Stage III Non-Small Cell Lung Cancer

Stage III non-small cell lung cancer (NSCLC) is described as locally advanced, meaning that the tumor has spread beyond the lung and into the chest wall, diaphragm or lymph nodes that are further away from the lung, such as the neck. However, in stage III lung cancer the affected lymph nodes are restricted to the same side of the body as the tumor.

This stage of lung cancer is classified as stage IIIA or IIIB, depending on the size and location of the tumor, and how far it has spread.

About 30 percent of those diagnosed with lung cancer are at stage III at the time of diagnosis. The five-year survival rate for stage IIIA lung cancer varies widely, and is about 23 percent on average. For stage IIIB lung cancer, the survival rate is around 10 percent.

There are numerous treatment options available for patients with advanced-stage disease at Cancer Treatment Centers of America (CTCA). We also provide therapies to ease the symptoms that can be associated with NSCLC, while improving your quality of life.

Stage IIIA Lung Cancer

There are three main types of stage IIIA non-small cell lung cancer, which are demonstrated below using the TNM scale.

T1 - T3, N2, M0

• The main tumor can be any size, ranging from less than 3 cm (T1) up to 7 cm (T3).
• The tumor has not grown into the space between the lungs, the heart, any large blood vessels near the heart, the trachea, the esophagus, backbone or carina (the cartilaginous ridged area that separates the opening of the right and left main bronchi stems).
• The cancer has spread to the lymph nodes around the carina, or in the space located between the lungs.
• The tumor has not spread to different lobes in the initial lung.
• The cancer has not spread to distant organs.

T3, N1, M0

In this category of stage IIIA lung cancer, the disease has spread to the lymph nodes within the lung and/or where the bronchus connects with the lungs, hence the N1 rating. The lymph nodes are located on the same side as the cancer, and it has not spread to distant organs. Additionally, one or more of the following features will be true:

• The tumor is larger than 7 cm.
• The cancer has grown into the chest wall, the diaphragm, the membranes located in the space between the lungs or the sac that surrounds 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 the main tumorous lung.

T4, N0 or N1, M0

In this type of stage IIIA non-small cell lung cancer, the cancer has not spread to distant organs, but the tumor may or may not have (N1 vs. N0) spread to the lymph nodes within the lung and/or the area where the bronchus meets the lung.

One or more of the following features will also be present:  

• A tumor of any size has grown into the space between the lungs, the heart, any large blood vessels near the heart, the trachea, the esophagus, backbone or carina.
• Two or more separate tumors are present in different lobes of one lung.

Stage IIIB Lung Cancer

Stage IIIB 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.  In both instances, the cancer has not spread to distant organs (M0). For each category, one or more of the features listed below will be present.

Any T, N3, M0

• The tumor can be of any size.
• The cancer may or may not have grown into nearby structures, caused the lung to collapse or caused an inflammation/pneumonia of the entire lung.
• The cancer has spread to lymph nodes near the collarbone on either side, and/or has spread to the lymph nodes on the side opposite of the main tumor.

T4, N2, M0

• The tumor can be of any size and has grown into the space between the lungs, the heart, any large blood vessels near the heart, the trachea, the esophagus, backbone or carina, where the trachea meets the bronchi.
• Two or more separate tumors are present in different lobes of one lung.
• The cancer has spread to the lymph nodes around the carina, where the bronchi meets the trachea, or the space between the lungs.
• The affected lymph nodes are on the same side as the main tumor.

Stage III Lung Cancer Treatment

In both stage IIIA and IIIB non-small cell lung cancer, surgery may be an option if the lymph nodes haven’t been affected. Surgery will be combined with radiation therapy and chemotherapy.

At CTCA, each patient’s stage III lung cancer treatment options are personalized to the size and location of the tumor, including how far it has spread. Below are some treatment options for stage III NSCLC.

• Surgery – In some cases, surgery is an option to remove the tumor from the lung, but follow up treatments of radiation therapy and/or chemotherapy will be necessary.
• Radiation Therapy: With or without surgery, radiation therapy can be used to treat stage III lung cancer.
• Chemotherapy: These drugs can kills cancer cells and slow the growth of the cancer.
• Chemotherapy/Radiation Combination: Chemotherapy and radiation therapy can be given simultaneously, or one after the other when combining the treatment.
• Clinical Trials: Many clinical trials are open to patients with stage III lung cancer. Enrolling in a clinical trial may give you access to new therapies. Your doctor can provide information about ongoing studies that may be available to you.