Non-Small Cell Lung Cancer

Description

Alternative Names

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. Surgical removal of the tumor, if one can be located, allows identification of its stage and often results in cure.

Stage 0 or Carcinoma in Situ

Stage 0 or carcinoma in situ (Tis, N0, M0) are noninvasive cancers and 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.

Treatment Options. Surgery, often a limited procedure (wedgectomy or segmentectomy). In patients who cannot be treated surgically consider photodynamic therapy, cryotherapy, or brachytherapy.

Stage I

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

General Treatment Options. Primary treatment is surgery, such as lobectomy (removal of a whole lobe), if possible. Patients with poor lung function should undergo partial lobectomy (wedge or bronchopulmonary segment) if possible. Radiotherapy may be appropriate and beneficial for patients who cannot have surgery. It has not been clear if early-stage lung cancer patients who supplement their surgical treatment with radiation or chemotherapy have higher survival rates. In fact, a 2002 analysis suggested that the use of radiotherapy after surgery in patients whose tumors had been completely removed might be associated with reduced survival rates. An analysis of studies using chemotherapy in addition to surgery or radiotherapy, however, indicated positive benefits on survival. Overall five-year survival rates for early stage-cancer are in the range of 30% to 50%. Clinical trials should be considered for prevention of recurring cancer after primary treatment. The risk for recurrence is highest in patients who continue to smoke

• Stage IA (T1, N0, M0). The five-year survival rates for stage IA patients after successful treatment can be as high as 80%. 1. Lobectomy or sometimes pneumonectomy (removal of one lung). Wedge or segment resection may be appropriate, particularly in patients with poor lung function who cannot withstand lobectomy. 2. Radiation, even with intent to cure, in selected patients whose condition is inoperable (e.g., older patients with T1 tumors). Five-year survival rates can be equal to those from surgery, between 32% and 60%. 3. Clinical trials of adjuvant chemotherapy following surgery.
• Stage 1B (T2, N0, M0). Stage IB survival rates after treatment can be better than 60%. 1. Lobectomy or sometimes pneumonectomy. Wedge or segment resection may be appropriate, particularly patients with poor lung function. 2. Clinical trials of adjuvant chemotherapy following surgery. 3. Clinical trials of chemotherapy before surgery (induction therapy). (Studies are promising.) 4. Clinical trials for radiation, even with intent to cure, in selected patients whose condition is inoperable. 5. Clinical trials of chemotherapy before, after, or during radiation treatments.

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. Five-year survival rates associated with stage II surgery can vary. A 2000 literature review places the numbers as high as 40% to 50%, but notes that they can drop to 25% and below if it has spread beyond the immediate lymph nodes. Patients whose cancer is inoperable may consider radiation treatments. In appropriate candidates who can complete treatment, five-year survival rates average 20% to 30%, with higher rates for IIA. Clinical trials should be considered for prevention of recurring cancer after primary treatment. To date, however, supplementing surgical treatment with radiation or chemotherapy does not appear to prolong survival rates.

• Stage IIA (T1, N1, M0). Survival rates can be as high as 60%. 1. Surgery. 2. Radiation with intent to cure in selected patients. 3. Clinical trials of postoperative (adjuvant) chemotherapy. 4. Clinical trials of chemotherapy before, after, or during radiation treatments. 5. Clinical trials of chemotherapy (induction therapy) to reduce tumor size before surgery.
• Stage IIB (T2, N1, M0) or (T3, N0, M0). Survival rates can be over 40%. 1. Surgery. 2. Radiation with intent to cure in selected patients. 3. Clinical trials of postoperative (adjuvant) chemotherapy. 4. Clinical trials of chemotherapy before surgery (induction therapy) 5. Clinical trials of chemotherapy before, after, or concurrent with radiation treatments.

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, stage III tumors are treated with radiation and sometimes with surgery, chemotherapy, or combinations of each. Combination approaches may be significantly more effective than single treatments. For example, of particular interest is a treatment approach that uses initial concurrent chemotherapy and radiation followed by surgery. In one study five-year survival in stage III patients was nearly 50%.

• Stage IIIA (T1, N2, M0) or (T2, N2, M0) or (T3, N1, M0) or (T3, N2, M0). 1. Surgery is considered if tumor and affected lymph nodes can be completely removed. Consider adjuvant platinum-based chemotherapy or radiation therapy afterward. 2. Concurrent radiation treatment plus platinum-based chemotherapy for those in otherwise good health followed by surgery, if possible. 3. Clinical trials using advanced radiation techniques, including continuous hyperfractionated accelerated or 3-D conformal radiation 4. Other clinical trials of various multimodal therapies, preventive radiation therapy to the brain, other second-line agents, and many other approaches and investigational agents.
• Stage IIIB (Any T, N3, M0) or (T4, Any N, M0). Some patients may consider surgery if there is no lymph node involvement (T4, N0) and tumor can be removed. Other IIIB patients cannot be treated surgically. 1. Radiation alone, usually for symptom control. It may improve survival in certain patients, such as those with node involvement above the clavicle. 2. Chemotherapy alone. 3. Concurrent cisplatin-based chemotherapies plus radiation, sometimes followed by surgery if possible. 4. Clinical trials using induction chemotherapy alone to reduce tumors, which may then be treated with surgery or radiation. 5. Clinical trials using advanced radiation techniques, including continuous hyperfractionated accelerated or 3-D conformal radiation. 6. Other clinical trials of various multimodal therapies, preventive radiation therapy to the brain, other second-line agents, and many other approaches and investigational agents.

Stage IV

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

Treatment Options. 1. Combination of two- or three-drug chemotherapies that include platinum-based and newer agents. Best patient candidates are those in otherwise good health who have a limited number of distant metastasized sites. Chemotherapy not recommended for patients with poor performance scores. 2. External-beam radiation for symptoms. 3. Paclitaxel or gemcitabine as a single agent. 5. Other clinical trials. 6. If metastasized cancer involves only one or two areas in the brain, it may respond to surgical resection followed by radiation to the brain.

Recurring or Additional New Tumors

Recurring or additional new tumors occur in half of treated patients, usually again in the lung. Research indicates that a solitary tumor in the lung is more often a new tumor that, in many cases, may be operable.

Treatment Options. 1. Radiation for symptom control. 2. Chemotherapy. 3. If metastasized cancer strikes only one site and in the brain, it may be treated surgically and with postoperative whole-brain radiation. Prolonged disease-free survival is possible. If not operable, the brain tumor is treated with radiation. Even if cancer returns in the brain (in 50% of cases), retreatment is possible in many patients if the disease has not metastasized elsewhere. 4. Laser therapy or interstitial radiation for tumors within the airways. 5. Stereotactic radiosurgery (in a few selected patients).