Stage 3 Lung Cancer

What Is Stage 3 Lung Cancer?

Lung cancer interferes with the respiratory process and makes breathing difficult. It develops in lung tissues and the lining of the airways. Lung cancer has two common types: non-small cell lung cancer, or NSCLC, and small cell lung cancer, or SCLC.

NSCLC is categorized into different stages. Stage 3 lung cancer is defined as a “locally advanced [¹], or locoregionally” stage, which means cancer has spread to the area lying near the original tumor.

Stage 3 NSCLC is a “heterogeneous group” [²] of lung cancer, which consists of a diversity of tumor invasions in areas outside the lungs and in lymph nodes. Patients of stage 3 lung cancer exhibit different extents and localization of the disease. [³]

What Are the Subtypes of Stage 3 Lung Cancer?

Knowing lung cancer helps the doctor decide how to help the patient and which treatment is most appropriate. In stage 3 lung cancer, cancer has spread to nearby tissues and lymph nodes from the affected lungs. Non-small cell lung cancer is often not diagnosed until it has progressed to advanced stages. Approximately 20 to 35% of NSCLC patients are diagnosed at stage 3.

Stage 3 lung cancer is further divided into the following sub-stages:

• Stage IIIA lung cancer
• Stage IIIB lung cancer
• Stage IIIC lung cancer

The sub-stages of stage 3 lung cancer are based on the tumor size and to which lymph nodes it has spread to. NSCLC patients are often diagnosed at advanced stages of lung cancer, which are stages 3 or 4. Stage 3 lung cancer has different clinical conditions.

Stage IIIA Lung Cancer

Includes small tumors which are associated with N1 or N2 lymph nodes. This stage also involves large but locally invasive tumors with N0 or N1 lymph node involvement. Cancer hasn’t reached distant organs.

Stage IIIB Lung Cancer

Stage IIIB is associated with N3 lymph node involvement, more than one tumor in the same lung, and cancer may have spread to nearby tissues.

Stage IIIC Lung Cancer

Stage IIIC lung cancer is a newly defined group [3] that covers patients with larger tumors and N3 lymph node involvement. It is the most advanced stage 3 lung cancer sub-stage. Cancer has reached nearby tissues such as in chest wall, breastbone, and heart.

Stage 3 Lung Cancer Staging and Diagnosis

Lung Cancer Staging

In general, the TNM system is used to describe and classify cancers, including {cancer type}, where:

T (tumor) describes the size and location of the tumor

N (nodes) indicates whether or not it has spread to nearby lymph nodes

M (metastasis) describes if and how far cancer has spread from its origin

How Common Is Stage 3 Lung Cancer?

Lung cancer is a leading cause of cancer deaths worldwide, with more than 2 million newly diagnosed patients and an 18.4% mortality rate in 2018.

Lung cancer is a leading cause of death by cancer among male patients, with prostate cancer following by. In female patients, lung cancer is the most commonly diagnosed cancer after breast cancer. [⁵]

Lung cancer is divided into NSCLC and SCLC. With NSCLC accounting for 85% of lung cancer cases. [⁶] Different studies conducted in Italy, Denmark, the United Kingdom, Norway, and Sweden, showed that the sub-stage data of stage 3 lung cancer hardly differed by sex. [⁴]

Furthermore, 50.4% of patients who were diagnosed with stage 3 lung cancer were between 65 to 79 years of age.

How Is Stage 3 Lung Cancer Diagnosed?

Lung cancer diagnosis differs from patient to patient, and the chosen diagnostic tests are based on the following factors:

• Symptoms
• Medical history
• Results from physical examination and tests.

Imaging Tests

Imaging tests help doctors find tumors and to check whether cancer has spread and where it has spread to. These imaging tests also identify whether ongoing treatment is working and whether cancer has returned after treatment. [⁷]

Chest X-ray

A chest X-ray is the first test and suggests if the patient has cancer. Most lung tumors can appear on the X-ray. However, chest X-rays are not efficient in differentiating between a possible tumor or some other lung condition, such as lung abscess. [⁸]

Chest CT or CAT scan

A CT scan can more likely show a lung tumor, along with its size, position, and shape. [⁹] CT scans also help doctors find cancerous enlarged lymph nodes.

PET-CT

After the results of a CT scan suggest that a patient has lung cancer, PET-CT shows active cancer cells, which helps doctors diagnose the lung cancer stage and decide the best treatment plan.

Other Diagnostic Procedures

When CT or PET scan shows an abnormal presence in the lungs, doctors study tissue and fluid obtained from or near the lungs and examine them under a microscope to determine the presence of cancer.

