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Stage 3B Non-Small Cell Lung Cancer

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Updated April 10, 2014

Stage 3B non-small cell lung cancer is considered advanced lung cancer along with stage 4, and though it is not usually curable, it is treatable. About 20% of people have stage 3B lung cancer at the time of diagnosis, with another 40% of individuals having already progressed to stage 4.

Definition of Stage 3B Non-Small Cell Lung Cancer

Stage 3B lung cancer is defined as a tumor of any size that has spread to distant lymph nodes, has invaded other structures in the chest (such as the heart or esophagus), or has a malignant pleural effusion (fluid build-up containing cancer cells between the layers lining the lungs).

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 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
  • M1 – The tumor has spread (metastasized) to other regions of the body or the other lung

Using the TNM System Stage 3B is described as:

  • Any T, N3, M0 – Meaning a tumor of any size that has spread to lymph nodes on the other side of the chest from the tumor or to nodes near the collarbone or neck muscles, but has not spread to distant regions of the body
  • T4, Any N, M0 – Meaning a tumor of any size that is located in the airways, has invaded local structures such as the heart or esophagus, or has a malignant pleural effusion. Nodes may or may not be involved, and when affected, can be near the tumor or further away in the chest or neck, but the tumor has not spread to distant regions of the body

Symptoms

Common symptoms of Stage 3 lung cancer include a persistent cough and shortness of breath. Tumors near the airways can result in hemoptysis (coughing up blood). When the tumor involves areas such as the esophagus and other chest structures, dysphagia (difficulty swallowing) and hoarseness can occur. Pain in the back, chest, and ribs is common if a pleural effusion is present, and this can result in increasing shortness of breath as well. General symptoms of cancer such as fatigue and unintentional weight loss may be present as well.

Treatment

With rare exceptions, stage 3B lung cancer is considered inoperable (surgery will not cure the cancer), but is not untreatable. For those that are relatively healthy, a combination of chemotherapy or chemotherapy and radiation therapy is often recommended. If individuals are unable to tolerate chemotherapy, radiation therapy can be used alone. While radiation therapy is not usually given with the intent of curing cancer, it can be helpful in treating symptoms such as pain, shortness of breath, and coughing.

Because treatment outcomes are poor, the National Cancer Institute states that all individuals with stage 3 lung cancer should be considered candidates for clinical trials -– studies that evaluate new treatments and treatment combinations for lung cancer.

Prognosis

The 5-year survival rate with stage 3B lung cancer is similar to stage 4 lung cancer at only about 10%. The median survival time (time at which 50% of patients are alive and 50% have passed away) is roughly 13 months with treatment.

What Can I Do to Help Myself?

Studies suggest that learning what you can about your cancer helps with the outcome. Ask questions. Consider joining a support group. Learn about clinical trials that might be appropriate for your particular cancer and situation. Ask for, and learn to let others help you in your journey. Don’t lose hope -– even if that hope is only to be as comfortable as possible while you enjoy the company of your loved ones.

Sources:

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

Faithi, A. and J. Brahmer. Chemotherapy for advanced stage non-small cell lung cancer. Seminars in Thoracic and Cardiovascular Surgery. 2008. 20(3):210-6.

Jett, J. et al. Treatment of Non-small Cell Lung Cancer – Stage IIIB: ACCP Evidence-Based Clinical Guidelines (2nd Edition). Chest. 2007. 132(3 Suppl):266S-276S.

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 IIIB Non-Small Cell Lung Cancer. 08/01/08. http://www.cancer.gov/cancertopics/pdq/treatment/non-small-cell-lung/HealthProfessional/page11

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