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Stage III Lung Cancer (Stage 3)

About 30% of NSCLC patients are diagnosed when they are in Stage III. Prospects for these patients are brighter than for those diagnosed at a more advanced stage. The doctors have more options, and the absence of metastasis (spread) to other parts of the body means there is a chance they can confine the cancer to one section of the anatomy. However, the cancer in both Stage IIIA and Stage IIIB has spread to the lymph nodes and has usually taken up a good deal of volume in the lung tissue, so the situation is very serious and the treatment has a relatively low percentage success rate.

In Stage IIIA, the tumor has extended into lymph nodes in the tracheal area outside the lung, which may include the diaphragm and chest wall, on the same side of the body on which the cancer originated.

In Stage IIIB, the cancer has extended into lymph nodes in the neck or in the opposite lung from its origin.

All forms and stages of lung cancer are established in a definitive diagnosis through a biopsy. This involves the doctor inserting a needle into the chest and withdrawing a sample of tissue. The tissue is examined under a microscope for presence of cancerous cells. Sputum cytology is sometimes employed in suspected lung cancer cases. The material the patient coughs up is analyzed for cancer. This is less definitive than a needle biopsy.

The diagnosis of lung cancer almost always includes investigation to find if the cancer has metastasized. Metastasis means the cancer has spread beyond the organ it originated in. Most types of cancer can metasticize. The cancer is still referred to by the organ of origin. Thus cancers that start in the lung are called lung cancer (metastatic lung cancer) if they spread so other parts of the body become cancerous. The most common places for lung cancer to spread are the liver, the bones, and the brain.

The CT scan of the head can reveal if the cancer has spread to the brain. CT scans of the abdomen can reveal the spread of cancer to the liver and adrenal glands. A scintigraph is an image of the bone generated by injecting radioactive material into the bloodstream and allowing the tracer to preferentially attach to malignant cells. Several hours after injection, a scanner reads radioactivity coming off the bone and a computer algorithm puts together a picture to reveal cancer presence.

Pulmonary function tests are another common set of medical diagnoses procedures for many patients and many illnesses. They are frequently administered to lung cancer patients and can provide some insight into how much lung capacity remains. Doctors will incorporate this into their planning for a treatment plan.

Blood and urine tests are ubiquitous in modern medicine and specific tests may be employed in scoping out the extent of lung cancer.

Epidemiologists have determined the 5-year survival rate when the patients are diagnosed at Stage IIIA is 23%. When the cancer is at Stage IIIB at diagnosis, survival rate is 10%.

Stage 3 of Lung Cancer
Stage TNM (Tumor, Nodes, Metastasis) Definition
IIIA T1a, N2, M0

T1b, N2, M0

T2a, N2, M0

T2b, N2, M0

T3, N1, M0



T3, N2, M0


T4, N0, M0


T4, N1, M0
T1a = Tumor =2 cm in greatest dimension.

T1b = Tumor >2 cm but =3 cm in greatest dimension.

T2a = Tumor >3 cm but =5 cm in greatest dimension.

T2b = Tumor >5 cm but =7 cm in greatest dimension.

T3 = Tumor >7 cm or one that directly invades any of the following: parietal pleural (PL3) chest wall (including superior sulcus tumors), diaphragm, phrenic nerve, mediastinal pleura or parietal pericardium.

Tumor in the main bronchus (<2 cm distal to the carina but without involvement of the carina).

Associated atelectasis or obstructive pneumonitis of the entire lung or separate tumor nodule(s) in the same lobe.

T4 = Tumor of any size that invades any of the following: mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina or separate tumor nodule(s) in a different ipsilateral lobe.

N0 = No regional lymph node metastasis.

N1 = Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension.

N2 = Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s).

M0 = No distant metastasis.
IIIB T1a, N3, M0

T1b, N3, M0

T2a, N3, M0

T2b, N3, M0

T3, N3, M0



T4, N2, M0


T4, N3, M0
T1a = Tumor =2 cm in greatest dimension.

T1b = Tumor >2 cm but =3 cm in greatest dimension.

T2a = Tumor >3 cm but =5 cm in greatest dimension.

T2b = Tumor >5 cm but =7 cm in greatest dimension.

T3 = Tumor >7 cm or one that directly invades any of the following: parietal pleural (PL3) chest wall (including superior sulcus tumors), diaphragm, phrenic nerve, mediastinal pleura or parietal pericardium.

Tumor in the main bronchus (<2 cm distal to the carina but without involvement of the carina).

Associated atelectasis or obstructive pneumonitis of the entire lung or separate tumor nodule(s) in the same lobe.

T4 = Tumor of any size that invades any of the following: mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina or separate tumor nodule(s) in a different ipsilateral lobe.

N2 = Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s).

N3 = Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene or supraclavicular lymph node(s).

M0 = No distant metastasis.

 

Treatment

Treatment options include surgery, radiation, and chemotherapy. Multi-modality treatment (more than one type of treatment) are common in treatment of Stage III. The oncology team determines the appropriate treatment for a given patient based on many factors. The patient's age and overall health are important in determining eligibility for surgery. There are many chemotherapy medicines and combination regimens available and more are in development.

Treatment for stages 2 and 4 are more straightforward. Stage III requires the most discernment from the medical team because there is less of a consensus as to what course of action to take. Indeed, the National Cancer Institute recommends clinical trials for Stage III patients – the thinking is that Stage IV patients should only be treated with palliative care while stage 2 patients stand a good chance of survival with currently approved treatment methods, while Stage III patients are not likely to recover with conventional treatments but still have a fair chance of benefitting from potentially curative treatment.

Compensation information is available for those diagnosed with lung cancer. Call us toll-free at 1-800-258-1054.

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