Stage 3B Non-Small Cell Lung Cancer

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Stage 3B non-small cell lung cancer is considered advanced lung cancer along with stage 4, and though it is not usually curable, it is treatable. In fact, about 40% of people have advanced lung cancer (stage 3B or 4) at the time of their initial diagnosis. 


Stage 3B lung cancer 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).

Oncologists use the TNM system to further define stages of lung cancer. A simplified description of the TNM system is defined below.

T refers to tumor size:

  • T1:  The tumor is less than 3 cm (1 ½ inches) in size.
  • T2: The tumor is larger than 3 cm but less than 7 cm.
  • T3: The tumor is larger than 7 cm or directly invades any of the following: chest wall, diaphragm, the nerve innervating the diaphragm (phrenic nerve), membrane covering the space between two lungs (mediastinal pleura), or one of the membranes covering the heart (parietal pericardium); or tumor in the main bronchus at least 2 cm below the carina; or it is associated with collapse of the entire lung or separate tumor nodule(s) in the same lobe of the lung.
  • T4: Tumor of any size that invades any of the following: space between the lungs (mediastinum), heart, great vessels, trachea, one of the nerves innervating the vocal cords (recurrent laryngeal nerve), esophagus, vertebral body, or the place where the trachea splits into two main bronchi (carina); or separate tumor nodule(s) in a different lung lobe on the same side of the chest.

N refers to lymph nodes:

  • N0: No nodes are affected.
  • N1: The tumor has spread to nearby nodes on the same side of the chest.
  • N2: The tumor has spread to nodes further away but on the same side of the chest.
  • N3: Cancer cells are present in lymph nodes on the other side of the chest from the tumor, or in nodes near the collarbone or neck muscles.

M refers to metastatic disease:

  • M0: No metastases are present.
  • M1: The tumor has spread (metastasized) to other regions of the body or the other lung.

Using the TNM system, stage 3B is described as:

  • Any T, N3, M0: A tumor of any size that has spread to lymph nodes on the other side of the chest from the tumor or to nodes near the collarbone or neck muscles, but has not spread to distant regions of the body.
  • T4, Any N, M0: A tumor of any size that is located in the airways, has invaded local structures such as the heart or esophagus or has a malignant pleural effusion. Nodes may or may not be involved, and when affected, can be near the tumor or further away in the chest or neck, but the tumor has not spread to distant regions of the body.


Common symptoms of ​stage 3 lung cancer include a persistent cough and shortness of breath. Tumors near the airways can result in hemoptysis (coughing up blood). When the tumor involves areas such as the esophagus and other chest structures, dysphagia (difficulty swallowing) and hoarseness can occur. Pain in the back, chest, and ribs is common if a pleural effusion is present, and this can result in increasing shortness of breath as well. General symptoms of cancer such as fatigue and unintentional weight loss may also be present.


With rare exceptions, stage 3B lung cancer is considered inoperable (surgery will not cure cancer) but is not untreatable. For those that are relatively healthy, a combination of chemotherapy or chemotherapy and radiation therapy is often recommended. If individuals are unable to tolerate chemotherapy, radiation therapy can be used alone. While radiation therapy is not usually given with the intent of curing cancer, it can be helpful in treating symptoms such as pain, shortness of breath, and coughing.

Newer treatments such as targeted therapies and immunotherapy are making a difference for people with the advanced stages of lung cancer. Everyone with non-small cell lung cancer should have molecular profiling (gene testing) done on their tumor. Medications to treat EGFR mutations, ALK rearrangements, and ROS1 rearrangements have been approved, and drugs targeting other mutations are being studied in clinical trials. In some cases, these treatments have allowed people to live with lung cancer almost as a form of chronic disease.

Immunotherapy is an exciting option, with the first drugs being approved in 2015. These drugs have resulted in "durable responses"—an oncology term which can be translated to mean long-term survival for some people with advanced lung cancer. Some of these drugs are also being used in combination to treat the more advanced stages of lung cancer. In 2018, one immunotherapy drug, Imfinzi (durvalumab), was approved specifically for the treatment of unresectable stage 3 non-small cell lung cancer. It is used after chemotherapy and radiation therapy and was found to improve progression-free survival.

Another treatment option is to enroll in a clinical trial; clinical trials are studies that test new cancer treatments and treatment combinations.​ Clinical trials are available for stage 3B non-small lung cancer as well as other stages and types of cancer.


The 5-year survival rate with stage 3B non-small lung cancer is sadly only 6%. The median survival time (time at which 50% of patients are alive and 50% have passed away) is roughly 13 months with treatment. Keep in mind that these statistics are numbers that were obtained before newer drugs—such as some targeted therapies and immunotherapy—had been approved for the treatment of lung cancer.​


Studies suggest that learning what you can about your cancer helps with the outcome. There is a wealth of information online, yet it can be hard to know where to look for good information. Perhaps the most important thing you can do is to learn to be your own advocate in your cancer care. Treatments for lung cancer are changing rapidly, and it can be hard for even lung cancer specialists to stay abreast of all of the research.

A good way to seek out both support and good information is to become involved in a lung cancer support group or support community. You may hear less about lung cancer groups than say, breast cancer groups, but what these groups lack in numbers they do have in depth. The hashtag #LCSM stands for lung cancer social media. Most of all, don't lose hope. Both the treatments and survival rate for lung cancer have been improving. As of 2015, several new treatments have been approved for lung cancer, and further treatments are currently being evaluated in clinical trials.

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