage II lung cancer is detected through routine chest imaging. More likely, your doctor may check for it after you reported symptoms. If so, you may get such tests as:

Chest X-ray. This is often the first image test. If it suggests you have cancer, you’ll have follow-up tests, including one or more scans:

Chest tests. Several procedures can check to see if your cancer has spread to your chest. The findings can help your doctors decide how best to treat it. Imaging tests include:

  • Endobronchial ultrasound. This uses sound waves to make a picture of the inside of your body.
  • Endoscopic esophageal ultrasound. Your doctor threads a lighted scope through your throat to peer inside.

Mediastinoscopy and mediastinotomy. Your surgeon makes a small cut on your body to insert an instrument to get tissue samples.

Biopsy. A doctor will examine a sample of your tissue under a microscope to confirm if it’s cancer.

If you’re healthy enough, your doctor probably will want to remove your cancer with surgery. They may take out a small slice of tissue, or the whole lung. If the cancer might be in your lymph nodes, surgeons will remove those, too.

You may need other treatments before or after your operation:

  • Chemotherapy. These drugs help shrink your tumor before surgery and kill any cancer cells that might be left afterward.
  • Radiation. This therapy uses a machine to beam high-energy rays at your cancer cells from outside your body. You might get it if surgery isn’t a good option for you. You also might get radiation after your surgery to zap any remaining cancer.

More than half of the people diagnosed with stage II live 5 years or longer. Specifically, the 5-year survival rate is 30-55% for stage IIA/IIB.

Your cancer may never go away completely. If your first treatment didn’t destroy all of it, you may have to come back for more chemo and/or radiation.

If your doctor sees no sign of cancer, you’ll likely get a CT scan every 6-12 months for the first 2 years, then once a year after that. It’s important to stay on top of your appointments and get all the tests your doctor orders.

Learning that you have cancer can be tough news to bear. But better treatments are helping people live longer than ever. You can take steps to stay strong mentally and physically. Try and:

Quit smoking. You can get lung cancer even if you’ve never smoked. But many have or still do smoke. Stopping even today can help you better handle your treatments.

Eat well, stay active, and limit alcohol. Get lots of fresh vegetables and fruits and lean proteins to keep you weight up. Exercise or just get out as much as you can. It may help lower your chances of depression. Drink no more than a glass of alcohol a day if you’re a woman and two if you’re a man.

Find support. Reach out to friends and family for emotional, practical, and other types of help. Or talk to a mental health therapist, a medical social worker, someone from your faith institution, or other trained professionals.

Connect with others. People who have cancer may understand what you’re going through in a way that that’s harder for others. Join a cancer support group, either in person or online. The American Cancer Society has a searchable directory of groups and programs in your area. You can look up free or reduced-fee transportation, wigs, and other support.