What is Early Stage Lung Cancer?

In This Article

Early stage lung cancer can have different symptoms and is often treated differently than advanced stage disease. The term "early stage" usually refers to stage I, II, and IIIA non-small cell lung cancer as well as limited stage small cell lung cancer. At these stages, the cancer may not have any symptoms and may be found on screening or accidentally when a scan is done for another reason.

In general with early stage lung cancer, surgery may be an option for curing the disease. In other words, the goal of treatment is often "curative," rather than "palliative," treatment that instead focuses on prolonging life and reducing the symptoms of cancer.

The stages that are considered early stage depend on the particular type of lung cancer.

Non-Small Cell Lung Cancer Early Stages

Non-small cell lung cancer is the most common type of lung cancer accounting for around 85 percent of lung cancers. These cancers are further broken down into lung adenocarcinoma, squamous cell carcinoma of the lungs, and large cell lung cancers. Stages considered early stage (or operable) include:

Small Cell Lung Cancer Early Stage

Small cell lung cancer is the second most common type of lung cancer and is broken down into only two types, limited and extensive.

  • Limited stage small cell lung cancer may be referred to as early stage (Even though these tumors are early stage, however, surgery is not as commonly done for small cell lung cancer.)

Carcinoid Tumors of the Lung

Carcinoid tumors of the lung are less known of the lung cancers.

If you are wondering whether or not something you hear about “early stage lung cancer” applies to your particular situation, share your questions with your oncologist.

Symptoms

Early on, early stage lung cancer may not have any symptoms. These cancers may be found on lung cancer screening or found "incidentally" (accidentally) when a scan is done for another reason.

When lung cancer symptoms are present, they may include a chronic cough, coughing up blood, shortness of breath, or just not feeling well. In recent years, the symptoms of lung cancer have been changing, and like heart disease, the symptoms of lung cancer in women may differ from those in men. For this reason, people with these cancers may not have "typical" symptoms like coughing, but instead often note vague symptoms, such as decreased exercise tolerance and fatigue.

Diagnosis and Staging

There are several tests and procedures used to diagnose lung cancer. Imaging tests such as a CT scan may be done to visualize the tumor and to look for the spread of a tumor to other regions of the body. A lung biopsy is usually performed in order to confirm the diagnosis and determine the type of cancer. It's important that everyone with lung adenocarcinoma, and ideally all lung cancers, have molecular profiling done on their tumor. If this does not sound familiar, talk to your oncologist about this testing. A blood test (liquid biopsy) may also be done to look for gene mutations and other genomic alternations in the tumor.

Treatment

To best understand lung cancer treatments it helps to break these treatments down into two categories

  • Local treatments are treatments that treat the cancer locally where it originated. Both surgery and radiation therapy are considered local treatments.
  • Systemic therapies treat lung cancer cells wherever they may be in the body, for example, these treatments may reach both tumors in the lungs and cancer that has spread (metastasized) to the bones.

With early stage lung cancer, local treatment is often done with a curative intent: the goal being to cure the disease. With very early stage lung cancer, local therapy with surgery or radiation therapy (such as SBRT) may be all that is needed.

Systemic therapy is often used in addition to surgery (adjuvant treatment) or before surgery (neoadjuvant treatment) for early stage lung cancer.

Surgery

Surgery is often the treatment of choice for early-stage non-small cell lung cancer. There are several different types of surgery which may be done, depending on the size and location of your tumor. Surgery may be done through a large chest incision, but is increasingly being done in a less invasive procedure called video-assisted thoracoscopic surgery (VATS.) Not all surgeons perform this procedure. In addition, there are some tumors that cannot be accessed well with this method.

Since outcomes from surgery have been found to be better when performed at cancer centers which do larger volumes of these surgeries, you may wish to have a second opinion at one of the larger National Cancer Institute-designated cancer centers.

Surgery for small cell lung cancer is done less frequently, but may be appropriate if the tumor is small.

Radiation Therapy

Radiation therapy may be done after surgery as an adjuvant treatment.

For tumors that are early stage, but inoperable for some reason, stereotactic body radiotherapy (SBRT), also known as "cyberknife" may be done with a curative intent. SBRT may be considered as an alternate to surgery in older adults with lung cancer, those who have other medical conditions that could make surgery risky, people with certain mutations in their tumors, or among those who simply wish to avoid surgery. Since this is currently an area of debate, it's important to have a careful discussion with your doctor and consider a second opinion.

Photodynamic Therapy

Photodynamic therapy is used much less commonly that surgery or SBRT, but may be used with a curative intent with some early stage lung cancers, such as very small tumors (less than one centimeter in diameter) that are centrally located.

Adjuvant Chemotherapy

Chemotherapy for lung cancer may be used before or after surgery with early stage lung cancer, especially tumors that are stage 2 or stage 3A.

With adjuvant chemotherapy, the drugs are given with the goal of eliminating any cancer cells that may have spread beyond the lungs, but cannot be detected on imaging tests. It is thought that recurrences of early stage lung cancer are related to these cells that have metastasized, but cannot be detected. With neoadjuvant chemotherapy, the drugs are given to decrease the size of the tumor prior to surgery.

Targeted Therapy and Immunotherapy

While targeted therapies and immunotherapies are used very often with advanced lung cancer, they are not yet approved for early stage disease. Clinical trials are currently in place looking at adjunctive treatment with these drugs to see if they may lead to a lower risk of recurrence.

Coping 

Being diagnosed with lung cancer is terrifying whether it is early stage or advanced stage tumor, and you may wonder where to begin.

It's important to ask a lot of questions and be your own advocate in your care. The treatment of lung cancer is advancing rapidly, and finding an oncologist who specializes in lung cancer is helpful.

Connecting with others who have lung cancer is a great way to obtain support, and can sometimes be an excellent way to learn about the latest research on your disease. After all, people living with lung cancer are often very motivated to learn as much as they can. There are many online lung cancer support groups and communities available. If you are trying to find others on Twitter, using the hashtag #lcsm (lung cancer social media) is helpful.

Risk and Fear of Recurrence

While early stage lung cancer has the potential to be cured with surgery, the risk of recurrence is significant, and coping with this fear can be challenging. Again, it can be helpful to connect with others facing the same fear, but if you find the fear is interfering with your quality of life, seeking out professional help is important.

For Loved Ones 

If it is your loved one who has been diagnosed, you are probably feeling frightened as well, and in addition, have to cope with the feelings of helplessness that go with cancer caregiving. This article on "when your loved one has lung cancer" talks about what lung cancer patients have wished their friends and families knew about living with the disease. It's also important to make sure you take care of yourself. Check out these tips on caring for yourself as a caregiver.

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Article Sources
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