What Is Early-Stage Lung Cancer?

Early-stage lung cancer usually refers to stage 1, 2, and 3A non-small cell lung cancer (NSCLC) as well as limited-stage small cell lung cancer (SCLC). You may have no symptoms in these early stages of lung cancer. In fact, diagnoses are often only made when cancer is seen on imaging done for an unrelated condition.

When lung cancer is found early, your prognosis is much better. With some stage 1 cancers, treatments may cure your cancer. In other types of early-stage cancer, you have a good chance of remission and a low chance of recurrence with prompt treatment. Healthcare providers may be hesitant to use the word "cured" in those cases, but you should be able to manage your symptoms so you can enjoy a full, active life for many years.

Types of Early-Stage Lung Cancer

Early-stage lung cancer is divided into different categories depending on whether the cancer is NSCLC or SCLC, how far it has spread, and how large the tumors are.

Non-Small Cell Lung Cancer Early Stages

Non-small cell lung cancer is the most common type of lung cancer, accounting for up to 85% of lung cancers. These cancers are further broken down into:

• Lung adenocarcinoma
• Squamous cell carcinoma of the lungs
• Large cell lung carcinoma

Stages considered early stage (or operable) include:

• Stage 0: The tumor is only in a few top layers of the lungs.
• Stage 1: Tumors measure less than 4 centimeters (cm). They may have entered the tissue surrounding the lungs, but have not spread into the lymph nodes.
• Stage 2: Cancer may have entered the lymph nodes surrounding the lungs, and tumors may measure between 4 cm and 7 cm.
• Stage 3A: Tumors may be small (under 3 cm) or up to 7 cm while having spread further into the lymphatic system.

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 SCLC may be considered an early stage of lung cancer. Because this type of cancer grows so quickly, chemotherapy or radiation are considered the best treatments for stopping their growth.

Carcinoid Tumors of the Lung

Carcinoid tumors of the lung account for just 1% to 2% of lung cancers. These rare tumors grow slowly and are often caught early enough to be successfully removed by surgery.

Early-Stage Lung Cancer Symptoms

In its early stages, lung cancer may not cause any symptoms, or the symptoms might be mistaken for a common cold. Some of these early signs and symptoms include:

• A persistent cough that does not go away or gets worse
• Bloody spit or phlegm
• Chest pain that's worse when breathing deeply
• Hoarseness
• Loss of appetite
• Unexplained weight loss
• Fatigue
• Recurrent lung infections

Some people with NSCLC or SCLC may not have "typical" symptoms. Instead, they present with vague complaints such as less tolerance for exercise or lack of strength for certain activities. New diagnostic methods are placing emphasis on different types of symptoms that may alert healthcare providers to lung cancer earlier.

It's also important to consider that symptoms of lung cancer in women may differ from those in men. Especially if you are at risk for lung cancer, keep your healthcare provider informed about any unusual health concerns.

Diagnosis and Staging

There are several tests and procedures used to diagnose lung cancer.

• Computed tomography (CT) scans use multiple X-ray images to create a three-dimensional visual image of the lungs and surrounding tissue to look for abnormal cells.
• Magnetic resonance imaging (MRI) implements a strong magnetic field and radio waves to show contrast images and details of soft tissue.
• Positron emission tomography (PET) scans require you to be injected with a radioactive substance that allows the scanner to pick up how the cells are functioning, not just how they look.
• Lung biopsy is when healthcare providers take sample tissue from the lungs or other areas via surgery, a scope, or a special needle; the sample is then studied under a microscope.
• Liquid biopsy is a blood test that looks for gene mutations and other genomic alternations in the tumor.

Treatment

Advance stage lung cancer is primarily treated with systemic therapies, which treat lung cancer cells in lung tumors and anywhere else the cancer has metastasized in the body. In last-stage lung cancer specifically, healthcare providers focus mainly on palliative care, which involves managing pain and reducing symptoms (rather than extending life).

On the other hand, with early-stage lung cancer, there is a greater chance that you may have a complete remission. And local therapies may be sufficient enough to do it, especially with very early-stage cases.

Local therapies, as the name implies, treat the cancer where it originated. Both surgery and radiation therapy are considered local treatments.

Surgery

Surgery is often the treatment of choice for early-stage NSCLC with five-year survival rates ranging from 77% for those with the least invasive type of stage 1a cancer to 23% for those with stage 3A tumors. 

For NSCLC, there are several different types of surgery that may be done depending on the size and location of your tumor.

Traditionally, a large chest incision was required, but, surgery 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.

Adjuvant Chemotherapy

If the cancer has started to spread, systemic therapy may be used after surgery via adjuvant chemotherapy to try and ensure that all the cancer cells have been destroyed.

Chemo drugs can act on cancer cells that may exist but cannot be detected on imaging tests. Killing these unseen metastasized cells may help prevent recurrences of cancer. This approach is most often used for tumors that are stage 2 or later.

With larger tumors, the chemo drugs may be administered prior to surgery to decrease the size of the tumor before operating. This is known as neoadjuvant chemotherapy and isn't usually necessary for early-stage cancer.

Radiation Therapy

Radiation therapy may also be used after surgery as an adjuvant treatment. It may be the first course of action, especially if tumors are small, but inoperable (due to their location). In such instances, stereotactic body radiotherapy (SBRT), also known as "cyberknife," may be done.

There is some research suggesting that patients who survived five years following SBRT remain cancer-free longer than the average patient treated for NSCLC.

SBRT is sometimes considered a good alternative to surgery in older adults or for those who have other medical conditions that could make surgery risky. There is still some debate regarding how best to apply this treatment, so it's important to have a careful discussion with your healthcare provider and consider a second opinion.

Photodynamic Therapy

Photodynamic therapy, also called PDT or light-activating treatment, uses a light-sensitive medication that is injected into your bloodstream. Healthcare providers then insert a scope into your lungs via the bronchial passage and use a special light to destroy cancer cells that have absorbed the medication. It's usually used along with other treatments.

Photodynamic therapy is used less often than surgery or SBRT, but, in some cases, it may successfully get rid of all signs of cancer when used for early-stage NSCLC with small tumors that are centrally located.

Targeted Therapy and Immunotherapy

While targeted therapies and immunotherapies are used very often with advanced lung cancer, they are not yet approved to treat early-stage lung cancer.

Researchers, however, continue to study how these treatments might support surgery and lower the risk of recurrence.

Coping 

Being diagnosed with lung cancer is terrifying, whether it is an early-stage or advanced-stage tumor, and you may wonder how to begin to plan your next step.

It's important to ask many 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.

Risk and Fear of Recurrence

While early-stage 1A lung cancer has the potential to be cured with surgery, the risk of recurrence is significant. Dealing with this fear can be challenging.

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. There are many online lung cancer support groups and communities available, and finding others who are facing the same diagnosis can offer you moral support and comfort.

If you ever find that fear is interfering with your quality of life, seek out a professional who can help you with your emotions.

For Loved Ones 

If it is your loved one who has been diagnosed, you are probably feeling frightened and, perhaps, helpless as well. As you take on the role of caregiver, learn how to support loved ones with cancer and research ways to help your family member or friend enjoy life while managing the disease. It's also important to make sure you take care of yourself so you can be a strong caretaker for others.