Large Cell Lung Cancer Stage III

Large cell lung cancer stage III is a locally advanced form of cancer where the disease has begun to spread beyond the lungs to nearby tissues and lymph nodes, but has not yet reached distant parts of the body. Understanding this stage and the available treatment options is essential for patients facing this diagnosis.

Table of contents

• What is Large Cell Lung Cancer?
• Understanding Stage III Disease
• Stage III Substages
• How Common is Stage III Large Cell Lung Cancer?
• Signs and Symptoms
• Diagnosis Process
• Treatment Approaches
• Outlook and Survival

What is Large Cell Lung Cancer?

Large cell lung cancer, also called large cell carcinoma, is a type of non-small cell lung cancer (NSCLC) that begins in cells making up the outer lining of the lungs. It is the least common type of lung cancer, accounting for about 1 in 10 cases of all lung cancers^[3].

Under a microscope, the cancer cells in large cell carcinoma appear larger than those in small cell lung cancer. This size difference is one way doctors distinguish between different types of lung cancer. Large cell carcinoma tends to be less aggressive and more treatable than small cell lung cancer^[3].

There are two main types of lung cancer: small cell lung cancer and non-small cell lung cancer. Non-small cell lung cancer is further divided into three types: adenocarcinoma (which begins in glandular cells on the outer part of the lungs), squamous cell carcinoma (which begins in thin, flat cells lining the airways), and large cell carcinoma^[3].

Understanding Stage III Disease

Stage III lung cancer is sometimes called locally advanced cancer. At this stage, the cancer has started to spread beyond the lungs to other organs in the chest, but it has not spread to distant parts of the body^[1]. The cancer is considered more advanced than stages I and II, but not as advanced as stage IV.

Stage III lung cancer tumors may be found in various locations within the chest. The cancer can spread to the bronchus (the main airway of the lungs), the diaphragm (the muscle that helps with breathing), the esophagus, the heart and its lining called the pericardium, lymph nodes on either side of the chest, the mediastinum (the space between the lungs), the pleura (lung lining) and chest wall, or even the spine^[5].

Almost always, stage III cancer is present in just one lung. It is also limited to the lymph nodes, organs, and other tissue near that organ. The cancer has not spread, or metastasized, beyond the chest area^[8].

Stage III Substages

Doctors divide stage III lung cancer into three substages: 3A, 3B, and 3C. These substages help doctors get a more detailed picture of the cancer and decide on the best treatments. The differences between each substage are based on the size of the tumor, where it is located, and whether it has spread to the lymph nodes or not^[2].

Stage IIIA

In stage IIIA, the cancer may be 3 cm or smaller and has spread to lymph nodes in the area where the windpipe divides (the carina) or the space between the lungs (mediastinum) on the same side as the cancer. The cancer has not spread to other parts of the body^[1].

Stage IIIA can also mean the cancer is between 3 cm and 5 cm, or it has grown into the main airway of the lung (main bronchus), or into the membrane covering the lung (visceral pleura), and has spread to lymph nodes in the same area^[1].

Another possibility is that the cancer is between 5 cm and 7 cm and has grown into the chest wall (ribs, muscle or skin), the inner lining of the chest wall, the nerve close to the lung (the phrenic nerve), or the layers of the sac that covers the heart. There may be two or more areas of cancer in the same lobe of the lung, but it has not spread to lymph nodes^[1].

Stage IIIA can also describe cancer larger than 7 cm that has grown into various structures such as the diaphragm, the center area of the chest (mediastinum), the heart, major blood vessels, the windpipe (trachea), the nerve that goes to the voice box, the esophagus, a spinal bone, or the area where the windpipe divides. In this case, the cancer has spread to lymph nodes within the lung on the same side as the cancer^[1].

Stage IIIB

Stage IIIB describes cancer that has spread to lymph nodes in the space between the lungs (mediastinum) on the opposite side of the lung with cancer, or to lymph nodes where the bronchus enters the lung (hilar lymph nodes) in the opposite lung, or to lymph nodes in the side of the neck or above the collarbone on either side of the body. The cancer itself can be any size and may have grown into nearby structures^[1].

