Stage 3 Lung Cancer Symptoms, Treatments, and Life Expectancy

An Overview of Stage 3 Lung Cancer

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If you have been told that you have stage 3 lung cancer, you're likely frightened and nervous. What does this mean? What kind of treatments are used for this stage of lung cancer? And, what is the prognosis?

Before we begin talking about this stage of cancer it's important to note that significant advances in both the treatment of survival rate for stage 3 lung cancer have occurred in just the past few years.

You may have family or friends who have had lung cancer in the past or may notice people respond to you with a frown when they hear you have stage 3 lung cancer. You may need to politely remind your loved ones that treatments have improved and there are now many ways to treat this stage of the disease with further methods available in clinical trials.

What Is Stage 3 Lung Cancer?

Stage 3 non-small cell lung cancer is a broad and diverse category of lung cancers that is further broken down into stage 3A and stage 3B. Since stage 3A and 3B are very different and often treated quite differently, let's define these separately.

  • Stage 3A lung cancer - Stage 3A lung cancers are considered locally advanced lung cancers. These are tumors which have not spread to distant regions of the body (they have not metastasized,) but have spread to lymph nodes somewhere in the chest, but on the same side of the body as the cancer. Stage 3A lung cancers may be considered operable (similar to stage 1 and stage 2 lung cancers.)
  • Stage 3B lung cancer - Along with stage 4 lung cancer, stage 3B lung cancer is considered an advanced lung cancer. These cancers have invaded or spread to nearby tissues to a degree such that surgery is not possible; at least not initially. While these cancers are not usually curable, they are very treatable and a wide range of treatments are available. In time, a 3B lung cancer is reduced in size enough with chemotherapy and radiation that surgery—and hence, the chance of a cure—may be possible.

    Prevalence

    Roughly 30 percent of people have stage 3 lung cancer at the time of diagnosis. Roughly 30 percent of people are diagnosed at an earlier stage (stage 1 or stage 2) and 40 percent of people have already progressed to stage 4 lung cancer, the most advanced stage of the disease.

    Staging

    Lung cancer staging is a very important step in choosing the best treatment options, especially making the distinction between stage 3A and stage 3B. 

    • 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.
    • Stage 3B lung cancer is defined as a tumor of any size that has spread to distant lymph nodes or has invaded other structures in the chest (such as the heart or esophagus.) Tumors involving a malignant pleural effusion (fluid build-up containing cancer cells in the pleural cavity between the layers lining the lungs) were changed from stage 3B to stage 4 in 2009.

    Oncologists use the TNM system to further define stages of lung cancer. A simplified description of the TNM system includes:

    T 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.

    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 3A lung cancer is described as:

      • T1N2M0 – 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.

      Using the TNM System, stage 3B is described as:

      • Any T, N3, M0 – 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 – A tumor of any size that is located in the airways, or has invaded local structures such as the heart or esophagus. 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

      Stage 3 lung cancer is most often diagnosed when a person sees their physician with some type of symptoms. Common lung cancer symptoms with stage 3 lung cancer include:

      • A persistent cough
      • Shortness of breath
      • Coughing up blood
      • Wheezing
      • Repeated respiratory infections such as pneumonia or bronchitis.

      Wheezing and coughing up blood are more common in tumors located near the large airways of the lungs (the bronchi and bronchioles) whereas shortness of breath is more common with tumors located deep within the lungs. Tumors that are located in the outer regions of the lungs near the lung lining (the pleura) may cause pleurisy, a type of usually sharp chest pain which worsens with breathing.

      Since many of these cancers have spread locally, people may have symptoms of pain in their chest, ribs, shoulders, or back. When a tumor involves areas such as the esophagus and other chest structures, dysphagia (difficulty swallowing) and hoarseness can occur. 

      General symptoms of cancer such as fatigue and unintentional weight loss may be present as well.

      Treatments

      The treatment of stage 3 lung cancer is the most controversial of all lung cancer stages, partly because this group is so varied. The National Cancer Institute recommends that anyone with stage 3 lung cancer consider taking part in a clinical trial, studies that evaluate new treatments of combinations of treatments.

      One of the most significant advances in the treatment of lung cancer, especially non-small cell lung cancer, has been the addition of targeted therapies. There are now several treatments available which specifically target lung cancer cells. In addition, immunotherapy drugs have been approved that, when effective, have resulted in long-term survival for some people with even the advanced stages of lung cancer. Treatment options include:

      Surgery

      For some stage 3A lung cancers, lung cancer surgery can be performed to remove the tumor. Since the risk of recurrence is fairly high, this is usually followed by adjuvant chemotherapy (chemotherapy after surgery) to address any cancer cells which may have spread away from the tumor. For stage 3B lung cancers, surgery is not usually the best treatment. For some people, however, chemotherapy (neoadjuvant chemotherapy) may reduce the size of the tumor so that surgery is then possible.

