Understanding Stage 1 Lung Cancer

In stage 1 lung cancer, the primary (original) tumor is no larger than 4 centimeters (cm). In addition, the cancer cells have not spread to the lymph nodes or distant parts of the body (such as other organs).

The TNM system is used to help categorize lung cancer:

• T indicates the size and other features of the primary tumor.
• N indicates if the cancer has reached the lymph nodes.
• M indicates if the cancer has metastasized, or spread, to other parts of the body.

Once the TNM categories are assigned, the overall stage can be determined.

Stage 1 lung cancer is divided into four substages, according to the American Cancer Society (ACS):

• Stage 1A1. There are two scenarios where a doctor may diagnose stage 1A1 lung cancer:
  • The tumor is 1 cm or smaller.
  • The tumor is an adenocarcinoma, which originates in lung cells that make mucus. It’s 3 cm or smaller. No more than 0.5 cm of the adenocarcinoma has moved into deeper lung tissues.
• Stage 1A2. The tumor is between 1 and 2 cm.
• Stage 1A3. The tumor is between 2 and 3 cm.
• Stage 1B. A doctor will diagnose stage 1B lung cancer if at least one of the following statements applies:
  • The tumor is between 3 and 4 cm.
  • The tumor has grown into one of the two main bronchi (airways), but it’s at least 2 cm away from the carina (the cartilage that divides the bronchi). The tumor is no larger than 4 cm.
  • The tumor has grown into the visceral pleura, the membrane that covers the lung. The tumor is no larger than 4 cm.
  • The tumor is partially blocking the airways, but it’s no larger than 4 cm.

Stage 1 lung cancer does not usually cause symptoms.

If you experience any early symptoms, they may be mild and easy to ignore. In the early stages of lung cancer, symptoms can include:

• shortness of breath
• hoarseness
• coughing

Contact a doctor if you have any concerns. This is especially crucial if you smoke or have other risk factors for lung cancer.

Symptoms of advanced cancer

A 2021 report from the ACS states that most lung cancer cases in the United States are not diagnosed until the cancer is considered regional or distant. This occurs in stages 3 and 4, which is when symptoms typically become noticeable.

Symptoms of NSCLC can come on slowly for some people. According to a 2016 study, it can take 1 to 1.5 years for NSCLC to progress from the early to advanced stages in African Americans and Asian people. For white people, it can take under 1 year.

Later-stage lung cancer may lead to symptoms such as:

• coughing up blood
• wheezing
• chest pain
• unexplained weight loss

Lung cancer is a serious condition that can be challenging to diagnose in its earlier stages. However, researchers are working on more effective diagnostic tools to help detect lung cancer earlier. Early detection helps make treatment more effective.

The U.S. Preventive Services Task Force (USPSTF) recommends annual screening with a low dose CT scan for people who meet all of the following criteria:

• are between ages 50 and 80
• have a history of at least 20 pack-years, which are years in which they smoked an average of 20 cigarettes (or one pack) per day
• currently smoke or have quit in the last 15 years

A low dose CT scan exposes you to less radiation than a traditional CT scan. It’s also more accurate than a chest X-ray, which was previously used to help screen for lung cancer. Learn more about lung cancer screening.

The National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program tracks cancer statistics in the United States.

The SEER database does not group cancers according to the TNM system. Instead, it groups lung and bronchus cancers into these three stages:

• Localized. Cancer is limited to one lung.
• Regional. Cancer has moved from the lung to nearby lymph nodes or other nearby parts of the body.
• Distant. Cancer has spread to the other lung or other distant parts of the body.

Stage 1 lung cancer is considered localized. The 5-year relative survival rate, based on statistics from 2010 to 2016, is 63 percent for people with localized NSCLC.

The relative survival rate is used to compare people with the same cancer type and stage to people in the population at large. This means that people with localized NSCLC are, on average, 63 percent as likely as people without NSCLC to live for at least 5 years after their cancer diagnosis.

The three major forms of NSCLC are:

• adenocarcinomas
• squamous cell carcinomas
• large cell carcinomas

The relative survival rates are higher for people with adenocarcinomas than they are for people with squamous cell carcinomas and large cell carcinomas.

Your treatment options depend on a number of factors, including:

• the type of lung cancer you have
• which genetic mutations are involved
• your general health, including other medical conditions
• your age

Once you finish with treatment, it will take some time to fully recover. Afterward, you’ll still need regular checkups and follow-up testing so your doctor can look for evidence of recurrence. Recurrence is cancer that comes back after you’ve had treatment and were considered to be cancer-free.

