Non-Small Cell Lung Cancer - Staging Systems

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Stage II

In stage II the cancer cells have spread to nearby lymph nodes.

General Treatment Options. Surgery, usually removal of a lobe (lobectomy) or one lung (pneumonectomy), is the treatment of choice. Radiation treatment after surgery does not seem to improve survival.

If the tumor is completely removed, radiation therapy is usually not performed after surgery. Patients whose cancer is inoperable may consider radiation and chemotherapy treatments.

Patients who do well after surgical removal of the tumor often receive a platinum-based chemotherapy regimen.

In patients who can complete treatment, 5-year survival rates average around 45% for stage IIA and around 35% for stage IIB.

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Stage III

In stage III, the cancer cells have spread beyond the lung to the chest wall, diaphragm, or further lymph nodes, such as those in the neck.

General Treatment Options. Generally, the treatment options for stage III tumors are:

• Surgery, if the tumor and affected lympth nodes can be completely removed.
• Consider chemotherapy or radiation therapy before or after surgery.
• Consider clinical trials using advanced radiation techniques, including continuous hyperfractionated accelerated radiation, or 3-D conformal radiation (discussed below).
• Consider other clinical trials, including those of various combination treatments, preventive radiation therapy to the brain and new drugs.

Combination approaches may be significantly more effective than single treatments.

Stage IIIA (T1, N2, M0) or (T2, N2, M0) or (T3, N1, M0) or (T3, N2, M0).

Researchers have confirmed good survival rates with resection after chemotherapy and radiation therapy.

Stage IIIB (Any T, N3, M0) or (T4, Any N, M0). Some patients may consider surgery if the lymph nodes are not involved (T4, N0), and the tumor can be removed. Surgery is not an option for other patients with stage IIIB cancer.

Stage IV

In stage IV (any T, any N, M1), the cancer has spread (metastasized) to other parts of the body.

Treatment Options.

• Combination of two- or three-drug chemotherapies that include platinum-based drugs and newer drugs; the best candidates are patients in otherwise good health, who have a limited number of distant tumors. Chemotherapy is not recommended for patients who are too ill.
• Bevacizumab (Avastin) may be used for patients with non-squamous lung cancer, no spread to the brain, and who are not coughing up blood.
• External-beam radiation for symptom relief
• Paclitaxel, gemcitabine, or docetaxel are all additional drug options
• Other clinical trials
• If metastasized cancer involves only one to four areas in the brain under 4 cm, it may respond to stereotactic radiosurgery (an outpatient procedure without anesthesia) followed by radiation to the brain. Larger tumors are candidates for resection with radiation therapy.