      Chemotherapy

      Chemotherapy and radiation therapy are both often used to treat stage 3 lung cancers. As noted above, chemotherapy may be used either before or after surgery, or may be used alone for those who have cancers which cannot be treated with surgery. Chemotherapy may also be combined with other treatments for lung cancer.

      Radiation Therapy

      As noted above, radiation therapy is often used along with chemotherapy to treat areas involved with stage 3 lung cancer which cannot be surgically treated. Radiation therapy can also be effective for dealing with complications related to stage 3 lung cancer, such as obstruction of the airways by a tumor.

      Targeted Therapy

      Everyone with non-small cell lung cancer should have molecular profiling (gene testing) done on their tumor. especially those with lung adenocarcinoma. Medications have been approved for people with driver mutations such as EGFR mutationsALK rearrangements, and ROS1 rearrangements, and these targeted therapies can sometimes result in excellent control of the disease. Resistance often develops in time, but next generation medications are currently approved and being tested in clinical trials for when this occurs. For those with squamous cell carcinoma of the lungs, anti-EGFR antibodies may be used. Clinical trials are also studying medications which address other genetic changes in lung cancer.

      Immunotherapy

      Two new immunotherapy drugs were approved in 2015 for the treatment of lung cancer. These medications work by essentially enhancing the ability of our own immune systems to fight cancer. While they do not work for everyone, some people have achieved long-term disease-free control of their cancer.

      Life Expectancy

      Many people wonder about the prognosis of their cancer, but it's important to say a few things about what life expectancy statistics mean with regard to stage 3 disease.

      There are many variables which can affect life expectancy with lung cancer. Some of these include your age, your sex, the location of your tumor, the molecular profile of your tumor, your general health at the time of diagnosis, and how you respond to the treatments you receive.

      It's also important to say a word or two about statistics. Statistics tell us how the "average" person will do with a disease, but nobody is "average." In addition, statistics are, by definition, old. When we talk about the 5-year survival rate from a disease, we are referring to how well people did who were diagnosed at least 5 years ago. Since there were more drugs approved for lung cancer between 2011 and 2017 than had been approved during the preceding 40 years, these numbers may not be very helpful.

      That said, the median life expectancy for stage 3 non-small cell lung cancer (the time at which 50 percent of patients are alive and 50 percent have passed away) is around 15 months for stage 3 lung cancer. The 5-year survival rate—that is the percent of people who are expected to be alive 5 years after a diagnosis of stage 3 lung cancer—is sadly only 14 percent for stage 3A and around 5 percent for stage 3B.

      As a final note, it's time to dispel some of the myths about clinical trials.The idea of people being guinea pigs had some basis in the past, as many medications were first tested on humans with little knowledge of how they would work. This has changed drastically. Now, most of the new cancer medications being studied have been carefully designed to address specific targets on cancer cells or specific roles that the immune system plays in fighting cancer. It has changed to the point at which phase 1 trials—the first clinical trials in which a new drug is tested in humans—not only are much safer but are often the only option for keeping the disease at bay. The only option to stay alive.

      A Word From Verywell

      Studies suggest that learning what you can about your cancer helps with the outcome. Ask questions. Involve your loved ones and encourage them to ask questions as well. Consider joining a support group and/or connect with the amazing lung cancer community online. In recent years this community has flourished and you will be welcomed in with open arms.

      Learn about clinical trials that might be appropriate for your particular situation. In fact, on Twitter, there is a tweet chat every other week in which patients, caregivers, researchers, and oncologists all draw together to discuss the latest research as well as a wide arrange of concerns related to lung cancer. To find the community, use the hashtag "LCSM" which stands for lung cancer social media.

      Ask for and allow your loved ones and friends to help and encourage 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:

      Boffa, D., Fernandez, F., Kim, S. et al. Surgically Managed Clinical Stage IIIA-Clinical N2 Lung Cancer in The Society of Thoracic Surgeons Database. Annals of Thoracic Surgery. 2017 May 17. (Epub ahead of print).

      National Cancer Institute. Non-Small Cell Lung Cancer Treatment (PDQ) – Health Professional Version. Updated 03/21/17. https://www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq

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