Bronchoscopy

When a CT scan shows that there is cancer in the central part of the patient’s chest, then a bronchoscopy is recommended.

Bronchoscopy is also an initial diagnostic step for former or current smokers having lesions in their lungs that might be suspected to be cancerous. [¹⁰]

A flexible tube called a bronchoscope is passed through the nose or down the throat into large airways of the lungs. This procedure helps doctors to see inside patients’ lung airways and also to remove a sample of cells.

Endobronchial Ultrasound (EBUS)

Endobronchial ultrasound (EBUS) is a highly effective diagnostic procedure that combines bronchoscopy with an ultrasound scan.

In this procedure, a light and flexible tube, which is fitted with an ultrasound device, is passed down the throat into the windpipe to examine nearby lymph nodes and other chest structures.

A hollow needle can also be guided into a suspicious area to take biopsy samples.

Stage 3 Lung Cancer Symptoms

The following symptoms are common in stage 3 lung cancer patients.

• A persistent cough that keeps getting worse.
• Chest pain and bloody cough.
• Weight loss and loss of appetite.
• Hoarseness.
• Shortness of breath.
• Repeated pneumonia.
• Weakness.

When stage 3 lung cancer spreads to an advanced sub-stage, the following symptoms also start to appear.

• Limbs weakness and numbness.
• Bone pain.
• Dizziness.
• Headache.
• Jaundice.
• Swollen lymph nodes.
• Seizures.

Stage 3 Lung Cancer Treatment

Stage 3 lung cancer treatment depends on the following factors.

• Sub-stage of cancer.
• Location of cancer.
• Where cancer has spread to.
• Associated health conditions.

Stage 3 NSCLC is associated with different tumor types, which spread to different areas near the affected lung. The heterogeneous nature of stage 3 NSCLC is treated by many different treatment options.

Factors that determine treatment

Course of treatment

Why some patients may not receive the treatment

Stage 3 Lung Cancer First-Line Treatment

The first course of treatment for stage 3 lung cancer depends on the sub-stage and whether or not surgery is possible.

Treatment Procedure for Stage IIIA NSCLC

Stage 3 NSCLC, which can be removed with surgery, may involve the following treatment protocols.

• Chemotherapy and radiation therapy followed by surgery to remove a part or all of the lung. Eligibility for the surgery depends on the general health and fitness of the patient and how likely they are to recover well. The surgery may be followed by more chemotherapy.
• Surgery in which all or part of the lung is removed is followed by chemotherapy.
• In certain cases, immunotherapy with nivolumab is followed by chemotherapy and then surgery.
• Surgery is followed by targeted therapy with an EGFR TKI, such as osimertinib, that is designed to change the behavior of tumor cells. [¹]
• Surgery followed by adjuvant chemotherapy, followed by adjuvant immunotherapy for a year, or adjuvant radiation therapy if it hasn’t been given to the patient before.
• Surgery is followed by additional or adjuvant immunotherapy with drugs like atezolizumab. [¹¹]

Stage 3 NSCLC, which cannot be removed with surgery, may involve the following treatment protocols.

• Radiation therapy, followed by chemotherapy.
• Immunotherapy involves an immune checkpoint inhibitor (ICIs) like durvalumab. [¹²]
• External beam radiation therapy.
• Palliative radiation therapy for symptom relief. [¹³]

Treatment Procedure for Stage IIIB and Stage IIIC NSCLC

In stages IIIA and IIIB NSCLC, cancer spreads to lymph nodes and important structures in the chest, which cannot be removed with surgery alone. [¹⁴] Treatment for stage IIIB and IIIC NSCLC involves the following procedures:

• Chemotherapy combined with external radiation therapy.
• Immunotherapy with immunocheckpoint inhibitors (ICIs) like durvalumab after chemoradiation.
• External radiation therapy alone for patients who cannot receive chemotherapy.
• External radiation palliative therapy for symptom relief.
• Internal radiation therapy for the relief of symptoms.

Other Types of Treatment for Stage IIIA Lung Cancer

Superior Sulcus Or Pancoast Tumors

The treatment of NSCLC of the superior sulcus includes:

1. Surgical procedure.
2. Chemoradiotherapy followed by surgery.
3. Radiation therapy.

Chest Wall Tumors

Stage IIIA NSCLC that grows unto the chest wall may be treated and completely removed. Treatment includes:

1. Surgery.
2. Radiation therapy.
3. Chemotherapy in combination with surgery and radiation therapy.

Can Stage 3 Lung Cancer Be Cured?

Stage 3 lung cancer is referred to as an advanced stage of lung cancer. Till now, there is no cure for lung cancer, but several treatment options are available that ease the pain of a patient, improve their quality of life, control the spread of the tumor, and kill the cancer cells.

