NSC Lung Cancer: the common treatments by stage

As previously discussed in the first article dedicated to lung cancer, in 80-85% of cases they manifest themselves in the form of NSCLC (Non-small cell lung cancer), declinable in its subspecies: adenocarcinoma, carcinoma a squamous cell and large cell carcinoma. With this article we will present the different methods of treatment available today, since their treatment and their prognosis (perspectives) are often similar.

To define the options for the treatment of non-small cell lung cancer (NSCLC), we start with the definition of the developmental stage of the cancer, and then take into account other factors, such as general health and lung function. In fact, depending on the specificity of the case, more than one method of treatment can be used. Common treatments include palliative care, surgery, chemotherapy, and radiation therapy. Of course, as a first measure to fight the disease, people who have lung cancer should be encouraged to quit smoking, although there is no hard evidence to show that quitting smoking can lead to longer life expectancies.

Staging NSCLC

Occult-stage: Cancer cells are found in sputum, but no tumor can be found in the lung by imaging tests or bronchoscopy, or the tumor is too small to be checked.

Stage 0: Cancer at this stage is also known as carcinoma in situ. The cancer is tiny in size and has not spread into deeper lung tissues or outside the lungs.

Stage I: Cancer may be present in the underlying lung tissues, but the lymph nodes remain unaffected.

Stage II: The cancer may have spread to nearby lymph nodes or into the chest wall.

Stage III: The cancer is continuing to spread from the lungs to the lymph nodes or to nearby structures and organs, such as the heart, trachea and esophagus.

Stage IV: The cancer has metastasized, or spread, beyond the lungs into other areas of the body. About 40% of NSCLC patients are diagnosed with lung cancer when they are in stage IV. The five-year survival rate for those diagnosed with stage IV lung cancer is less than 10 percent. In this stage, chemotherapy is often the recommended treatment, while immunotherapy may also be recommended as a secondary approach.

NSCLC Stage Treatments

Occult-stage: since no obvious tumor is present, bronchoscopy or imaging tests can usually be repeated periodically to look for a tumor and to define its progress.

Stage 0: because stage 0 cancer has not penetrated deeply into lung tissue, it is usually only treatable with surgery, requiring no chemotherapy or radiotherapy. Only in some cases, treatments such as photodynamic therapy (PDT), laser therapy or brachytherapy (internal radiation) can be alternatives to surgery.

Stage 1: in the case of stage I NSCLC, several surgical approaches can be considered: lobectomy (extraction of the affected lung lobe) or segmentectomy / wedge resection (extraction of a smaller piece of the lung) for very small stage I tumors. In case of severe health problems, where surgery would not be tolerated, stereotaxic body radiation therapy (SBRT) could be considered. Furthermore, radiofrequency ablation (RFA) may be evaluable if the tumor is small and on the outside of the lung.

Stage 2: At this stage, a lobectomy or sleeve resection surgery may not be enough, requiring removal of the entire lung (pneumonectomy), which also removes all lymph nodes that may have cancer. If cancer cells are still present after surgery, a second surgery may be performed, followed by chemotherapy (chemo).

Stage 3A: in cases of stage IIIA NSCLC, a mix of radiotherapy, chemotherapy and / or surgery is possible, thus providing for the participation of an oncologist, a radiotherapist and a thoracic surgeon in the treatment planning. Treatment usually begins with chemo, often combined with radiation therapy; surgery is possible if the doctor believes there are conditions to remove the remaining tumor. If surgery, radiotherapy, or chemoradiotherapy are not deemed tolerable, immunotherapy with pembrolizumab is an option for initial treatment.

Stage 3B: we are faced with cancer that has spread to the lymph nodes outside the affected lung, near the other lung, in the neck and other thoracic structures, so they cannot be completely removed by surgery. If the patient is in good general health, chemotherapy combined with radiotherapy may be a treatment; otherwise, the patient is treated with radiotherapy alone.