Non-Small Cell Lung Cancer Stage I

Stage I non-small cell lung cancer is an early form of the disease where the tumor is small and has not spread beyond the lung. With proper treatment, many people with this stage have a good chance of living for many years.

Table of contents

• What Is Non-Small Cell Lung Cancer Stage I?
• Subtypes of Stage I
• Symptoms
• How Doctors Diagnose the Disease
• Treatment Options
• Outlook and Prognosis

What Is Non-Small Cell Lung Cancer Stage I?

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, making up about 80% to 85% of all lung cancer cases^[2]. Stage I represents an early phase of the disease where the cancer is still small and confined to the lung.

In stage I non-small cell lung cancer, the tumor has not spread to the lymph nodes (small bean-shaped structures that help fight infection) or to other parts of the body^[5]. This makes it easier to treat compared to more advanced stages. The cancer cells are larger than those in small cell lung cancer and typically grow more slowly^[2].

Stage I is also called early-stage lung cancer. It can often be cured, and most people can expect to live 5 years or longer with proper treatment^[18].

• Lungs
• Bronchi (airways)
• Pleura (membrane surrounding the lungs)

Subtypes of Stage I

Doctors divide stage I non-small cell lung cancer into two main subtypes: stage IA and stage IB. These subtypes help doctors understand how serious the cancer is and decide on the best treatment approach^[5].

Stage IA

Stage IA means the tumor is no larger than 3 centimeters at its widest part—about the size of a walnut^[18]. This stage is further divided into three substages based on the exact size of the tumor^[5]:

• Stage IA1: The cancer may be a type called minimally invasive adenocarcinoma, with the tumor no more than 3 centimeters wide and grown no more than 0.5 centimeters into deeper lung tissue. Alternatively, the tumor is 1 centimeter or less and has not grown into the membranes surrounding the lungs or the main branches of the airways^[5].
• Stage IA2: The tumor is between 1 and 2 centimeters. It has not grown into the membranes around the lungs or the main airways^[5].
• Stage IA3: The tumor is between 2 and 3 centimeters. It has not spread into the membranes around the lungs, the main airways, nearby lymph nodes, or distant parts of the body^[5].

Stage IB

Stage IB means one or more of the following conditions exist^[5]:

• The tumor is between 3 and 4 centimeters in size
• The tumor is smaller than 4 centimeters but has grown into the main airway of the lung (called the main bronchus)
• The tumor is smaller than 4 centimeters and has grown into the membrane covering the lung (called the visceral pleura)
• The tumor is smaller than 4 centimeters and has caused the lung to partly or completely collapse by blocking the airway or causing inflammation of the lung tissue^[5]

In all stage IB cases, the cancer has not spread to nearby lymph nodes or other parts of the body^[5].

Symptoms

Stage I non-small cell lung cancer may not cause any symptoms at all. Many people with early-stage lung cancer feel completely normal^[2]. However, when symptoms do occur, they can include^[2]:

• A new cough that lasts 3 weeks or more
• A cough that gets worse over time
• Coughing up blood or blood-stained mucus
• Chest pain
• Pain or ache when breathing or coughing
• Shortness of breath
• Hoarseness (a rough or strained voice)
• Tiredness or lack of energy
• Loss of appetite
• Weight loss without trying
• Wheezing
• Infections like pneumonia or bronchitis that don’t get better or keep coming back^[18]

Because stage I lung cancer often does not cause noticeable symptoms, it is frequently discovered during tests done for other reasons. This is why early detection and screening are so important^[2].

How Doctors Diagnose the Disease

Your healthcare provider will perform a physical examination and ask about your symptoms and medical history. If they suspect non-small cell lung cancer, they will recommend certain tests to diagnose and determine the stage of the disease^[2].