Surgery

You’ll most likely need surgery to remove the cancerous part of your lung. This surgery may include removing nearby lymph nodes to check for cancer cells. It’s possible that you will not need any other treatment.

If you’re at high risk of recurrence, your doctor may recommend chemotherapy after surgery.

Chemotherapy involves the use of powerful drugs that can destroy cancer cells near the surgical site or those that may have broken free of the original tumor. For people with NSCLC, it’s usually administered intravenously (IV) in cycles of 3 to 4 weeks.

If surgery is not a suitable option for you, radiation therapy or radiofrequency ablation may be used as your primary treatment.

Radiation therapy

Radiation therapy uses high energy X-rays to kill cancer cells. It’s a painless procedure that’s typically performed 5 days a week for several weeks. Though it’s usually pain-free, there may be side effects. Your doctor can help you determine how to manage them.

Radiation therapy is also sometimes used as a secondary treatment to destroy cancer cells that may have been left behind after surgery.

Radiofrequency ablation

Radiofrequency ablation uses high energy radio waves to heat the tumor. Guided by imaging scans, a small probe is inserted through the skin and into the tumor. Radiofrequency ablation can be performed under local anesthesia as an outpatient procedure.

Did you know?

Targeted drug therapies and immunotherapies are generally reserved for later stage or recurrent (returning) lung cancer.

Symptom management

In addition to treating the lung cancer, your doctor can help treat individual symptoms. There are a variety of medications to help control coughing, such as cough syrups. Experts also recommend treating any underlying conditions that may be contributing to your cough.

There are also a few things you can do on your own when you feel short of breath:

• Change your positioning. Leaning forward makes it easier to breathe.
• Concentrate on your breathing. Focus on the muscles that control your diaphragm. Purse your lips and breathe in rhythm.
• Try to relax. Anxiety can add to the problem, so choose a relaxing activity such as listening to your favorite music or meditating to keep calm.
• Take a break. If you try to power through, you’ll overexert yourself and make matters worse. Save your energy for the most important tasks, or ask someone else to pitch in when possible.

A 2015 study out of Italy looked at rates of recurrence in people with various stages of lung cancer. The data was collected between 2002 and 2005.

The researchers found that about one-third of people with stage 1A or 1B lung cancer had a recurrence. Distant metastasis was more likely than local recurrence for all people from stages 1 to 4.

Your doctor will schedule follow-up testing for you well after you finish treatment. In addition to a physical examination, you might need periodic imaging tests and blood tests so your doctor can monitor any changes.

See your doctor if you experience any of the following symptoms of recurrence:

• hoarseness
• shortness of breath
• new or worsening cough
• coughing up blood
• wheezing
• chest pain
• unexplained weight loss

Other symptoms may appear depending on where the cancer has recurred. For example, bone pain could signal the presence of cancer in your bones. New headaches could mean that cancer has recurred in the brain.

If you’re experiencing new or unusual symptoms, tell your doctor right away.

You may find that you’re able to cope better if you take an active role in your own care. Partner with your doctor and stay informed.

You can ask about the goals of each treatment, as well as potential side effects and how to handle them. You can also ask about any potential clinical trials, as research is making strides. Be clear about your own wishes.

You do not have to deal with lung cancer alone. Your family and friends probably want to be supportive but do not always know how. That’s why they might say something like, “Let me know if you need anything.” Take them up on the offer by making a specific request. This could be anything from going with you to an appointment to cooking a meal.

Do not hesitate to reach out for additional support from:

• social workers
• therapists
• clergy
• support groups

Your oncologist or treatment center can refer you to resources in your area.

For more information about lung cancer support and resources, visit:

• American Cancer Society
• GO₂ Foundation for Lung Cancer
• LUNGevity Foundation
• Macmillan Cancer Support (United Kingdom)
• National Cancer Institute

You can also connect with people through forums and blogs.

Lung cancer can be a life threatening condition. However, early stage lung cancer, such as stage 1, has a better outlook than later stage lung cancer.

Early diagnosis is key, but it’s also difficult since lung cancer does not usually cause symptoms until it reaches its later stages.

If you’re at risk of lung cancer and you have symptoms associated with the condition, make an appointment with a doctor. The low dose CT scan is more effective at detecting early cancer than diagnostic tools used in the past.