Stage 3 lung cancer: Symptoms, treatment, and outlook

 

Written by Jennifer HuizenReviewed by Christina Chun, MPH

Stage 3 lung cancer is often described as late, locally advanced or advanced lung cancer.

There are a number of different types of lung cancer that are classed as stage 3. Lung cancers can be either non-small cell lung cancers (NSCLC) or small cell lung cancers (SCLC). Stage 3 lung cancers are further divided into stage 3a and stage 3b cancers depending on the extent and size of the tumor.

Roughly one-third of people diagnosed with lung cancer have stage 3 lung cancers.

Stage 3 lung cancer classification

Lung cancers are ranked on a scale of 1 through 4, according to the extent of the cancer’s growth and spread. Generally speaking, the lower the number the better the outlook, but averages don’t represent individual cases.

Many different factors work together to influence diagnosis, treatment, and recovery. Some with higher numbered cancers will outlive those with lower numbered cancers.

Some characteristics of stage 3 lung cancers include:

  • a tumor with a diameter of 3 centimeters or more
  • a primary tumor that has spread to chest lymph nodes
  • a primary tumor that has spread to other organs or structures outside of the lung
  • affected lymph nodes or organs are on the same side of the body as the primary tumor

Stage 3 lung cancers are further classified based on whether or not they are NSCLC or SCLC.

Cases of NSCLC are also classified using the TNM system, which describes the primary tumor’s size, whether it has spread to lymph nodes, and whether it has metastasized to other organs.

Once the TNM stage has been determined, a doctor will probably gather more information to further define the cancer in a process called stage grouping.

Cases of NSCLC are also defined as clinical, based on the results of tests, such as biopsies, scans, and pathology. The tests will also take into account surgical discoveries and results.

Cases of SCLC are classified as limited or advanced. In limited SCLC cases, tumors and affected lymph nodes appear in one lung and on the same side of the body. In advanced SCLC cases, the primary tumor has spread further in the chest or to other organs.

Stage 3 NSCLC and SCLC cases are both additionally described as either 3a or 3b based on the size, spread, and location of the tumors involved. Cases of 3b are typically more severe than 3a, representing a more advanced state of the disease. Stage 3b lung cancers share many characteristics with stage 4 lung cancers.

Stage 3a cancers are often considered the point past which surgical intervention becomes extremely unlikely.

Symptoms

By the time the disease has reached stage 3, symptoms are typically apparent. However, symptoms can vary greatly from person to person. The severity of symptoms also depends on the location, size, and growth rate of the tumor and cancer.

Symptoms of stage 3 lung cancers include:

  • pain in the chest
  • pain when breathing
  • wheezing
  • whirling or high pitched sound upon inhalation or exhalation
  • persistent cough
  • cough with blood
  • blood in saliva and mucus
  • hoarseness or altered voice
  • unplanned weight loss
  • loss of appetite
  • pain or difficulty swallowing
  • fatigue
  • headache
  • weakness
  • bone pain that can increase over the course of the day
  • fever

Many additional symptoms are associated with the treatment of stage 3 lung cancers. The most common of these symptoms are pain, nausea, skin burns, and loss of hair and weight.

Treatments

Most stage 3 lung cancer cases are treated with some combination of chemotherapy, radiation therapy, and if possible, surgery.

The treatment plan for each case depends on the stage of the cancer as well as the overall health of the patient. Given the advanced stage of the disease, people with stage 3 lung cancers often undergo the most aggressive form of treatment they can.

Age, gender, family history, and lifestyle habits can also influence the treatment plan selected.

Given the poor outlook of the stage, the National Cancer Institute recommend that all people with stage 3 lung cancer consider participating in clinical trials, which are carried out to improve treatment and to test new medicines and methods.

An estimated 33 percent of stage 3 and higher NSCLC cases are treated by a combination of chemotherapy and radiation therapy. Around 18 percent are treated with chemotherapy alone and 15 percent with radiation therapy alone. The targeted therapy bevacizumab is used by 15 percent of people treated with chemotherapy.

Surgery is not an option for the majority of SCLC cases given the advanced state of the disease. Chemotherapy and radiation are often used for limited SCLC cases. Extensive SCLC cases are treated using chemotherapy alone.

Treatment options for stage 3a lung cancers include:

  • chemotherapy to shrink the tumor followed by surgery
  • radiation to shrink the tumor before surgery
  • surgery followed by chemotherapy to prevent reoccurrence
  • surgery followed by radiation to prevent reoccurrence
  • chemotherapy, radiation, or both when surgery is not possible
  • gene testing for SCLC cases
  • targeted therapiesfor so-called “driver mutations”
  • immunotherapy

Treatment options for stage 3b lung cancers include:

  • chemotherapy
  • radiation therapy
  • targeted therapies similar to those for stage 3b
  • chemotherapy and radiation in combination

Surgery is not often an option given the extent of tumor growth and additional organs involved.

Doctors and healthcare professionals may recommend that a person try complementary therapies alongside conventional treatments to help lessen symptoms. Popular complementary therapies include massage therapy, hydrotherapy, yoga, relaxation techniques, and sometimes palliative care.

Outlook

According to the American Cancer Society, the current estimated 5-year survival rate for stage 3 cancers depends on the form and type of the cancer. Lung cancers have the lowest 5-year survival rate of all cancers in the United States at an estimated 16.8 percent.

Five-year survival rates for stage 3 lung cancers are:

  • stage 3a NSCLC: 14 percent
  • stage 3b NSCLC: 5 percent
  • stage 3 SCLC: 8 percent

The outlook for each case is unique based on a series of factors and influences. The earlier the cancer is caught and treated, the better the outlook. Treatment plans involving surgically removed tumors or a combination of chemotherapy and radiation therapy has the highest survival rates.

Older individuals and those in poor health are often at a greater risk of dying from lung cancer. Women generally have a better outlook than men. Family history and reactions to therapeutic treatments or drugs can also affect outcomes.

Treatment advances

Currently, no definite cure exists for stage 3 lung cancers. Many late or advanced lung cancers will return even after responding to therapies.

New treatment plans suggest combining therapies for best results. A 2013 study found that combined therapies are the best way to treat stage 3 lung cancers.

Extensive work is also being done to establish treatment plans tailored to individual people, stages, and tumors.

The American Cancer Society’s guidelines for screening have recently been revised following the conclusion of the National Cancer Institute’s National Lung Screening Trial.

To increase early detection rates, new recommendations advise that high-risk individuals undergo annual screening by low-dose computed tomography.

High-risk individuals are typically people aged 55 to 74 with a 30-pack-a-year history of smoking, current smokers or those who have quit smoking within the last 15 years.

 

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