Medical tests that help diagnose non-small cell lung cancer include^[2]:

• Chest X-rays or CT scans (computed tomography scans): These imaging tests create pictures of the inside of your chest to look for abnormal areas
• PET scans (positron emission tomography): These tests help show if cancer has spread to other parts of the body
• MRI scans of the brain: These may be done to check if cancer has spread to the brain
• Lung biopsy: A small sample of tissue is removed and examined under a microscope to confirm the diagnosis
• Bronchoscopy: A thin tube with a camera is inserted through your nose or mouth to view inside your airways
• Video-assisted thoracic surgery (VATS): This helps your provider get a better look inside your chest^[2]

During surgery for non-small cell lung cancer, lymph nodes in the chest and around the lungs are removed and checked for cancer. If there is cancer in more lymph nodes than was shown with earlier tests, the surgery may be stopped because the cancer has spread too far^[7].

Treatment Options

The stage of your cancer helps your doctor decide which treatment you need. Treatment also depends on your type of cancer, where the cancer is located, and your overall health^[5].

Surgery

Surgery is the standard treatment for stage I non-small cell lung cancer for people who are healthy enough to have the operation^[7]. A lobectomy removes the lobe of the lung where the tumor is located. This is the main type of surgery for stage I non-small cell lung cancer and offers the best chance that the cancer will be completely removed^[7].

For people who do not have very good lung function, a wedge resection or segmental resection may be offered. This removes the tumor along with a margin of healthy lung tissue around it^[7]. A sleeve resection removes a tumor from one of the airway tubes of the lung along with a margin of healthy tissue around it^[7].

You may need a second surgery if the lab report shows that there was cancer at the edges (called positive margins) of the tissue that was removed^[7].

Radiation Therapy

Radiation therapy is offered for stage I non-small cell lung cancer if you are not healthy enough to have surgery or if you choose not to have surgery^[7]. If you have stage I non-small cell lung cancer that has been completely removed with surgery, you are typically not offered radiation therapy after surgery. Research has shown that it can reduce survival instead of improving it^[7].

Stereotactic body radiotherapy (SBRT) may be offered if the cancer has not spread outside of the lung. This involves delivering a few high-dose radiation treatments with very high precision^[12]. If you are not able to have SBRT, other types of radiation therapy may be offered^[7].

You may have radiation therapy after surgery if cancer is found in the margins of the tissue that was removed and you cannot have surgery again^[7].

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It may be offered after surgery if you have stage IB non-small cell lung cancer and are healthy enough to receive it. Research has shown it might improve survival in some people with early stage lung cancer^[7].

The most common chemotherapy drug combination used is cisplatin and vinorelbine. If you are not able to take cisplatin, carboplatin and paclitaxel may be used instead^[7].

Immunotherapy

Immunotherapy is a type of treatment that helps your immune system fight cancer. Atezolizumab (Tecentriq) is a drug called a PD-L1 checkpoint inhibitor. It may be offered by itself for stage I non-small cell lung cancer that has been completely removed with surgery and has not progressed after chemotherapy^[7].

Another immunotherapy option involves neoadjuvant treatment (treatment given before surgery). Research shows that immunotherapy with nivolumab combined with chemotherapy for stage IB and II cancer can optimize outcomes^[12].

Clinical Trials

Your doctor may discuss clinical trials with you. Clinical trials look at new ways to prevent, find, and treat cancer. They may offer access to new treatments that are not yet widely available^[7].

Outlook and Prognosis

Stage I lung cancer is considered early-stage disease and often can be cured. Most people with stage I non-small cell lung cancer who receive treatment can expect to live 5 years or longer^[18]. Early detection and treatment are key to improving outcomes^[2].

The specific outlook depends on several factors, including the exact size of the tumor, whether it has grown into nearby structures, your overall health, and how well you respond to treatment. Your healthcare team will work with you to develop a treatment plan based on your individual needs and circumstances^[5].

After treatment, regular follow-up care is important to monitor for any signs that the cancer has returned and to manage any side effects from treatment^[7].