Non small cell lung cancer (NSCLC) is a type of malignant cancer of the lung tissues. It spreads more slowly than the small cell lung cancer. The following article provides information about the various types and stages of NSCLC.
Lung cancer is a condition where there is cancerous growth in the tissues of the lungs. Non small cell lung cancer (NSCLC) is a type of cancer where the tissues of the lung develop malignant cancer cells. At least 80% of the lung cancer cases in the United States are said to be NSCLC. The term is used for the different bronchogenic carcinomas that include adenocarcinoma, squamous cell carcinoma, and large cell undifferentiated carcinoma. Each of these types of NSCLC spreads and grows in different ways.
Types
Squamous Cell Carcinoma
The cancer of the squamous cells is called squamous cell carcinoma or epidermoid carcinoma. It begins in the bronchial tubes and is usually associated with a history of smoking in the patient.
Adenocarcinoma
It start in the cells that produce mucus and other substances. It is the most common type in non smokers. The cancer may be detected after a very long time after onset. Since it progresses slowly, it is found before it has spread to other organs.
Large Cell Carcinoma
It may develop in any part of the lungs. This is a less common type of cancer that is seen only on 10% of patients with NSCLC. It spreads very quickly, which makes its treatment very difficult.
Bronchiolo-Alveolar Carcinoma
The less aggressive sub-type of adenocarcinoma is bronchiolo-alveolar carcinoma. This cancer is seen to affect the small air sacs of the lungs.
Staging
Non small cell lung cancer staging is very important in assessment, treatment, and prognosis of this disease. There are basically four different stages of lung cancer.
Stage 1
The earliest stage of NSCLC, stage 1 has a good prognosis with long term survival rate. Stage 1 is divided into stage 1A and stage 1B.
Stage 1 A
In this stage, the tumor detected is less than 1½ inches or 3 centimeters in size.
Stage 1 B
The cancer has grown to a size that is greater than 3 centimeters, but not more than 5 centimeters. It has spread to the inner layers that cover the lungs.
The early symptoms of lung cancer are often asymptomatic and the tumor is detected during an X-ray for some other health concern. Other common signs and symptoms of NSCLC stage 1 are persistent cough, recurrent bouts of pneumonia, and bronchitis. The treatment for this condition is usually surgery.
If surgery is not possible due to the location of tumor, then radiation therapy is performed. However, chemotherapy or radiation therapy is not the line of treatment opted for when it comes to stage 1 A cancer. Stereotactic body radiotherapy (SBRT) is usually carried out for those who cannot undergo surgery.
Video assisted throracoscopic surgery (VATS) is a less invasive technique that may also be carried out to treat this cancer. Stage 1 cancer prognosis is most often very good. There is a 60% to 80% survival rate for a period of 5 years. Early detection and screening may show a 90% survival rate in patients with stage 1 NSCLC.
Stage 2
The second stage is localized cancer that is present within the lung and may have spread to local lymph nodes. The prognosis for stage 2 is definitely better than the later stages. The cancer may or may not have spread to the lymph nodes and the tumor may be greater than 3 cm in size. It is usually located in the main bronchus or may have invaded the lining of the lungs. Stage 2 is also divided into stage 2 A and stage 2 B.
Stage 2 A
The cancer is less than 5 cm in size but has spread to the lymph nodes present on the same side of the chest as the tumor. The cancer may have also spread to the inner layers covering the lungs.
OR
The cancer has not spread to the lymph nodes, and the tumor is less than 7 cm in size. The cancer may have spread to the inner layers covering the lungs.
Stage 2 B
The tumor is not more than 7 cm in size, but has spread to the lymph nodes present on the same side of the chest that are inside the lungs or are close to the bronchus. The cancer may have spread to the inner layers covering the lungs.
OR
The cancer has not spread to the lymph nodes. The tumor is not more than 7 cm in size, and the cancer may have spread to the bronchus, chest wall, or around the heart.
