Stage 2 Lung Cancer

What Is Stage 2 Lung Cancer?

Stage 2 lung cancer is the stage when lung cancer spreads into the lymph nodes, and the tumor grows to a certain size. Stage 2 lung cancer is still an early lung cancer stage, but a person needs different treatment than stage 1 lung cancer since the cancer is now locally advanced.

What Are the Subtypes of Stage 2 Lung Cancer?

Between the two main types, non-small cell lung cancer, or NSCLC, accounts for at least 80% of all lung cancers [¹]. Stage 2 lung cancer is classified into 2 subtypes according to the tumor size and where cancer has spread to.

Stage IIA lung cancer: Stage IIA lung cancer defines a tumor that has grown larger than 4 cm but lesser than or equal to 5 cm. The tumor hasn’t spread to nearby lymph nodes. However, cancer can be found in the bronchus or the main airway [²] and the membrane layer which covers the lung. All or a part of the lung may become inflamed.
Stage IIB lung cancer: Stage IIB lung cancer indicates a tumor which is equal to or less than 5 cm in size. Cancer spreads to the N1 lymph nodes within the lungs. [³] Stage IIB lung cancer can also be characterized by a tumor which is bigger than 5 cm in size but hasn’t spread to lymph nodes.

Stage 2 Lung Cancer Staging and Diagnosis

Lung Cancer Staging

In general, the TNM system is used to describe and classify cancers, including lung cancer, 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 2 Lung Cancer?

Lung cancer is the most common cancer that appears in men and the second most common cancer in women (after breast cancer).

More than 2.2 million cases of lung cancer appeared in 2020, with Hungary and Serbia being the top two countries with the highest number of deaths that occurred due to lung cancer in 2020. [⁴]

How Is Stage 2 Lung Cancer Diagnosed?

Different tests are used to diagnose or find NSCLC and to determine where it started and where cancer has spread to.

A doctor considers many factors, like the type of suspected cancer, symptoms, the health of the patient, and results of medical tests, before suggesting a specific type of diagnostic test.

Imaging Tests

Imaging tests or scans are combined with a patient’s medical history, blood test results from the biopsy, and physical examination to determine where the cancer began and where it has spread to. [⁵] Following diagnostic tests are important for NSCLC care.

CT or CAT Scan
PET scan
MRI scan
Bone Scan

Collecting Tissue Samples

Furthermore, doctors use different procedures to collect tissue for the diagnosis of lung cancer and plan appropriate treatment. Here we are discussing a few of them.

Biopsy

Removal of a small tissue amount and examining it under a microscope is called a biopsy. A biopsy is used to determine the subtype of NSCLC.

Bronchoscopy

Bronchoscopy is the process of passing a thin and flexible tube with a light into the nose or mouth, down the throat and main windpipe, and then into the lungs. A sample of fluid and tissue is taken and examined by a pathologist.

Fine Needle Aspiration Biopsy

An interventional radiologist removes a lung tumor sample. It is an important type of biopsy that helps a doctor determine whether the tissue removed had a tumor and whether the tumor was cancerous or benign. [⁶]

Chest Tests

Chest tests are used to examine whether cancer has spread to the chest. The results help the doctor decide the proper treatment plan for the patient. Chest tests include:

Endobronchial Ultrasound: It is a slightly invasive but high-efficiency procedure that can help diagnose lung cancer, chest infections, and other diseases.
Endoscopic Ultrasound: Endoscopic Ultrasound is used to detect tumors lying adjacent to or near the esophagus.

Stage 2 Lung Cancer Symptoms

Lung cancer doesn’t produce symptoms when it is in its earliest stage. However, as the disease advances, certain signs and symptoms may appear.

Stage 2 lung cancer can produce the following symptoms.

A chronic cough that doesn’t go away and gets worse.
Coughing up blood. [⁷]
Chest pain, which gets worse when coughing or laughing.
Shortness of breath.
Repeated lung infections.

Stage 2 Lung Cancer Treatment

Stage 2 lung tumors are usually removed with surgery, but sometimes, additional treatments are also recommended.

Stage 2 Lung Cancer Surgery

The first line of treatment for stage 2 lung cancer is surgery. People who are healthy enough can have their lung tumor removed by either segmentectomy, lobectomy, sleeve resection, or sometimes pneumonectomy is also performed.