Surgery, chemotherapy, and radiation therapy are available to get rid of the tumors, whereas complementary treatments and other medicines can make life with stage 3 lung cancer more comfortable for the patient. Immunotherapy most often improves lung cancer patients’ survival rate.

Lung cancer research is constantly evolving to ensure that patients receive the best medications and treatment. Many lung cancer patients resort to clinical trials to support lung cancer research.

Prognosis: Stage 3 Lung Cancer Survival Rate

Early diagnosis of lung cancer is of utmost importance to improve the survival rate. Higher TNM stages are related to advanced lung cancer and poor outcome of treatment.

Effective and regular screenings are associated with lower morbidity and mortality rates in individuals at high risk for lung cancer. In recent years, research studies supporting lung cancer have led to better diagnostic procedures and treatments, which directly improve the survival rate of patients.

Even though stage 3 NSCLC is an advanced lung cancer stage and difficult to treat, new and advanced clinical trials have created hope for promising results in the future. [¹⁷]

Researchers are actively focusing on immunotherapies to fight lung cancer. Many immune checkpoint inhibitors are recently approved for advanced stages of lung cancer. These ICIs target PD-L1 and PD-1. The ICIs for lung cancer treatment include:

• Nivolumab [¹⁵]
• Durvalumab
• Atezolizumab, etc.

Other targeted therapies are being researched to attack cancerous cells without harming normal cells, such as:

EGFR Inhibitors

The EGFR inhibitors block the activity of EGFR protein, which is found at higher levels in cancerous cells. Drugs targeting EGFR include:

• Afatinib
• Dacomitinib

ALK Inhibitors

Anaplastic lymphoma kinase inhibitors are being researched for patients having an ALK gene alteration. The recently approved anaplastic lymphoma kinase (ALK) inhibitors include:

• Ceritinib
• Alectinib
• Brigatinib
• Lorlatinib. [¹⁶]

What is the survival rate of lung cancer stage 3?

The five-year survival rate of those NSCLC patients whose cancer remains confined to the affected lung is 64%. However, if cancer spreads to nearby areas, the five-year relative survival rate drops to 37%.

The survival rate of patients diagnosed with stage 3 lung cancer varies according to the sub-types of cancer.

1 in 3 patients diagnosed with stage IIIA live for at least 5 more years. The 5-year survival rate for stage IIIB patients is 26%, and for stage IIIC patients, it is 13%.

Stage 3 Lung Cancer Recurrence Rate

Even though the data on lung cancer recurrence rates is limited, some studies show that for stage 3 NSCLC, the recurrence rate is between 24 to 49%. [¹⁹]

The recurrence rate for lung cancer increases with the increasing stage. According to this study, [¹⁸] 30% of patients with lung cancer stages 1 to 3 develop recurrent lung cancer.

Stage 3 Lung Cancer Growth Rate

The doubling time of NSCLC depends upon the subtype of cancer and the smoking history of the patient. Non-small cell lung tumors have a slower doubling time as compared to small-cell lung cancer. Similarly, lung tumors have a faster doubling time in patients with a smoking history, as compared to those patients who had quit smoking or never smoked at all.

According to this study, [²¹] the longest volume doubling time is of adenocarcinoma, which is 261 days. VDT of squamous cell carcinoma is 70 days.

Lung cancer doesn’t show its symptoms until it is progressed to the advanced disease stage. According to National Cancer Institute, [²⁰] more than 50% of lung cancers are diagnosed when cancer has spread beyond the chest.

Thousands of lives can be saved if early diagnosis and regular screenings are encouraged, especially in people at a higher risk of lung cancer.

Lifestyle Changes for Preventing and Managing Lung Cancer

According to the Centers for Disease Control and Prevention (CDC) [²²], more than 80% of lung cancer deaths in the USA are caused by smoking. If you smoke, it is for the best of your health to quit smoking immediately. Furthermore, secondhand smoke can also increase the chances of developing lung cancer.

Radon is the major cause of lung cancer development in non-smokers. [²³] Inhaling radon for a long time can lead to lung cancer. [²⁴] Get your homes and workplaces tested for radon, and avoid its exposure as much as possible.

Conclusion

Takeaway

Currently, there is no cure for stage 3 lung cancer, only treatment to improve survival chances and manage the disease and ease the pain. However, there are some recent breakthroughs in lung cancer research studies, which means that there is hope for better treatment and diagnostic procedures in the future.

If you or a loved one is diagnosed with lung cancer, it is important to find a doctor that you can trust, find a community with which you can connect, and get as much support from others as you can.