Stage 3A Non-Small Cell Lung Cancer

Definition, Symptoms, Treatment, and Prognosis of Stage IIIA Lung Cancer

Mature female doctor examining female patient with stethoscope
What should I know about stage IIIA lung cancer?. Bruce Ayres/The Image Bank/Getty Images

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 percent of people have stage 3A lung cancer at the time of diagnosis, with 60 percent of people having more advanced stages of the disease.

Definition of Stage 3A Non-Small Cell Lung Cancer

Stage 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 larger than 3 cm but less than 7 cm in size.
  • T3 – The tumor is larger than 7 cm or directly invades any of the following: the chest wall, the diaphragm, the nerve innervating the diaphragm (phrenic nerve), membrane covering the space between the two lungs (mediastinal pleura), or one of the membranes covering the heart parietal pericardium); or the tumor of the main bronchus is at least 2 cm below the carina; or it is associated with the collapse (atelectasis) of the entire lung or separate tumor nodule(s) in the same lobe of the lung.
  • T4 – Tumor of any size that invades any of the following: space between the lungs (mediastinum), heart, great vessels, trachea, one of the nerves innervating the vocal cord (recurrent laryngeal nerve), esophagus, vertebral body, or the place where the trachea splits in the two main bronchi (carina); or separate tumor nodule(s) in a different lung lobe on the same side of the chest.

    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 chest.
    • N2 – The tumor has spread to nodes further away but on the same side of the chest.
    • 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 but less than 7 cm, and has spread to lymph nodes further away but on the same side of the body.
      • T3N1M0 – The tumor is larger than 7 cm or has spread locally to an area like the chest wall or diaphragm, and nearby lymph nodes are affected. (see above definition of T3.)  The tumor is larger than 7 cm 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. 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 (see above definition of T3.)
      • 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 chest are affected.

      Symptoms 

      Symptoms 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.

      Treatment of Stage 3A Lung Cancer

      The 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 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.

      It's important that everyone with non-small cell lung cancer, especially lung adenocarcinoma have genetic testing (molecular profiling). There are several "treatable" mutations such as EGFR mutations, ALK rearrangements, and ROS1 rearrangements which have turned some lung cancers almost into a chronic disease. 

      Immunotherapy is also an exciting option for some people, with the first agent in this category approved for the treatment of lung cancer in 2015. While these treatments do not work for everyone, some people have had long-term control of their disease with these medications.

      Prognosis

      The overall 5-year survival rate with stage 3A lung cancer is 14 percent, but this varies widely among different cancers that are classified as stage 3A. Keep in mind that statistics tell us how people did in years past, and many advances have taken place in the treatment of lung cancer in just the past few years. There is much more room for hope in the treatment of lung cancer relative to that in the past.

      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. Take a moment to check out these tips on how to be your own advocate in your cancer care.  And here are some tips on ways to improve lung cancer survival that your doctor may not mention.

      When Your Loved One Has Lung Cancer

      If it is your loved one who has been diagnosed with lung cancer, you are probably equally as terrified, and being a family caregiver for someone with this disease can leave you feeling frustrated and helpless. Take a moment and check out this article titled "when your loved has lung cancer" to hear what people with lung cancer have hoped their loved ones would know. Here are some tips as well on supporting a loved one with cancer.

      Sources:

      American Cancer Society. Cancer Facts and Figures 2014. Atlanta: American Cancer Society; 2014. http://www.cancer.org/acs/groups/content/@research/documents/webcontent/acspc-042151.pdf

      American Cancer Society. Lung Cancer (Non-Small Cell.) Non-Small Cell Lung Cancer Survival Rates by Stage. 02/08/16. http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-survival-rates

      American Joint Committee on Cancer. Lung Cancer Staging. 7th Edition. Accessed 09/20/14. https://cancerstaging.org/references-tools/quickreferences/Documents/LungMedium.pdf

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

      National Cancer Institute. Non-Small Cell Lung Cancer Treatment (PDQ) – Health Professional Version. Updated 05/11/16. http://www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq#section/all

      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.

      Continue Reading