Lung Segmentectomy

Lung segmentectomy is a surgery which removes a piece of lung that has lung tumor and some surrounding tissue as well. This surgery is also known as segmental lung resection [⁸] and is a preferred choice of treatment for early-stage lung cancer.

Factors that determine whether segmentectomy is a proper choice of treatment

Type of cancer
Location of cancer
Size of tumor
Where cancer has spread
Health of patient
Other associated heart and lung conditions
Lung function.

How is the surgery performed?

The lung cancer patient is asked to quit smoking four to six weeks prior to the surgery. Then the eating and drinking habits and medications of the patient are reviewed, and many respiratory testing procedures determine whether they can tolerate the surgery, such as:

V/Q scan
Pulmonary function testing
And cardiac stress testing

The surgery is performed under general anesthesia through an IV line. A surgeon accesses the lungs in one of two ways.

Open surgery: A surgeon makes an incision in the chest, called thoracotomy, which usually ranges between 3 to 8 inches. The incision size and location depend upon the tumor location. Then the surgeon cuts through the skin and muscle and separates the ribs.
Video-Assisted Thoracoscopic Surgery: Also known as VATS, this surgery is less invasive and is performed using a tube with a video camera. VATS require smaller chest incisions which are quick to heal and pose lesser complications. VATS is only performed in patients who have a small tumor and early-stage cancer.

Sleeve Resection

Sleeve resection, sleeve lobectomy, or pulmonary sleeve resection [⁹], is a potential surgical treatment to extract a lung tumor, after which the remaining tissues are sewn back and reconnected. This is a choice of treatment for NSCLC and less commonly for SCLC too.

Factors that determine whether Sleeve resection is a proper choice of treatment

Sleeve resection is a preferred choice of treatment for patients with tumors located in the bronchi. Sleeve resection allows the patient to retain more lung function as compared to other lung cancer surgeries.

How is the surgery performed?

The patient is asked to quit smoking four to six weeks prior to surgery, and then their medications and eating habits are closely monitored.

The surgery is performed under general anesthesia through an IV line. The surgeon makes a 3 to 8 inches long incision in the chest, depending on the tumor’s size and location.

Then the surgeon either uses thoracotomy or a video-assisted thoracic surgery procedure to reach the lung. After removing the tumor, surrounding tissues are sewn together.

Lung Lobectomy

Lung lobectomy refers to the removal of a lobe of the cancerous lung. [¹⁰]

Factors that determine whether Sleeve resection is a proper choice of treatment

Lung lobectomy is a preferred choice of treatment for patients with lung cancer, benign lung growth, chronic obstructive pulmonary disease, or those having an infection.

Lung lobectomy is associated with major risks, including a prolonged air leak from inside the lung to the chest cavity, lung infection, collapsed lung, or pleural effusion.

How is the surgery performed?

The lung cancer patient undergoes many imaging tests that help a doctor determine whether cancer has spread outside the lung. Then pulmonary function tests are performed to determine if the other lobes of the patient’s lung can breathe well after lobectomy.

The surgeon uses either thoracotomy or VATS to reach the lung and remove the lobe. Sometimes, surrounding lymph nodes are also removed. A chest tube collects air and fluid during recovery, and after closing the incision, the surgeon applies surgical dressing.

Other Types of Treatment for Stage 2 Lung Cancer

Chemotherapy

Surgery is followed by chemotherapy for about a year. Radiation therapy, which is a treatment using high-energy X-rays to target remaining cancer cells, is also sometimes used in combination with chemotherapy.

If the tumor size of stage 2 lung cancer is greater than 4 cm, then immunotherapy drugs and chemotherapy is used prior to surgery. Immunotherapy drugs shut down certain key proteins, which doesn’t allow cancer to spread easily.

Can Stage 2 Lung Cancer Be Cured?

Lung cancer doesn’t exhibit its symptoms until it is advanced to later stages. This is why healthcare professionals recommend screening tests if you:

Are aged between 50 to 80.
Smoke recently or did in the past.

If you catch lung cancer at an early stage, your healthcare provider can remove the tumor and then follow up with different treatment procedures and more screening tests.

