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Last Updated on October 7, 2024
The treatment of lung cancer depends largely on the stage of the disease. Pathology is classified differently depending on the histological type of tumor: small cell and non-small cell (NSCLC) are pathologies with different prognosis, which is more favorable for non-small cell tumors. In this publication, we will discuss the importance of differentiating the stages of lung cancer for the choice of treatment tactics.
Stage 0
Very early stage lung cancer may be diagnosed during a bronchoscopy for another condition as no cancer symptoms are present. The tumor is localized to the epithelium. This cancer can be cured without surgery by using brachytherapy, photodynamic therapy, or by destroying the tumor with a laser. Some patients will need surgery, which is usually not followed by chemotherapy or radiation therapy.
Stage 1
Surgery is the only treatment the patient needs. This means that there is no need for adjuvant therapy after surgery.
Internationally, early-stage surgery is performed using minimally invasive techniques, including video-thoracoscopic surgery through short incisions between the ribs and the latest and safest robotic surgery.
Usually, one lobe of the lung is removed (lobectomy). In some cases, the extent of the operation is even smaller: the removal of a segment is sufficient (segmentectomy).
Adjuvant therapy is only required in cases of high risk of recurrence (aggressive tumor types). This includes chemotherapy, immunotherapy and targeted therapies. Radiation therapy is only needed if a positive resection margin (tumor cells at the edge of the removed tissue) is found after surgery.
Stage 2
Treatment often begins with neoadjuvant therapy. Doctors try to shrink the tumor before removing it. The treatment usually includes a combination of immunotherapy and chemotherapy. Surgery is then performed, which can be done in a variety of ways:
- Lobectomy – removal of a single lobe of the lung
- Pneumectomy – removal of the entire lung
- Sleeve resection – non-anatomical resection with crossing and suturing of large bronchi, vessels (to save more lung tissue).
After the operation, the patient will receive medications.
Stage 3A
It is still possible to try to cure some patients even at stage 3. Treatment usually starts with chemoradiation, possibly combined with immunotherapy. Surgery is then considered.
Stage 3B
It is believed that this stage cannot be cured by surgery. Such patients receive chemoradiation therapy to shrink the tumor. In addition, immune therapy is used.
Stages 4A и 4B
In rare cases where metastases have occurred in only one anatomical area, surgery may be performed at stage IVA. In this case, combined surgery is performed to remove tumors in different locations: for example, in the lung and in the brain at the same time.
Most patients with stage 4 cancer receive systemic therapy: chemotherapy, targeted therapy and immunotherapy selected based on genetic analysis. Patients also receive palliative therapy for pulmonary hemorrhage, pleurisy, respiratory problems and other possible symptoms of cancer spread and its complications. Abroad, even at stage 4, good five-year survival rates are achieved.
Treatment of small cell lung cancer by stage
In oncological practice, a simplified classification is often used that distinguishes only two stages of small cell carcinoma: localized and advanced.
In the localized stage, surgery is performed to remove the tumor. This is usually preceded by a surgical staging procedure to assess the status of the lymph nodes: a minimally invasive diagnostic procedure called mediastinoscopy. If the tumor is removed during surgery, patients receive adjuvant chemoradiation therapy and possibly prophylactic cranial irradiation.
However, chemoradiation is the primary treatment option for most patients. If a person cannot tolerate this treatment, chemotherapy alone is used. In advanced stages, immunotherapy is often used.
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