Non-Small Cell Lung Cancer Stage II

Stage II non-small cell lung cancer means doctors have found one or more tumors in your lung that have started to spread, but only within the lung or to nearby lymph nodes. While the cancer is more extensive than stage I, surgery and other treatments can often remove it successfully, giving many patients a good chance at longer survival.

Table of contents

• What Is Stage II Non-Small Cell Lung Cancer?
• Substages: IIA and IIB
• Symptoms
• How It Is Diagnosed
• Treatment Options
• Outlook and Prognosis

What Is Stage II Non-Small Cell Lung Cancer?

Stage II lung cancer occurs when your doctor finds one or more tumors in one lung only. The cancer may or may not have spread to the nearest lymph nodes (small structures that are part of the body’s immune system and help fight infection). However, it has not reached distant sites like your bones or other organs^[1].

Non-small cell lung cancer (NSCLC) accounts for about 85% of all lung cancers^[1]. The numbered stages are used mostly with this more common type of lung cancer. Depending on the size of your tumor and the location of any affected lymph nodes, your cancer can be either localized or regional. Stage II lung cancer is sometimes called early stage NSCLC^[3].

Doctors often can remove stage II cancer with surgery^[1]. Many patients with stage II non-small cell lung cancer have a good long-term health outlook as a result.

Substages: IIA and IIB

Doctors divide stage II lung cancer into two more detailed subtypes: stage IIA and stage IIB. The evaluation relies on three main criteria, called TNM: Tumor (how big and where it is), Nodes (whether the cancer is in nearby lymph nodes), and Metastasis (how far the cancer has spread to other parts of the body)^[1].

Stage IIA

Stage IIA means the cancer is only in your lung. The tumor is bigger than 4 centimeters (about the size of a walnut) but not larger than 5 centimeters (the size of a lime). In addition, one or more of the following may be true^[1]:

• Your cancer is in your main airway (bronchus, the tube that carries air into the lungs)
• The cancer is in the membrane that covers your lung
• Part or all of your lung has collapsed
• Your lung is inflamed (pneumonitis, inflammation of lung tissue)
• The cancer has not spread to the lymph nodes
• The cancer has not spread to different parts of the body^[3]

In the TNM staging system, stage IIA is the same as T2b, N0, M0^[3].

Stage IIB

This is the more advanced phase of stage II. Stage IIB can be defined in several different ways^[3].

Stage IIB can mean the cancer is 3 centimeters or smaller and^[3]:

• Has not grown into the membranes that surround the lungs
• Has not grown into the main airways of the lungs
• Has spread to lymph nodes within the lung on the same side as the cancer and might have spread to the lymph nodes where the bronchus enters the lung
• Has not spread to a different part of the body

Or stage IIB means one or more of the following^[3]:

• The cancer is between 3 centimeters and 5 centimeters
• It is smaller than 5 centimeters and has grown into the main airway of the lung
• It is smaller than 5 centimeters and has grown into the membrane covering the lung
• It is smaller than 5 centimeters and has caused the lung to partly or completely collapse by blocking the airway or causing inflammation of the lung tissue
• It has spread to lymph nodes within the lung on the same side as the cancer and might have spread to the lymph nodes where the bronchus enters the lung
• It has not spread to a different part of the body

Or stage IIB means one or more of the following^[1][3]:

• The tumor size ranges from larger than 5 centimeters to 7 centimeters
• The cancer has reached your chest wall or its membranes, the nerves connected to your diaphragm, or the outer layer of the sac around your heart
• You have more than one tumor in the same area (lobe) of the lung as your main tumor
• It has not spread to the lymph nodes
• It has not spread to different parts of the body

In the TNM staging system, stage IIB is the same as one of the following: T1a-c, N1, M0; T2a-b, N1, M0; or T3, N0, M0^[3].

Symptoms

Most lung cancers are not diagnosed until they’re past stage II. That’s partly because this cancer grows fast and because you may not notice any signs until the disease becomes more serious. Symptoms are typically mild and could be mistaken for less serious health problems like asthma or the flu^[1].

Stage II lung cancer symptoms may include^[1]:

• A cough, bronchitis, or pneumonia that doesn’t go away
• Weight loss
• Coughing up blood or rust-colored spit
• Chest pain
• Hoarse voice
• Shortness of breath or wheezing
• Tiredness

How It Is Diagnosed

Some stage II lung cancer is detected through routine chest imaging. More likely, your doctor may check for it after you report symptoms^[1].