Lung cancer might be considered cured if it is diagnosed before spreading to an advanced stage, but “cured” is not often used to describe the treatment protocol.

Doctors use the term “NED,” or “no evidence of disease,” which suggests complete remission or that all symptoms of cancer are gone. If a patient is in NED for more than 5 years, it is considered that the lung cancer is “cured.” However, there is always a slight chance that there are any remaining cancerous cells, which is why regular screening tests ensure that cancer doesn’t come back.

Prognosis: Stage 2 Lung Cancer Survival Rate

Recent advancements in diagnosis and treatment have made it possible to treat non-small cell lung cancer at any stage. In the past decade, there has been a revolution in advanced management for the screening, diagnosis, and treatment of NSCLC.

The development of molecular targeted therapies, anti-angiogenic agents, and immune checkpoint inhibitors has transformed the outlook on NSCLC treatment with improved patient outcomes. [¹¹]

Lung cancer is diagnosed and examined by certain tests that determine how far cancer has progressed, including lungs, lymph nodes, and other parts of the body.

Stage 2 lung cancer patients who are healthy enough for surgery have the tumor removed by surgical processes, live sleeve resection, and lobectomy. After surgical removal of tumor tissues, or sometimes the whole cancerous lung (as in pneumonectomy), the surrounding cancerous lymph nodes are also removed.

When the tumor is removed from the lung, the surgery specimen is checked to see if there are any cancer cells at the borders, which means that a few cancer cells may be left behind. These results may be followed by a second surgery, where any remaining cancerous cells are removed.

After that, adjuvant therapy involving chemotherapy and immunotherapy is followed, coupled with radiation treatment.

Even if the surgical specimen doesn’t contain any positive margins, adjuvant therapy is recommended after surgery to remove and destroy any remaining cancer cells.

Stage 2 cancer patients with tumors larger than 4 cm are recommended immunotherapy with nivolumab, in combination with chemotherapy, prior to the surgical procedure.
Patients with cancer cells having mutations in EGFR genes are recommended adjuvant therapy with osimertinib, which is a targeted drug.

Stage 2 Lung Cancer Survival Rate

The five-year survival rate for patients treated for stage 2 NSCLC is 35%, which means that 35 out of 100 patients survive for 5 years or more than that after the treatment. [¹²]

Stage 2 lung cancer patients’ survival rate depends on disease progression, response to treatment, and overall health. However, due to advancements in treatment and early diagnosis of lung cancer, stage 2 lung cancer patients are showing a decline in mortality rates in recent years.

Stage 2 Lung Cancer Recurrence Rate

The chances of recurrence depend upon the stage of lung cancer. The greater the advancement of cancer, the higher the chances that it can come back. The 5-year survival rate of stage 2 lung cancer patients can be improved by adjuvant treatment in margin-positive cancers.

Stage IIB lung cancer patients show a higher distant metastasis probability after surgical procedures, as compared to other stages of lung cancer. [¹³] This could be due to the inclusion of metastasis in lymph nodes in stage IIB lung cancer.

Stage 2 Lung Cancer Growth Rate

Lung cancer growth rate is the change in the tumor’s volume. Growth rate and doubling time are used to estimate how fast a tumor is growing. This study shows that the tumor volume doubling time of non-small cell lung cancer is related to the smoking history and histological subtype of cancer. [¹⁴]

Some types of lung cancer can progress within weeks, while others can take a few years to grow.

Lifestyle Changes for Preventing and Managing Lung Cancer

There are many lifestyle modifications you can adopt to lower the risks of developing lung cancer.

Do not smoke: [¹⁵] Smoking is the major cause of more than 80% of lung cancer deaths. Prevent lung cancer by not smoking at all, and if you do, quit smoking immediately.
Avoid exposure to carcinogens: Knowing cancer-causing agents in the workplace can help you avoid exposure to them or keep it at a minimum.
Eating a healthy diet: [¹⁶] Eating fruits and vegetables can lower the risk of developing lung cancer. The positive effects of these fruits and vegetables protect people who do or do not smoke against lung cancer.

Conclusion

Takeaway

Stage 2 lung cancer is a specific stage of non-small cell lung cancer. It is an early-stage lung cancer, which is why early diagnosis and proper treatment protocol can increase the survival rate of patients.