What Are the Stages and Survival Rates of NSCLC?

Non-small cell lung carcinoma (NSCLC) is staged to determine the size and spread of the tumor. Learn about stages and survival rates

Non-small cell lung carcinoma (NSCLC) is staged to determine:

• Size of the tumor
• Whether the cancer has spread
• How far the cancer has spread

Staging helps the doctor plan treatment and predict the survival rate (prognosis) for the patient. 

Stages

Staging can be done in different ways. In one method used by the SEER (surveillance epidemiology, end results) database, NSCLC can be divided into three stages:

1. Localized: Has not spread beyond the lungs.
2. Regional: Has spread beyond the lungs to nearby structures or lymph nodes.
3. Distant: Has spread to distant organs.

NSCLC can also be staged according to the American Joint Committee on Cancer (AJCC) TNM staging method, which is commonly used by health professionals. Staging is based on three main parameters:

1. Tumor size (T): Determines the size of the main tumor and whether it has grown into nearby structures or organs.
2. Lymph node involvement (N): Determines whether the cancer has spread to nearby lymph nodes.
3. Metastasis (M): Determines whether the cancer has spread to distant organs, such as the liver, brain, adrenal glands, etc.

Survival rates

Staging helps determine the survival rates or prognosis of the disease. Survival rates are generally expressed as a 5-year relative survival rate, which indicates the percentage of people with the same stage of NSCLC who are likely to live for at least 5 years after being diagnosed, compared to the general population. 

For example, if the 5-year relative survival rate for a particular stage of NSCLC is 50%, it means that a person with that stage of NSCLC has a 50% likelihood of living at least for the next 5 years compared to the overall population.

Localized
63%

Regional
35%

Distant
7%

All SEER stages combined
25%

^{The above data is based on the values obtained from patients diagnosed between 2010-2016. Individual survival rates may differ based on several other factors, such as the general health of the patient and how early the treatment was started after diagnosis.}

What is NSCLC?

Non-small cell lung carcinomas are the most common type of lung cancer, accounting for about 85% of all lung cancer cases. Based on the types of cells (histology) that form the cancer, NSCLC is further divided into subtypes:

• Adenocarcinoma
• Squamous cell carcinoma
• Large cell carcinoma

NSCLC may not present with any symptoms in its initial stages. About 55% of patients have a distant spread of the disease by the time they are diagnosed. Localized disease is seen in about 20% of the cases at the time of diagnosis while the rest (25%) present with a regional spread at the time of diagnosis.

What are the symptoms of NSCLC?

Symptoms of non-small cell lung carcinoma may vary depending on the stage of the disease. Patients generally present with:

• Cough
• Difficulty breathing
• Chest pain or discomfort
• Hemoptysis (coughing up blood)
• Noisy breathing or wheezing
• Frequent chest infections
• Hoarseness
• Unexplained weight loss
• Appetite loss
• Poor stamina
• General feeling of being unwell

Additional symptoms may appear when the cancer spreads (metastasizes) depending on the site of metastasis:

• Bone pain
• Headache
• Dizziness
• Numbness or tingling
• Weakness of limbs
• Seizures
• Back pain
• Pain abdomen

What is the treatment for NSCLC?

Treatment of NSCLC largely depends on the stage of the disease, as well as the patient’s general health, existing comorbidities, tolerance to the treatment, type of tumor, and lung function. 

In patients with localized tumors, surgery is the treatment of choice. Post-surgery, chemotherapy may be given to prevent tumor recurrence. Radiation therapy may be used in inoperable cases. Radiation therapy may be given after surgery to destroy the residual tumor and prevent a recurrence.

Targeted drug therapy involves using medications that kill cancer cells by targeting their specific abnormalities or requirements. These include drugs that:

• Inhibit new blood vessel formation or angiogenesis (angiogenesis inhibitors, such as bevacizumab and ramucirumab)
• Bind to the KRAS G12C protein thereby inhibiting cancer cell growth (KRAS inhibitors, such as sotorasib)
• Block the EGFR protein thereby inhibiting cancer cell growth (EGFR inhibitors, such as erlotinib, afatinib, and osimertinib)

Additionally, drugs that use the person’s immune system to kill cancer cells (immunotherapy) may be used and include nivolumab, atezolizumab and durvalumab. Treatment involves medications and measures to ease symptoms and improve the person’s quality of life.