How staging is used
Lung cancer is cancer that begins in the lungs. Cancer stages provide information on how big the primary tumor is and whether it has spread to local or distant parts of the body. Staging helps your doctor determine what type of treatment you need. And it helps you get a handle on what you’re facing.
The TNM staging system helps categorize key elements of the cancer as follows:
- T describes the size and other features of the tumor.
- N indicates if cancer has reached the lymph nodes.
- M tells if cancer has metastasized to other parts of the body.
Once the TNM categories are assigned, the overall stage can be determined. Lung cancer is staged from 0 to 4. Stage 1 is further divided into 1A and 1B.
If your TNM score is:
T1a, N0, M0: Your primary tumor is 2 centimeters (cm) or less (T1a). There is no lymph node involvement (N0) and no metastasis (M0). You have stage 1A lung cancer.
T1b, N0, M0: Your primary tumor is between 2 and 3 cm (T1b). There is no lymph node involvement (N0) and no metastasis (M0). You have stage 1A lung cancer.
T2a, N0, M0: Your primary tumor is between 3 and 5 cm. It may be growing into a main airway (bronchus) of your lung or the membrane that covers the lung (visceral pleura). Cancer may be partially blocking your airways (T2a). There is no lymph node involvement (N0) and no metastasis (M0). You have stage 1B lung cancer.
- Limited stage: Cancer is found on only one side of your chest.
- Extensive stage: Cancer has spread throughout your lung, on both sides of your chest, or to more distant sites.
What are the symptoms?
Stage 1 lung cancer usually doesn’t cause symptoms, but you may experience:
- shortness of breath
Later-stage lung cancer may lead to coughing up blood, wheezing, and chest pain, but that doesn’t usually happen in stage 1.
In addition to treating the lung cancer, your doctor can treat individual symptoms. There are a variety of medications to help control coughing.
In addition, there are 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.
- Practice meditation. 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 energy for the most important tasks, or ask someone else to pitch in when possible.
What treatment options are available?
Your treatment options depend on a number of factors, including:
- what type of lung cancer you have
- what genetic mutations are involved
- your general health, including other medical conditions
- your age
If you have non-small cell lung cancer
You’ll most likely need surgery to remove the cancerous part of your lung. This surgery may include removal of nearby lymph nodes to check for cancer cells. It’s possible that you won’t need any other treatment.
If you’re at high risk for 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. It’s usually given intravenously in cycles of three to four weeks.
If your body isn’t strong enough to withstand surgery, radiation therapy or radiofrequency ablation may be used as your primary treatment.
Radiation therapy uses high-energy X-rays to kill cancer cells. It’s a painless procedure usually given five days a week for several weeks.
Radiofrequency ablation uses high-energy radio waves to heat the tumor. Guided by imaging scans, a small probe is inserted through the skin and to the tumor. It can be performed under local anesthesia as an outpatient procedure.
Radiation therapy is also sometimes used as a secondary treatment to destroy cancer cells that may have been left behind after surgery.
Targeted drug therapies and immunotherapies are generally reserved for later-stage or recurrent lung cancer.
If you have small cell lung cancer
Treatment usually consists of chemotherapy and radiation therapy. Surgery may also be an option at this stage.
What’s the outlook?
Lung cancer is a life-threatening disease. Once you finish with treatment, it will take some time to fully recover. And you’ll still need regular checkups and follow-up testing to look for evidence of recurrence.
Early stage lung cancer has a better outlook than later stage lung cancer. But your individual outlook depends on many things, such as:
- the particular type of lung cancer, including which genetic mutations are involved
- whether you have other serious health conditions
- the treatments you choose and how well you respond to them
The five-year survival rate for stage 1A NSCLC is approximately 49 percent. The five-year survival rate for stage 1B NSCLC is about 45 percent. These figures are based on people diagnosed between 1998 and 2000 and include people who died from other causes.
The five-year relative survival rate for people with stage 1 SCLC is approximately 31 percent. This figure is based on people diagnosed between 1988 and 2001.
It’s worth noting that these statistics haven’t been updated to reflect people diagnosed more recently. Advances in treatment may have improved the overall outlook.
A 2015 study looked at more than 2,000 people diagnosed with lung cancer from 2002 to 2005. Up to 70 percent of those who were surgically treated for stage 1A were alive five years later. For stage 1, the probability of death in the first year after diagnosis was 2.7 percent.
Is recurrence likely?
Recurrence is cancer that comes back after you’ve had treatment and were considered to be cancer free.
Your doctor will schedule you for follow-up testing well after you finish treatment. In addition to physical examination, you might need periodic imaging tests and blood tests to monitor any changes.
You should also see your doctor if you experience any of the following symptoms of recurrence:
- new or worsening cough
- coughing up blood
- shortness of breath
- chest pain
- unexplained weight loss
Other symptoms depend 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.
What are my options for coping and support?
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. Ask about the goals of each treatment, as well as potential side effects and how to handle them. Be clear about your own wishes.
You don’t have to deal with lung cancer alone. Your family and friends probably want to be supportive but don’t always know how. That’s why they might say something like “let me know if you need anything.” So take them up on the offer with a specific request. This could be anything from accompanying you to an appointment to cooking a meal.
And, of course, don’t hesitate to reach out for additional support from social workers, therapists, clergy, or 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: