Stage II Non-Small Cell Lung Cancer

Stage II non-small cell lung cancer (NSCLC), like stages 0, IA and IB, is considered a localized cancer. The tumor is present in one lung and also may have spread to lymph nodes surrounding the lung, but the cancer has not spread to distant organs.

About 30 percent of lung cancers are diagnosed at this stage, and the treatment success rate is higher than later stages because the cancer is still contained in the vicinity of the lungs. For patients who complete treatment, the five-year survival rate is about 20 – 30 percent, with stage IIA lung cancer on the higher end of the spectrum.

Stage II non-small cell lung cancer is divided into stage IIA and IIB, with each stage then broken into additional sections, depending on the size of the tumor, where it is found, and whether or not the cancer has spread to the lymph nodes.

Stage IIA Non-Small Cell Lung Cancer

Stage IIA lung cancer can be classified into two additional categories, which are determined by whether or not the cancer has spread to the lymph nodes and the size of the tumor itself.

If the cancer has spread to the lymph nodes in stage IIA non-small cell lung cancer, it is only the lymph nodes on the same side of the chest as the tumor that are affected by the disease. The cancerous lymph nodes are also maintained within the lung or near the bronchus.

TNM Categories of Stage IIA

When the stage IIA lung cancer tumor has spread to the lymph nodes, which would be characterized as N1 on the TNM scale, the cancer is staged as either T1A/T1B, N1, M0 or T2A, N1, M0. The M0 designation indicates for both cases that the cancer has not yet spread to other organs.

T1A/T1B, N1, M0

• The tumor is either 2 cm or less (T1A) or larger than 2 cm but smaller than 3 cm (T1B).
• The cancer has not grown into the membranes surrounding the lungs.
• The main branches of the bronchi are not affected.
• The cancer has spread to lymph nodes within the lungs and around the location where the bronchus connects to the lung.

T2A, N1, M0

The cancer has one or more of the following features:

• The tumor is larger than 3 cm but smaller than 5 cm.
• Cancer has spread to the main bronchus and is at least 2 cm below the carina, the cartilaginous ridged area that separates the opening of the right and left main bronchi stems.  
• Cancer has spread to the lining of the lung.
• Part of the lung has collapsed or developed an inflammation in the carina, which can partially clog the patient’s airways.

If the cancer has not spread to the lymph nodes, it is known as T2B, N0, M0. The cancer will have one or more of same features listed above, except the T2B stage indicates that the tumor is between 5 and 7 cm.

Stage IIB Non-Small Cell Lung Cancer

Stage IIB lung cancer also has two different subcategories, depending on the size of the tumor and whether or not it has spread to the lymph nodes.  

For each category, one or more of the features listed below will be present.

T2B, N1, M0

• The tumor is between 5 and 7 cm.
• Cancer has spread to the main bronchus and is at least 2 cm away from the carina.
• Cancer has spread to the lining of the lung.
• Part of the lung has collapsed or developed an inflammation in the carina, which can partially clog the patient’s airways.

T3, N0, M0

If the cancer has not spread to the lymph nodes, it is classified as T3, N0, M0 and one or more of the following features will be present:

• The tumor is larger than 7 cm.
• The tumor has expanded into the chest wall, the diaphragm, the membranes present in the space between the lungs or the membranes located in the sac surrounding the heart.
• The cancer has spread into the main bronchus and is within 2 cm of the carina, but does not actually affect the carina.
• The airways are blocked enough that the entire lung could collapse or become inflamed.
• Two or more separate tumors are present within the same lobe of one lung.

Stage II Lung Cancer Treatment

In both stage IIA and IIB non-small cell lung cancer, surgery surgery may be a treatment option, as the cancer has not spread to other areas of the body. If the cancer has not spread to the lymph nodes, for some patients surgery could be the only treatment used. Factors that are considered when choosing the appropriate treatment include the severity of the disease and the overall health of the remaining lungs. Here are a few specific types of surgery that may be part of a treatment plan.  

• Wedge Resection – The surgical removal of cancerous cells in the lung, as well as a margin of surrounding healthy tissue.
• Lobectomy – The surgical removal of a lobe of the lung.
• Pneumonectomy – The surgical removal of an entire lung.  

When treating stage II lung cancer, additional treatments may be necessary to supplement the initial surgery.

• Radiation therapy is used destroy any remaining cancer cells for people with stage II lung cancer who have undergone surgery.
• Neoadjuvant or primary systemic chemotherapy may be used before surgery to destroy cancer cells. It also allows your oncologist to determine the effectiveness of a particular lung cancer treatment regimen on the tumor.
• Adjuvant chemotherapy is used after surgery or radiation to target cancer cells that were not removed during lung cancer surgery, and helps prevent the cancer from spreading to other parts of your body.