Stage 3A non-small cell lung cancer is considered a “locally advanced” cancer, meaning the tumor has not spread to distant regions of the body but has spread to lymph nodes on the same side of the body as the tumor. Roughly 10% of people have stage 3A lung cancer at the time of diagnosis, with 60% of people having more advanced stages of the disease.
Definition of Stage 3A Non-Small Cell Lung CancerStage 3A lung cancer includes tumors that are large and have spread to nearby lymph nodes, or tumors of any size that have spread to lymph nodes that are further away but still on the same side of the body as the cancer.
Oncologists use the TNM system to further define stages of lung cancer. A simplified description of the TNM system includes:
T – That refers to tumor size:
- T1 – A tumor is less than 3 cm (1 ½ inches) in size
- T2 –The tumor is greater than 3 cm
- T3 – The tumor can be any size, but is near the airway or has spread to local areas such as the chest wall or diaphragm
- T4 – The tumor is any size, but is located in the airway, or has invaded local structures such as the heart or the esophagus. A tumor is also considered T4 if cancer cells are present in the space between the layers lining the lungs (malignant pleural effusion).
N refers to lymph nodes:
- N0 – No lymph nodes are affected
- N1 – The tumor has spread to nearby nodes on the same side of the body
- N2 – The tumor has spread to nodes further away but on the same side of the body
- N3 – Cancer cells are present in lymph nodes on the other side of the chest from the tumor, or in nodes near the collarbone or neck muscles
M represents metastatic disease:
- M0 – No metastases are present M0 – The tumor has spread (metastasized) to other regions of the body or the other lung
Using the TNM System, Stage 3A lung cancer is described as:
- T1N2M0 – Meaning the tumor is less than 3 cm in size and has spread to lymph nodes further away but on the same side of the body as the tumor
- T2N2M0 – The tumor is larger than 3 cm, and has spread to lymph nodes further away but on the same side of the body
- T3N1M0 – The tumor is any size but is near an airway or has spread locally to an area like the chest wall or diaphragm, and nearby lymph nodes are affected
- T3N2M0 – The tumor is any size but is near an airway or has spread locally to an area like the chest wall or diaphragm, and lymph nodes that are further away but on the same side of the body are affected
SymptomsSymptoms of stage 3A lung cancer are variable since stage 3A includes a wide spectrum of cancers. Symptoms due to cancer in the lungs such as a persistent cough, shortness of breath, and repeated infections such as pneumonia or bronchitis, are common. Spread to areas such as the chest wall and diaphragm can result in pain in the chest, ribs, shoulders, and back. Tumors located near the airways can cause hemoptysis (coughing up blood), wheezing, and hoarseness.
TreatmentThe treatment of stage 3A lung cancer is the most controversial of all lung cancer stages, partly because this group is so varied. Due to the poor survival rate, the National Cancer Institute states that everyone with stage 3A lung cancer should be considered a candidate for clinical trials –- studies that are evaluate new treatments or combinations of treatments for lung cancer.
In some cases, surgery can be performed to remove the tumor, and is usually followed up with adjuvant chemotherapy (chemotherapy after surgery). Preoperative chemotherapy (chemotherapy before surgery) has been found to improve survival in a few studies. Combination chemotherapy (using a combination of chemotherapy medications) along with radiation therapy or another treatment is often used if a stage 3A lung cancer is considered inoperable because of it’s location, how far it has spread, or if your general health would make surgery risky. For those that are unable to tolerate surgery or chemotherapy, radiation therapy remains an option.
PrognosisThe overall 5-year survival rate with stage 3A lung cancer is 23%, but this varies widely among different cancers that are classified as stage 3A.
What Can I Do to Help Myself?Studies suggest that learning what you can about your cancer helps with the outcome. Of all the stages of lung cancer, stage 3A is the most variable, and has the greatest number of options for treatment. Ask questions. Involve your loved ones and encourage them to ask questions as well. Consider joining a support group. Learn about clinical trials that might be appropriate for your particular situation. Learning about your cancer and going through treatment can take a tremendous amount of time. Ask for, and allow your loved ones and friends to help and encourage you in your journey.
- How to Find a Lung Cancer Support Group
- Supporting a Loved One With Cancer
- Tips for Improving Lung Cancer Survival
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Labadede, O. et al. TNM Staging of Lung Cancer – A Quick Reference Chart. Chest. 1999. 115(1):233-235.
National Cancer Institute. Non-Small Cell Lung Cancer Treatment (PDQ). Stage IIIA Non-Small Cell Lung Cancer. 08/01/08. http://www.cancer.gov/cancertopics/pdq/treatment/non-small-cell-lung/HealthProfessional/page10.
Robinson, L. et al. Treatment of Non-small Cell Lung Cancer – Stage IIIA: ACCP Evidence-Based Clinical Guidelines (2nd Edition). Chest. 2007. 132(3 Suppl):243S-265S.
Santos, E. et al. Controversies in the management of stage IIIA non-small-cell lung cancer. Expert Review of Anticancer Therapy. 2008. 8(12):1913-29.