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Stage 1 Non-Small Cell Lung Cancer

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Updated April 09, 2014

Stage 1 lung cancer is the earliest stage at which most lung cancers are diagnosed and the stage where long-term survival is the longest. About 30% of non-small cell lung cancers are detected when they are still at stage 1 or 2.

Definition of Stage 1 Non-Small Cell Lung Cancer

Understanding the stage of a lung cancer is very important – both for determining the best treatment options, and to have an idea of what the future holds as far as prognosis. Stage 1 lung cancer is localized, which means it has not spread to any lymph nodes or distant organs. Stage 1 is further broken down into:
  • Stage 1A – The tumor is less than 3 cm (about 1 ½ inches)
  • Stage 1B – The tumor is greater than 3 cm

Your oncologist might describe the stage of your cancer based on something called the TNM system, where T stands for tumor size, N stands for nodes, and M stands for metastasis (spread of cancer). According to the TNM system, stage 1 lung cancer would be described as:

  • Stage 1A – T1N0M0 – Meaning a tumor less than 3cm, with no nodes and no metastasis
  • Stage 1B – T2N0M0 – Meaning a tumor greater than 3 cm, with no nodes and no metastasis

Symptoms

Stage 1 lung cancer can be present without any symptoms, and is often picked up incidentally when an x-ray is done for another reason. Sometimes, stage 1 lung cancer is found when an individual at risk for lung cancer undergoes CT screening for lung cancer. Common symptoms when present may include a persistent cough, shortness of breath or recurrent episodes of pneumonia or bronchitis. Since the cancer has not spread, symptoms such as major fatigue, unintentional weight loss, or significant pain are usually absent.

Treatment

Surgery is the treatment of choice for stage 1 lung cancer. There are 3 major types of surgery performed for lung cancer. Sometimes surgery is not possible due to the location of the tumor or your general health condition. A technique called video-assisted thoracoscopic surgery (VATS) is less invasive than traditional surgery and may be used in some people that are unable to tolerate a full surgical procedure. For patients with inoperable stage 1 lung cancer, radiation therapy is an option that can sometimes result in a cure. A new technique called stereotactic body radiotherapy (SBRT) appears quite promising for those who are unable to go through surgery for stage 1 lung cancer for whatever reason. With stage 1A lung cancer, chemotherapy or radiation therapy are not usually recommended. With stage 1B lung cancer, some oncologists recommend adjuvant chemotherapy -- chemotherapy that is started shortly after surgery in an attempt to kill any cancer cells that remain after surgery.

Stage 1 Lung Cancer Recurrence

Even with successful surgery, stage 1 lung cancer recurs either locally or at distant sites in roughly a third of patients. If stage 1 lung cancer recurs, another surgical procedure may be recommended, or further treatment with chemotherapy and radiation. Several clinical trials are in progress to evaluate treatment options after recurrence of early stage lung cancer.

In those that have smoked in the past, there is also a risk of developing a second primary tumor related to smoking, either within the lungs or in other regions of the body.

Survival Rate

The overall 5-year survival rate for stage 1 lung cancer at this time is 60 to 80%. Recent studies have shown survival rates in the range of 90% when stage 1 lung cancer is found with CT screening, and hopefully screening methods will be developed soon to improve early detection and overall survival.

What Can I Do to Help Myself?

Studies suggest that learning as much about your disease as possible can improve your outcome. Ask questions. Seek the support of loved ones and involve them in your care decisions. Find a support group. Learn about clinical trials. But remember that the decisions you make belong to you alone, and those close to you need to support you in your journey.

Sources:

Edge, S. et al (Eds.). AJCC Cancer Staging Manual. 7th Edition. Springer. New York, NY. 2010.

Henschke, C. et al. Survival of patients with stage 1 lung cancer detected on CT screening. The New England Journal of Medicine. 2006. 355(17):1763-71.

Kelsey, C. et al. Local/regional recurrence following surgery for early-stage lung cancer: A 10-year experience with 975 patients. Journal of Clinical Oncology. 2008. 26, No 15S(May 20 Suppl):7542.

Kelsey, C. et al. Local recurrence following initial resection of NSCLC: salvage is possible with radiation therapy. Cancer. 2006. 12(4):283-8.

Labadede, O. et al. TNM Staging of Lung Cancer – A Quick Reference Chart. Chest. 1999. 115(1):233-235.

Martini, N. et al. Incidence of local recurrence and second primary tumors in resected stage 1 lung cancer. Journal of Thoracic and Cardiovascular Surgery. 1995. 109(1):120-9.

National Cancer Institute. Non-Small Cell Lung Cancer Treatment (PDQ). Stage 1 Non-Small Cell Lung Cancer. 08/01/08. http://www.cancer.gov/cancertopics/pdq/treatment/non-small-cell-lung/HealthProfessional/page8.

Pennathur, A. et al. Stereotactic radiosurgery for the treatment of stage 1 non-small cell lung cancer in high risk patients. Journal of Thoracic and Cardiovascular Surgery. 2009. 137(3):597-604.

Scott, W. et al. Treatment of Non-small Cell Lung Cancer Stage I and Stage II: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition). Chest. 2007. 132(3 Suppl):234S-242S.

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