Non-Small Cell Lung Cancer - Staging Systems

Treatment Options by Stages

Occult Stage

In the occult stage (TX, N0, M0), cancer cells are found in a sample of a patient's coughed-up sputum, but no cancer cells have yet been detected in the lung.

Treatment Options. Surgically removing the tumor (if one can be located) can allow doctors to identify the stage, and often results in a cure.

Stage 0 or Carcinoma in Situ

Stage 0 or carcinoma in situ (Tis, N0, M0) are noninvasive cancers. Only a few layers of cancer cells are detected within one local area. The cancer has not grown through to the top lining in the lung and can be surgically removed. There is a high risk for development of a second tumor, however.

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Treatment Options:

• Surgery, often a limited procedure, where only part of a lobe is removed from the lung.
• In patients who cannot be treated surgically, consider photodynamic therapy, cryotherapy, or brachytherapy (discussed below).

Stage I

In stage I, the cancer has reached the higher layers of the lung but has not spread into the lymph nodes or beyond the lung.

General Treatment Options. The primary treatment is surgery, such as lobectomy, if possible. Patients with poor lung function should have partial lobectomy, if possible. Radiation treatments may be appropriate and beneficial for patients who cannot have surgery. It is not clear if early-stage lung cancer patients who have radiation or chemotherapy in addition to surgery have higher survival rates.

The overall 5-year survival rates for early stage-cancer are around 70% for stage IA and close to 60% for stage IB. Patients should consider clinical trials to prevent cancer from returning after the initial treatment. The risk for recurrence is highest in patients who continue to smoke.

Treatment for stage IA and IB lung cancer includes:

• Lobectomy (removal of a whole lobe) or sometimes pneumonectomy (removal of one lung).
• Wedge or segment removal, particularly in patients with poor lung function who cannot handle lobectomy.
• Radiation in selected patients who would not tolerate having surgery or whose cancer is cannot be fully removed.
• In general, chemotherapy is not done following surgery unless the tumor is not completely removed.