With some important exceptions, the prognosis for lung cancer patients is poor. Lung cancer is the leading cause of cancer-related deaths in the United States making it one of the deadliest cancer types. However prognosis greatly depends on the stage in which the cancer is detected. If the lung cancer is diagnosed in its earliest stages, cure is possible through surgery, chemotherapy, and radiation therapy. Unfortunately, cases of lung cancer are most often detected relatively late in the illness, which makes cure less likely. However, with appropriate treatment, survival and prognosis can be improved considerably.
When physicians discuss prognosis in lung cancer, they often think about the disease in terms of survival rates. A survival rate is determined by observing a large number of patients with lung cancer and seeing how long those people live after diagnosis. For example, a 5-year survival rate would be the percentage of patients that live for five years after diagnosis. Certainly many patients that live for those five years may live for longer, but the five year cutoff is often used for comparison.
Survival rates are divided into meaningful groups. One important grouping for lung cancer survival is the stage at which the disease was diagnosed. These survival rates allow doctors to provide patients with a rough idea about their prognosis. For example, the 5-year survival rate of those with lung cancer is approximately 15%; however depending on cancer type and stage, this number can vary between 1% and 50%.
Non-small cell lung cancer (NSCLC) is associated with a better overall prognosis than small cell lung cancer (SCLC). Like most cancers, the prognosis of NSCLC depends greatly on the stage in which the cancer is diagnosed. The 5-year survival rates are given in the table:
|Non-Small Cell Lung Cancer 5-year Survival Rates|
Race and gender influence prognosis in lung cancer as well. Men are harder hit by lung cancer than women, both in terms of the incidence of cancer and in the deadliness of the disease. In other words, men get lung cancer more often than women and more men die of the disease than women. Black men are especially affected by the disease—they have the highest percentage of lung cancer and mortality of the groups studied. Of note, women that take estrogen hormones have a greater risk of lung cancer-related death than women who do not.
Other than race, gender, and stage, the only two prognostic factors that have been identified as clearly having a role in the outcome of NSCLC are activity and weight loss. Patients that are more active tend to do better than those that are less active. People with NSCLC that are in bed or in a chair more than half of waking hours (assuming eight hours for sleep) do worse than more active people. In fact, it is usually suggested that patients remain as active as possible during treatment and recovery from NSCLC.
Likewise, patients that lose more than 10% of their body weight do worse with NSCLC. Since weight loss can be a symptom of cancer in the first place, the 10% figure represents the weight lost from a healthy, stable weight—even if that weight was measured before the diagnosis of lung cancer was made. Despite a decreased appetite, people with NSCLC are encouraged to maintain their body weight as much as possible.
Small cell lung cancer (SCLC) is particularly challenging for patients and physicians because it is so aggressive (fast growing and spreading). Two-thirds of all patients with SCLC are diagnosed after the disease has already spread throughout the body. As a result, prognosis of SCLC is quite poor.
For SCLC patients that have limited disease, the average life-span in untreated patients is about 12 weeks. Limited disease is defined as SCLC cancer that is completely contained in one half of the chest and can be treated through a single radiation therapy port. With aggressive treatment, the average life-span of limited stage SCLC is 20 months. The 2-year survival rate in limited SCLC is 45% and the 5-year survival rate is 20% with treatment.
For extensive SCLC disease, that is, cancer that has spread beyond half the chest, the average life-span in untreated patients is about 6 weeks. With aggressive treatment, the average life-span is 12 months. The 2-year survival rate with extensive SCLC disease is less than 5%.
Unlike non-small cell lung cancer, a number of prognostic factors can help oncologists provide an accurate prognosis in SCLC. Just as in NSCLC, activity and weight loss are important prognostic factors. In addition, various blood tests are helpful in determining prognosis in SCLC. A high lactate dehydrogenase (LDH) level in the blood is associated with a worse outcome. Also, low sodium in the blood means a faster decline, usually. Higher than normal alkaline phosphatase levels are also a poor prognostic sign.
A true prognosis in lung cancer requires careful consideration by an oncologist. Nevertheless, determining prognosis is not an exact science. Patients outlive doctors’ predictions for survival every day. It is important to stay both realistic and optimistic. Survival rates describe averages across many patients with lung cancer; individual results will vary depending on the extent of the disease, the body’s overall health and resiliency, and the methods of treatment used.
Compensation information is available for those diagnosed with lung cancer in our FREE Lung Cancer Information Packet or by calling toll-free 1-800-258-1054.