Stage IIIC

Stage IIIC is the most advanced stage within stage III. One or more tumors are present in the same lung. The cancer has spread to lymph nodes above the collarbone or to lymph nodes on the opposite side of the chest. The cancer may be in the chest wall, heart, breastbone, and other nearby tissues but has not spread to distant organs^[8].

How Common is Stage III Large Cell Lung Cancer?

About 30% of people with non-small cell lung cancer are diagnosed at stage III^[2]. Around one-third of lung cancer diagnoses occur at this stage, partly because people do not always notice symptoms at stage I or II^[6].

Roughly 20% of non-small cell lung cancer patients are diagnosed at stage III, according to research^[5]. Most patients with stage III lung cancer show poor differentiation and are diagnosed at an advanced stage^[11].

Signs and Symptoms

Most non-small cell lung cancer is found after it has become advanced. This happens partly because the disease worsens quickly and often does not have signs in the early stages^[8].

Common symptoms of stage III lung cancer include:

• A cough that will not go away (the most common symptom)
• Weight loss
• Shortness of breath or wheezing
• Pain in the chest
• Coughing up blood or rust-colored spit
• A hoarse voice

If stage III lung cancer has spread beyond the lungs to nearby structures, it can cause other symptoms. For example, if it has spread to bones in the chest area, patients may experience bone pain^[8].

Diagnosis Process

A diagnosis of large cell carcinoma is usually made after a biopsy of the lung tissue. A biopsy is a procedure in which tissue samples are removed from the body so that they can be viewed under a microscope by a pathologist to check for cancer cells^[3].

The pathologist will look at the tissue under a microscope and check for cancer cells. They will also check for certain features that are typical of large cell carcinoma^[3].

Doctors typically find lung cancer after checking symptoms. Most people are not routinely checked for the disease unless they smoke or otherwise face a higher risk. If someone has symptoms of lung cancer, doctors will likely order a chest X-ray to learn more^[8].

If the chest X-ray suggests cancer, follow-up tests will be ordered, such as a CT scan (which creates detailed images of the inside of the body). Doctors may order a “contrast-enhanced” version of this scan, which uses a special dye to make the images clearer^[8].

Treatment Approaches

Stage III lung cancer may be difficult to remove with surgery. The majority of cancer found in people with stage III non-small cell lung cancer is unresectable, meaning the cancer cannot be removed with surgery^[2].

Treatment for stage III lung cancer typically involves a combination of therapies. The standard approach for patients with unresectable, good performance status stage III disease has been platinum-doublet chemotherapy with high dose radiotherapy, given at the same time^[13].

Combining chemotherapy with radiotherapy (chemoradiation or CRT) gives better survival results than radiotherapy alone. This can be given either as concurrent chemoradiation (CCRT), where chemotherapy and radiation are given at the same time, or as sequential chemoradiation (SCRT), where chemotherapy is given first, followed by radiation^[13].

Research has shown that concurrent approaches tend to have better outcomes. Studies found that 5-year overall survival was significantly higher for patients treated with concurrent regimens compared to sequential treatment^[13].

The specific treatment plan depends on various factors, including the type of lung cancer, the exact substage, and the person’s overall health. Surgery combined with chemotherapy may achieve a better prognosis when it is possible^[11].

For elderly patients with stage III non-small cell lung cancer, studies have shown that adding chemotherapy to radiotherapy improves survival, even in older age groups^[13].

Outlook and Survival

Stage III is harder to treat than the earlier stages of lung cancer, but some patients can achieve long-term survival with aggressive treatment^[5].

A person’s outlook with stage III lung cancer depends on various factors, including the type of lung cancer they have, their age, and overall health^[18].

Statistics from England show that around 15 out of 100 people (around 15%) with stage III lung cancer will survive their cancer for 5 years or more after they are diagnosed^[22]. These statistics are based on people diagnosed between 2016 and 2020.

While there is currently no cure for stage III lung cancer, treatments can help extend life and alleviate symptoms. Early detection through screening may improve the outlook^[18].

It is important to remember that survival statistics are based on large groups of people and cannot predict what will happen in an individual case. Many factors influence prognosis, and advances in treatments continue to improve outcomes for patients with stage III lung cancer.