Non-Small Cell Lung Cancer - Treatment Options by Stages

Highlights	Diagnostic Tests	Chemotherapy Treatments
Introduction	Complications	Investigative Agents
Causes	Staging Systems	Resources
Symptoms	Treatment Options by Stages	References
Risk Factors	Surgical Procedures
Lifestyle Changes	Radiation Treatments

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.

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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.