The symptoms of stage 2 NSCLC include persistent cough, hemoptysis (coughing up blood), shortness of breath, recurrent bouts of pneumonia, and bronchitis. The tumor may be removed through surgery, after which the doctor may advice adjuvant chemotherapy that helps in the removal of any cancerous cells remaining after the surgery. Patients who cannot undergo surgery for any reason, may be treated using radiation therapy. The survival rate for stage 2 is 40% to 50%, and it may vary according to the individual’s health.
Stage 3 A
The tumors in this stage are larger and have spread to lymph nodes on the same side of the body but at a distance to each other. The stage 3A non small cell lung cancer is divided into different types depending on the size of the tumor, location of the tumor, and whether the cancer has spread to the lymph nodes.
1
The tumor may be any size and the cancer has spread to the lymph nodes that are on same side near the bronchus or the sternum. There may be one or more separate tumors in the same lobe of the lung. The cancer may have spread to the bronchus, chest wall, diaphragm, and the membrane around the heart.
2
The tumor may be any size, and the cancer may have spread to the lymph nodes present on the same side of the chest, either inside the lungs of near the bronchus. There may be one or more tumors in any lobe of the lung. The cancer may have spread to the chest wall, esophagus, membranes of the heart and lungs, trachea, sternum, major blood vessels, and bronchus.
3
The tumor may be any size, but the cancer has not spread to any lymph node. The cancer may have spread to heart, major blood vessels, trachea, esophagus, or sternum.
The symptoms of stage 3A NSCLC include persistent cough, shortness of breath, and recurrent pneumonia or bronchitis infections. If the cancer has spread to the diaphragm or the chest wall, it may cause chest pain, rib pain, shoulder pain, and back pain. One may also experience hemoptysis, wheezing, and hoarseness of voice.
The treatment includes surgery for tumor removal, adjuvant chemotherapy, or combination chemotherapy. Radiotherapy is considered for those who cannot undergo surgery or endure chemotherapy. The prognosis of this stage is poor and the survival rate for a 5 year period is just about 20% to 25%.
Stage 3 B
In this stage the size of the tumor may be very large, and it may have spread to distant lymph nodes as well as other organs in the chest. It may also be a malignant pleural effusion, that is, fluid filling up between cancer cells and the layers of cells in the lining of the lungs. The stage 3 B is divided into two types depending upon the size of the tumor, location of the tumor, and whether the cancer has spread to the lymph nodes.
1
The tumor may be of any size, and has spread to the lymph nodes present on the opposite side of the chest. There may be one or more of tumors present in any of the lobes of the lungs with cancer. The cancer may have spread to the bronchus, diaphragm, chest wall, membranes around the lungs and the heart, esophagus, major blood vessels, sternum, or trachea.
2
The tumor is of any size, and the cancer has spread to the lymph nodes present on the same side of the chest that are close to the sternum or the bronchus. The cancer may have spread to heart, esophagus, sternum, major blood vessels, or trachea
The symptoms of stage 3B include persistent cough, shortness of breath, hemoptysis, dysphagia, and hoarseness of voice. In case of pleural effusion, there may be chest and rib pain along with the general symptoms of fatigue and weight loss. NSCLC stage 3B is incurable but treatable. This stage is said to be inoperable and the treatment includes chemotherapy and radiation therapy. Stage 3 NSCLC prognosis is only about 4%.
Stage 4
Non small cell lung cancer stage 4, or metastatic lung cancer is the most advanced type of lung cancer. The tumor has metastasized to other parts of the body or to another lobe of the lung. This means the tumor is of any size, with or without lymph nodes involvement, and has metastasized to other parts of the body or another lung lobe.
The symptoms may include persistent cough, hemoptysis, hoarseness, shortness of breath, chest pain, back pain, wheezing, recurrent pneumonia, or bronchitis. The cancer that spreads to other organs may lead to symptoms like difficulty in swallowing, headaches, weakness, and seizures in case it has spread to the brain, and hip and rib pain or back pain if it has spread to the bones.
The general symptoms include fatigue, weight loss, and loss of appetite. This inoperable stage is treated with chemotherapy and radiation therapy. Stage 4 prognosis is less than 10%, and the survival rate for these patients is less than 8 or 9 months.
