Stage 3B Non-Small Cell Lung Cancer

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Stage 3B non-small cell lung cancer (NSCLC), along with stage 3C and stage 4 NSCLC, is considered advanced lung cancer. When cancer reaches this point, it's not considered curable, but it is treatable.

Although the road to feeling well and seeking possible remission may be tough, there is hope. Recent advancements in treatment have been improving survival rates and helping those with late-stage lung cancer manage symptoms.

If you've been diagnosed with stage 3B NSCLC, you have several options that can help you enjoy a higher quality of life and a significantly better prognosis than previous generations.

Doctor delivering diagnosis to patient in exam room
Jose Luis Pelaez Inc / Getty Images

Staging

Stage 3 lung cancer is divided into three sub-stages, of which stage 3B is one. It is defined as a tumor of any size that has spread to distant lymph nodes or has invaded other structures in the chest (such as the heart or esophagus).

About 17.6% of people with NSCLC are already at stage 3B when they're diagnosed. For others, an earlier diagnosis of stage 1, 2, or 3A tumors can develop into more advanced lung cancer (stage 3B or beyond).

To identify how advanced cancer is, oncologists use the TNM system. They rate the size of the tumor, determine whether any lymph nodes are involved and, if so, their location, and check whether cancerous lung cells have spread to other regions of the body.

Using this system, stage 3B is divided into four possible designations.

Stage 3B Lung Cancer
TNM Designations Description

T1a/T1b/T1c, N3, M0

SizeNo more than 3 centimeters (cm)

Spread: To lymph nodes near the collarbone(s) and/or to hilum lymph nodes or mediastinal lymph nodes


M0 metastases: No spread to other body parts

T2a/T2b, N3, M0

Size: Between 3 cm and 5 cm and meets 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
• H
as grown into the membranes surrounding the lungs
• Partially clogs the airways

Spread: Has spread to lymph nodes near the collarbone(s) and/or to hilum lymph nodes or mediastinal lymph nodes 

M0 metastases: No spread to other body parts

T3, N2, M0

Size: Tumor meets one or more of the following criteria:
• Is between 5 cm and 7 cm
• Has grown into the chest wall, the inner lining of the chest wall, the phrenic nerve, or membranes of the sac surrounding the heart
• 2 or more separate tumor nodules are in the same lobe of a lung

Spread: Cancer has spread to lymph nodes on the same side as the primary tumor

M0 metastases: No spread to other body parts

T4, N2, M0

SizeTumor meets one or more of the following criteria:
• 
Is larger than 7 cm 
• Has grown into the space between the lungs, the heart, the large blood vessels near the heart, the windpipe, the esophagus, the diaphragm, the backbone, or the point where the windpipe splits to main bronchi
• Two or more separate tumor nodules are in the same lobe of a lung

SpreadTo lymph nodes on the same side as the primary tumor

M0 metastases: No spread to other body parts

Symptoms

Common symptoms of stage 3B NSCLC include:

  • Persistent cough
  • Shortness of breath

General symptoms of cancer such as fatigue and unintentional weight loss may also be present.

Additional symptoms of stage 3B NSCLC can vary depending on where the tumor is. For example, hemoptysis (coughing up blood) can occur when tumors are near the airways. When a tumor involves areas such as the esophagus and other chest structures, dysphagia (difficulty swallowing) and hoarseness may be present.

In approximately 7% to 23% of lung cancers, a complication can occur in which fluid containing cancer cells builds up in the membranes that line the lungs. This is called a pleural effusion, and it can cause pain in the back, chest, and ribs. Other symptoms may include increased shortness of breath.

Treatment

With rare exceptions, stage 3B lung cancer is considered inoperable, which means that surgery will not cure your cancer. However, there are treatments that can help you increase your odds of living longer and enjoying those years to the fullest.

The most effective approach includes a combination of therapies. For instance, if you are otherwise healthy, a combination of chemotherapy and radiation therapy administered concurrently is often recommended. Receiving the two therapies concurrently—known as chemoradiation—has been shown to be more effective than receiving either one alone or one right after the other.

(In some instances, chemotherapy and radiation are still being used on their own—usually with the intent of relieving symptoms caused by tumors.)

In addition, newer treatments such as targeted therapies and immunotherapy are making a difference for people with advanced lung cancer. 

Using molecular profiling (gene testing), doctors can identify mutations in cancer cells and then use targeted therapy medications to stop these mutated cells from growing or causing more damage. In some cases, these treatments have allowed people to live with lung cancer almost as a form of chronic disease. That is, as long as they don't build up a resistance to the medication, they can live a relatively healthy life.

Targeted therapy medications to treat EGFR mutations, ALK rearrangements, and ROS1 rearrangements have been approved, and drugs targeting other mutations are being studied in clinical trials.

Again, some of these treatments may be combined with other therapies to manage stage 3B lung cancer. The use of bronchial artery infusion (chemotherapy) administered concurrently with oral icotinib hydrochloride (a targeted therapy drug that acts on EGFR mutations) has resulted in a complete remission of advanced lung cancer in at least one study and shows promise for helping other patients.

Immunotherapy drugs have resulted in durable responses—i.e., long-term survival for some people with advanced lung cancer. One immunotherapy drug, Imfinzi (durvalumab), was approved specifically for the treatment of inoperable stage 3 NSCLC. It's used after chemotherapy and radiation therapy and was found to improve progression-free survival.

Yet another treatment option is to enroll in a clinical trial—a study that tests new cancer treatments.​ Clinical trials are available for stage 3B non-small lung cancer as well as other stages and types of cancer.

Prognosis

Even the success of chemoradiation treatment and other advanced options needs to be seen in light of the fact that, overall, stage 3B lung cancer has a low survival rate. The improved prognosis with chemoradiation is still under 18 months.

The median survival time (time at which 50% of patients are alive and 50% have died) is roughly 13 months with treatment, and the five-year survival rate with stage 3B non-small lung cancer is sadly only 3% to 7%.

Keep in mind that these statistics include data collected over the course of several years and, in some cases, decades. They may not reflect improvements in life expectancy that have been made using newer drugs.​

A Word From Verywell

It is easy to feel discouraged and overwhelmed when you receive a diagnosis of advanced lung cancer, but you are not powerless. Learning everything you can about your cancer can help improve your prognosis, and working with your doctor to find the best course of treatment will ensure that nothing is overlooked.

There is a wealth of information online that can help you increase your understanding of the disease. Be sure you're looking at peer-reviewed research and well-defined studies to ensure you're getting facts about how to treat stage 3B lung cancer specifically. Also, learn to be your own advocate in your cancer care, speaking up when you want to try a particular treatment and asking specific questions to get the answers you need to make well-informed decisions.

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