Stage 2 lung cancer

About staging

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.

TNM stages

The TNM system describes:

• the size of the primary tumour (T)

• whether the cancer has spread to the lymph nodes (N)

• whether the cancer has spread to another part of the body (M)

The doctor gives each factor (T, N and M) a number. The number depends on how far the cancer has grown or spread. So, a very small cancer which hasn't spread to the lymph nodes or elsewhere in the body may be T1mi-T1a N0 M0. A larger cancer that has spread into the nearby lymph nodes and to another part of the body may be T3-T4 N1 M1. In the TNM staging system, stage 2A is the same as one of the following:

• T2b N0 M0

• T1 N1 M0

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

• T3 N0 M0

• T1 N2a M0

• T2a-T2b N1 M0

Find out about TNM staging for lung cancer

Stage 2A

There are 2 possible stages for stage 2A. T2b N0 M0

Stage 2A (T2b N0 M0) can mean the cancer is between 4cm and 5cm with or without the following features:

• it involves the inner lining of the chest cavity (the visceral pleura)

• it has grown into the nearby lobe

• it involves the main airway (the main bronchus) but is not close to the area where the bronchus divides to go into each lung (carina), or part or all of the lung has collapsed or is blocked due to inflammation

The cancer has not spread to nearby lymph nodes or any other part of the body. T1 N1 M0

Or stage 2A (T1 N1 M0) means the cancer:

• is no more than 3cm at its widest part

• has not grown into the membranes that surround the lungs (pleura)

• has not grown into the main branches of the airways

• has grown into lymph nodes within the lung or in lymph nodes in the area where the lungs join the airway (the hilum) or into both areas. These lymph nodes are on the same side as the cancer

• has not spread to any other part of the body

Stage 2B

There are 3 possible stages for stage 2B. T3 N0 M0

Stage 2B (T3 N0 M0) can mean the cancer is between 5cm to 7cm. Or the cancer is 7cm or less and has one or more of the following features:

• it has grown into the outer lining of the chest cavity (the parietal pleura) or the chest wall (the protective structure around the lungs and other organs in the chest)

• it has grown into the outer covering of the heart (the pericardium), the nerve close to the lung (phrenic nerve) or a big vein called the azygos vein

• it has grown into nerves that come out of the spinal cord in the chest area (thoracic nerve roots) or a group of nerves around the neck area (stellate ganglion)

• there is more than one tumour in the same lobe of the lung

The cancer has not spread to the nearby lymph nodes or any other part of the body. T1 N2a M0

Stage 2B (T1 N2a M0) can also 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 a single area of lymph nodes just under where the windpipe branches off to each lung (subcarinal) or in the centre of the chest (mediastinum). These lymph nodes are on the same side as the cancer

• has not spread to any other part of the body

T2a-T2b N1 M0

Stage 2B (T2a-T2b N1 M0) can also mean the cancer is between 3cm and 4cm. Or the cancer is 4cm or less with one or more of the following features:

• it involves the inner lining of the chest cavity (the visceral pleura)

• it has grown into the nearby lobe

• it involves the main airway (the main bronchus) but is not close to the area where the bronchus divides to go into each lung (carina), or part or all of the lung has collapsed or is blocked due to inflammation

Or the cancer is between 4cm and 5cm with or without the following features:

• it involves the inner lining of the chest cavity (the visceral pleura)

• it has grown into the nearby lobe

• it involves the main airway (the main bronchus) but is not close to the area where the bronchus divides to go into each lung (carina), or part or all of the lung has collapsed or is blocked due to inflammation

The cancer has grown into lymph nodes within the lung or in lymph nodes in the area where the lungs join the airway (the hilum) or into both areas. These lymph nodes are on the same side as the cancer. It has not spread to any other part of the body.

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. Treatment before surgery is called neoadjuvant treatment.

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 irradiation​ (PCI). 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 irradiation for limited stage disease if:

• your chemotherapy or radiotherapy treatment has stopped your cancer growing

• you are well enough

Read about lung cancer treatments

Other stages

• Stage 1

• Stage 3

• Stage 4

• Limited and extensive disease (small cell cancer)

• TNM staging