If lung cancer is suspected, your doctor will do a physical examination and ask about your symptoms and medical history. They will recommend certain tests to diagnose and stage the disease^[1].

Imaging Tests

A chest X-ray is often the first imaging test. If it suggests you have cancer, you’ll have follow-up tests, including one or more scans^[1]:

• Computed tomography (CT) scan
• Positron emission tomography (PET) scan
• MRI (magnetic resonance imaging)
• Bone scan

Chest Tests and Biopsy

Several procedures can check to see if your cancer has spread to your chest. The findings can help your doctors decide how best to treat it. Imaging tests include^[1]:

• Endobronchial ultrasound, which uses sound waves to make a picture of the inside of your body
• Endoscopic esophageal ultrasound, where your doctor threads a lighted scope through your throat to peer inside
• Mediastinoscopy and mediastinotomy, where your surgeon makes a small cut on your body to insert an instrument to get tissue samples

A biopsy is when a doctor examines a sample of your tissue under a microscope to look for cancer cells. This is the only way to confirm a cancer diagnosis^[1].

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 other health conditions that you have^[3].

Surgery

Surgery is a standard treatment for stage II non-small cell lung cancer for people who are well enough to have surgery^[5]. If you are fit enough, you usually have surgery to remove part of your lung or all of the lung^[3].

A lobectomy removes the lobe of the lung where the tumor is. This is the main type of surgery for stage II non-small cell lung cancer. It offers the best chance that the cancer will be completely removed^[5].

A wedge or segmental resection removes the tumor along with a margin of healthy tissue around the tumor. This type of surgery may be offered for stage II non-small cell lung cancer if your lung function is not very good^[5].

A sleeve resection removes a tumor from one of the airway tubes of the lung along with a margin of healthy tissue around the tumor^[5].

An extended pulmonary resection or a chest wall resection may be done for stage II non-small cell lung cancer that has spread to the chest wall or other tissues around the lung^[5].

During surgery for non-small cell lung cancer, the 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 diagnostic tests, the surgery may be stopped because the cancer has spread too far for surgery to be helpful as a treatment. You may have to have surgery again if the lab report shows that cancer is found in the margins (edges) of the tissue that was removed^[5].

Chemotherapy

Chemotherapy (treatment with drugs that kill cancer cells) may be offered before or after surgery for stage II non-small cell lung cancer if you are healthy enough to have chemotherapy. Some people might have chemotherapy or chemotherapy with immunotherapy before surgery (called neoadjuvant chemotherapy)^[3].

Research has shown chemotherapy after surgery might improve survival in some people with early stage lung cancer. Your healthcare team will discuss the benefits and risks of chemotherapy with you^[5].

The most common chemotherapy drug combination used is cisplatin and vinorelbine. If you can’t have cisplatin, carboplatin and paclitaxel may be used^[5].

Radiation Therapy

External radiation therapy (treatment that uses high-energy rays to kill cancer cells) is offered for stage II non-small cell lung cancer if you are not well enough to have surgery or if you choose not to have surgery^[5].

If you have stage II non-small cell lung cancer that has been completely removed with surgery, you are not offered radiation therapy after surgery. This is because research has shown that it reduces survival instead of improving it. 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^[5].

Stereotactic body radiotherapy (SBRT) may be offered if the cancer has not spread outside the lung. Other types of radiation therapy include hypofractionated radiation treatments, 3D conformal radiation therapy (3D-CRT), or intensity-modulated radiation therapy (IMRT)^[5].

Chemoradiation

Chemoradiation (chemotherapy combined with radiation therapy) may be offered as a treatment if you can’t have surgery and the tumor is 5 to 7 centimeters in size or if you have cancer that has spread to the lymph nodes. Your healthcare team will discuss the benefits and risks of chemoradiation with you^[5].

Immunotherapy

Atezolizumab (Tecentriq) is a type of PD-L1 checkpoint inhibitor. It may be offered by itself for stage II non-small cell lung cancer^[5]. Immunotherapy works by helping your body’s immune system recognize and attack cancer cells.

Outlook and Prognosis

Doctors often can remove stage II cancer with surgery^[1]. Many patients with stage II non-small cell lung cancer have a good long-term health outlook (prognosis) as a result. Treatment options like surgery can help patients live longer.

The stage of your cancer, along with your overall health and how well you respond to treatment, affects your prognosis. Your healthcare team is the best source of information about your individual outlook and can discuss what to expect based on your specific situation.