What Is Stage 2 Non-Small Cell Lung Cancer?

Chest X-ray showing stage 2 lung cancer
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Stage 2 non-small cell lung cancer (NSCLC) is a localized cancer, which means the tumor has not spread beyond one lung or the local lymph nodes (i.e., those on the same side of the chest). Any lung cancer diagnosis is serious, but being in this early stage means your disease is very treatable and your chances for a long-term remission are good, comparatively speaking.

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An Overview of Staging For Non-Small Cell Lung Cancer

Staging

Determining the stage of a lung cancer is very important in choosing the most appropriate treatment.

Oncologists talk about stages of lung cancer based on something called the TNM system. In this system, T refers to the size of the tumor, N refers to the involvement of any lymph nodes and where they are located, and M indicates if there are any metastases, spreading of the tumor to other regions of the body.

Stage 2 is divided into stages 2A and 2B. Stage 2B is divided into three possible designations.

Stage 2 Lung Cancer
Stage T, N, M Designations Description
2A

T2b, N0, M0

T2b size: Tumor is more than 4 cm but not greater than 5 cm across and may meet one or more of the following criteria:
• Has entered the main bronchus, but not within 2 cm of the point where the windpipe branches to the main bronchi
• Has grown into the membranes surrounding the lungs
• Partially clogs the airways

N0 spread: No spread to lymph nodes

M0 metastases: No spread to other body parts
2B T1a/T1b/T1c, N1, M0 T1a/T1b/T1c size: Tumor is no larger than 3 cm across, has not grown into the membranes that surround the lungs, and does not affect the main branches of the bronchi
 
N1 spread: Cancer is in the lymph nodes of the lung (on the same side as the cancer) and/or around the area where the bronchus enters the lung.
 
M0 metastases: No spread to other body parts
 
2B T2a/T2b, N1, M0 T2a/T2b size: Tumor is larger than 3 cm but not larger than 5 cm across and may meet one or more of the following criteria:
• Has grown into a main bronchus, but is not within 2 cm of the point where the windpipe splits to main bronchi
• Has grown into the membranes surrounding the lungs 
• Partially clogs the airways

N1 spread: Cancer is in the lymph nodes of the lung (on the same side as the cancer) and/or around the area where the bronchus enters the lung.
 
M0 metastases: No spread to other body parts
 
2B T3, N1, M0 T3 size: Tumor is larger than 5 cm but not larger than 7 cm across and may meet one or more of the following criteria:
• Has grown into the chest wall, the inner lining of the chest wall, nerves that affect breathing, or membranes of the sac surrounding the heart
• One lung has two or more separate tumor nodules

N0 Spread: No spread to lymph nodes

M0 metastases: No spread to other body parts
 
centimeters (cm)

Stage 2 Lung Cancer Symptoms

In the early stages of lung cancer, you may have no symptoms. As the disease progresses, though, common stage 2 lung cancer symptoms may arise.

These include:

Since stage 2 lung cancer has not metastasized beyond the lungs, symptoms such as unintentional weight loss and fatigue are less common than in more advanced stages.

The symptoms of lung cancer in women may differ from men, and symptoms in non-smokers may differ from current or former smokers. This is important to consider as cases of lung cancer have been increasing among young women who have never smoked, many of whom assume they are not at risk for the disease and miss early signs of a problem.

Treatment

Treatment options for stage 2 lung cancer most often include a combination of therapies.

Surgery

The greatest hope for long-term survival after your diagnosis is surgery. There are four main types of surgery for lung cancer:

  • Lobectomy: This removes one of the five lobes that make up your lungs (three on the right, two on the left). This surgery is often preferred for NSCLC.
  • Wedge resection: A wedge-shaped section of a lobe is removed. This is usually recommended if the tumor is small or there is a concern about lung function.
  • Sleeve resection: This removes part of the lung and a part of the main airway. It may preserve more lung function than other types of surgeries.
  • Pneumonectomy: The entire lung is removed. This is usually only recommended if the tumor’s location prevents less invasive surgeries.

In recent years, a less invasive form of surgery called video-assisted thoracoscopic surgery (VATS) has become available. With this technique, a part of the lung may be removed through small incisions in the chest wall. VATS procedures may result in a shorter hospital stay and less post-operative pain.

Which procedure your doctor recommends depends on where your tumor is located and your general state of health.

Chemotherapy

Most oncologists recommend adjuvant chemotherapy (chemotherapy after surgery) for those who undergo surgery for stage 2 lung cancer. The advantage of this type of chemotherapy is that it "cleans up" any cancer cells that may have spread beyond the lungs but are not yet visible on any imaging tests.

Depending on the location of your tumor, some oncologists may instead use neoadjuvant chemotherapy—chemotherapy given before surgery to decrease the size of a tumor and make removing the tumor easier.

Radiation Therapy

Radiation therapy is not often used with stage 2 lung cancer but is an option for those who are unable to have surgery due to the tumor's location or general health concerns.

Other techniques such as proton beam therapy are being evaluated for stage 2 disease.

Genetic Targeting

One of the recent advances in lung cancer treatment has been the ability to treat some of these cancers by "targeting" mutations in the tumor. Along with characterizing a tumor based on size and how far it has spread, oncologists are now using genetic testing (molecular profiling) of lung cancer to personalize the diagnosis and treatment.

Previously, testing was reserved primarily for people with more advanced stages of the disease. But with advances in treatment, it's likely that for those with stage 2 NSCLC, especially people with lung adenocarcinoma, this testing will become routine.

Ongoing Research

Targeted therapies and immunotherapy are treatments primarily used for advanced-stage lung cancer, but clinical trials continue to explore the utility of these options. Researchers are looking to see if they can help improve survival rates and reduce the risk of recurrence when used for early-stage lung cancer.

Prognosis

The five-year survival rate for stage 2 NSCLC is approximately 35% with treatment. Of course, this varies depending on your particular tumor and your general health.

This is in contrast to lung cancer's overall survival rate (just under 19%), partly because only about 16% of NSCLC is diagnosed in the localized stages (stage 1 or stage 2).

Keep in mind that survival statistics are often several years old, and newer treatments may not have been available when those numbers were recorded.

The key to improving your chances of having lung cancer go into long-term remission is getting the appropriate treatment. Discuss all your options with your doctor and be hopeful. Treatments are improving every day.

Risk of Recurrence

The overall lung cancer recurrence rate for stage 2 NSCLC is estimated to be about 38%. If a lung cancer recurs, further options are available for treatment. These may include radiation with or without chemotherapy, targeted therapies, or immunotherapy medications.

Coping

Studies suggest that learning about your disease can improve your outcome. Ask questions. Learn about clinical trials that might be appropriate for you. If you are newly diagnosed with lung cancer, take a moment to breathe and think carefully about your current situation.

This is a time to allow others to help you and look into support groups in your community as well as online where you can connect with people who understand and have advice to offer. Remember, too, that there are some things you can do yourself that can improve survival with lung cancer. Putting effort into these can make you feel more in control of your cancer journey.

A Word From Verywell

Both the treatments for, and survival rates from, lung cancer are improving rapidly. While this is wonderful, it can be hard for any general oncologist to stay abreast of the latest improvements in all areas of care. Learn how to advocate for yourself as a cancer patient, seek a second opinion if you feel you need one, and choose a cancer treatment center that you feel confident in.

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