Stage 2 lung cancer

The stage of a cancer tells you how big it is and whether it has spread. It helps your doctor decide which treatment you need. It can also give some idea of your outlook (prognosis).

Stage 2 is part of the number staging system. It uses the TNM system to divide cancers into stages. There are 4 stages of lung cancer, numbered from 1 to 4.

Stage 2 can be divided into stages 2A and 2B.

Stage 2 NSCLC is sometimes called early stage NSCLC.

Stage 2A

Stage 2A means that the cancer is one or more of the following:

• the cancer is between 4cm and 5cm
• it has grown into the main airway of the lung (main bronchus)
• it has grown into the membrane covering the lung (visceral pleura)
• it has caused the lung to partly or completely collapse by blocking the airway or causing inflammation of the lung tissue (pneumonitis)
• it has not spread to the lymph nodes
• it has not spread to different parts of the body

Stage 2B

There are 3 possible stages for stage 2B.

Stage 2B can mean the cancer is 3 cm or smaller. It:

• has not grown into the membranes that surround the lungs
• has not grown into the main airways of the lungs (bronchi)
• 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 (hilar lymph nodes)
• has not spread to a different part of the body

Or stage 2B means one or more of the following:

• the cancer is between 3cm and 5cm
• it is smaller than 5cm and has grown into the main airway of the lung (main bronchus)
• it is smaller than 5cm and has grown into the membrane covering the lung (visceral pleura)
• it is smaller than 5cm and has caused the lung to partly or completely collapse by blocking the airway or causing inflammation of the lung tissue (pneumonitis)
• 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 (hilar lymph nodes)
• it has not spread to a different part of the body

Or stage 2B means one or more of the following:

• the cancer is between 5cm and 7cm
• it has grown into the chest wall, the inner lining of the chest wall (parietal pleura), the nerve close to the lung (the phrenic nerve), the layers of the sac that covers the heart (parietal pericardium)
• there are two or more tumours in the same lobe of the lung
• it has not spread to the lymph nodes
• it has not spread to different parts of the body

TNM stages

The TNM staging system stands for Tumour, Node, Metastasis.

• T describes the size of the tumour (cancer)
• N describes whether there are any cancer cells in the lymph nodes
• M describes whether the cancer has spread to a different part of the body

In the TNM staging system stage 2A is the same as:

• T2b, N0, M0

Stage 2B is the same as one of the following:

• T1a-c, N1, M0
• T2a-b, N1, M0
• T3, N0, M0

Treatment

The stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on:

• your type of cancer (the type of cells the cancer started in)
• where the cancer is
• other health conditions that you have

The treatment for small cell lung cancer is different to the treatment for non small cell lung cancer.

Non small cell lung cancer

If you have surgery

Some people might have chemotherapy or chemotherapy with immunotherapy  before surgery (neoadjuvant chemotherapy).

If you are fit enough, you usually have surgery to remove:

• part of your lung (a lobectomy, segmentectomy or wedge resection)
• all of the lung (pneumonectomy)

Following surgery, your doctor may recommend chemotherapy, chemotherapy combined with immunotherapy or chemotherapy with a targeted drug called osimertinib. This is if your tumour tested positive for the EGFR mutation.

This will lower the chance of your cancer coming back. This is called adjuvant treatment.

If the surgeon couldn’t remove all the cancer you might have radiotherapy after your operation.

If you can't have surgery

If your cancer can be removed with surgery, but you aren’t fit enough for surgery, you may be offered one or more of the following treatments:

• radiotherapy - this is usually stereotactic ablative body radiotherapy (SABR)
• if you can’t have SABR, you might have traditional radiotherapy or radiotherapy that is divided into small doses and given more often, also known as continuous hyperfractionated accelerated radiotherapy (CHART)

Small cell lung cancer

If you are fit enough, you might have chemoradiotherapy for limited stage small cell lung cancer. This means you have chemotherapy at the same time as radiotherapy. Limited stage small cell lung cancer means the cancer is contained in a single area on one side of the chest.

If you are not well enough to have chemoradiotherapy, you might have chemotherapy first, followed by radiotherapy to the chest.

After you finish treatment, you might have radiotherapy to your head. This treatment is called prophylactic cranial radiotherapy (PCR). You have this because it is quite common for small cell lung cancer to spread to the brain. The radiotherapy aims to kill any cancer cells that may have already spread to the brain but are still too small to see on scans.

You might have prophylactic cranial radiotherapy for limited stage disease if:

• your chemotherapy or radiotherapy treatment has stopped your cancer growing
• you are well enough

Other stages