Non-Small Cell Lung Cancer: Know Stages And Treatment Process

Cancer is one of the deadliest diseases around, thousands of people get in trap of this disease which is hard to treat and has many complications. Apart from this it is also divided into several types depending on the part it has affected. Lung cancer is also one of the common types of cancer which spreads in people mostly due to consumption of tobacco or some other factors. What people do not know is that lung cancer also has subdivisions. These subdivisions determine the affect of cancer in lungs and probable cause of it. Today we will know about one sub-category of lung cancer that is Non-small cell lung cancer. 

What is Non-small cell Lung Cancer?

This is a disease in which malignant cells (cancer) form in a tissue in the lungs. We spoke to Dr. Tushar Pawar, Surgical Oncologist, HCG Cancer Centre Mumbai to know more details about this type of cancer. He told us that NSCLC is a type of lung cancer that occurs more commonly in people who eat or smoke tobacco. In this condition people majorly suffer from persistent cough that does not go away. There are 2 types of NSCLC, squamous and Adenocarcinoma. 

In many cases people suffer from cough and shortness of breath for a long period until treatment is done. There have been great advances recently in medical management of Adenocarcinoma, molecular testing of tumour sample if reveals certain mutations, targeted molecules are now available which gives good longevity and quality of life in these patients even in advanced stages.

Symptoms of Non-Small Cell Lung Cancer

• Chest discomfort or pain
• Persistent cough
• Trouble breathing
• Wheezing
• Loss of appetite
• Blood in sputum
• Swelling on face or veins in the neck
• Feeling exhausted and tired most of the times

Treatment of Non-Small Cell Lung Cancer

According to Dr. Tushan Pawar, First step in diagnosis is a biopsy from tumour, and then followed by investigation directed at staging the disease and assessing fitness of the patient. For staging usually a FDG PET CECT, MRI brain is necessary.

In early stages, upfront surgery either by open or   minimally invasive technique is possible, sometimes surgery is performed after chemotherapy if feasible. In advanced stage disease Systemic chemotherapy +/- Targeted therapy with or without Radiation Therapy is used. Advanced Radiation therapy techniques like SBRT, Gamma Knife are be used for certain type of patients or disease.

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1. Stage 0 NSCLC

In the first stage of NSCLC, the lining of the air passage gets affected but it has not gone deeper in the lung tissue or other surrounding areas. This stage can be usually treated by surgery alone and there no need of other methods including chemotherapy and radiation therapy in this stage.

If the person is in middle age, then treatment is done through segmentectomy or wedge resection. Cancer can be present in some areas near windpipe, in left or right bronchi which can be treated with sleeve resection, however it is little hard to completely remove a lobe from the lung in a single process.

Photodynamic therapy, laser therapy or brachytherapy is often recommended as other alternatives of the surgery in stage 0.

2. Stage I NSCLC

In the second stage of non-small-cell lung cancer, surgery is the only treatment needed just like the first stage. However the difference comes in the size of the lobe as it may increase or stretch to a wider section of windpipe or lungs. Hence surgery is done to take out the lobe of cancer by bringing out the smaller piece of lung (sleeve resection or wedge resection). 

By this treatment the space between lungs also gets removed and the lymph nodes in the lung are checked. Wedge sections is only applicable for treatment of very small stage I cancers and not for patients suffering from other health conditions. Those who have higher risk of diseases and problems, they are operated by lobectomy and then goes into chemotherapy to lower the risk of cancer to return.

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3. Stage II NSCLC

Treatment process of third stage of NSCLC becomes a little complicated now. However good part is that people suffering from this stage of cancer can also be treated with the help of surgery. Lobectomy or sleeve resection is usually done to remove the whole lung section which is infected with cancer. 

Any lymph which is likely to have cancer tissues or cells is removed from the body and other tissues are checked thoroughly for cancer. This is then followed by other therapies and process such as adjuvant treatment along with chemotherapy, then immunotherapy and sometimes radiation therapy might also be needed.

4. Stage IIIA NSCLC

In the initial treatment for stage IIIA of Non-small cell lung cancer, a combination of radiation therapy, chemotherapy and surgical methods are used to treat the cancer. This is because in this fourth stage of lung cancer, the size of cancer usually quite big and it starts spreading to lymph nodes and other part of the lungs. Hence to treat this issue, radiation therapy is performed and conducted. 

In this stage, the surgical process may take a long time, hence other combination of treatments are applied. This starts with chemotherapy, then radiation therapy is used. When the doctor feels that remaining cancer can be removed by surgical process, then surgery is done. After surgery, immunotherapy is also performed. All this treatment takes place with strict observation of health condition of the patient and how patient is responding to treatment.

5. Stage IIIB NSCLC

This is fifth stage of cancer, where it becomes hard to treat the patient; this happens because cancer cells affect lymph nodes in the neck and grows further to the chest. As a result the spread of non-small-cell lung cancer cannot be removed totally by surgical process. Therefore seeing overall health condition of the patient and other factors, chemotherapy and radiation therapy is started. It continues for a long period until the patient may becomes stable. Immunotherapy is also started when the patients does not respond well to the initial treatment options.

6. Stage IVA and IVB of NSCLC

These are the last two stages of non small cell lung cancer in which there is less chances of patient to make out of this deadly disease. In these stages, the cancer has already spread to lungs and surrounding organs because of which surgery does not work well. Further diagnosis is done at this stage to understand the symptoms and slow down the spread of cancer. 

In these stages, chemotherapy, targeted therapy, immunotherapy and radiation therapy are together put into place for the person to sustain the cancer for longer time. These therapies can also slow down cancer and relieve some symptoms of cancer, not more than that should be expected.

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