Stage 1 Lung Cancer

What Is Stage 1 Lung Cancer? 

Stage 1 lung cancer occurs after doctors have detected abnormal cells and tested them for cancer. In stage 1, the abnormal cells are now confirmed cancer. Although it is a cancer diagnosis and may be devastating, this stage offers the most hope for survival due to early treatment.

The earliest of the stages of lung cancer are classified by 1A and 1B. These stages apply only to cases of non-small-cell lung cancer, which is the type in 80% of lung cancer cases.

• Stage 1A: The cancer cells affect only the lung, with a tumor measuring 3 cm or smaller and has not spread to any lymph nodes or other organs and tissues. 
• Stage 1B: 
  • In some cases, the tumor measures larger than 3 cm – but smaller than 4 cm – and has not spread to other organs and tissues, including lymph nodes. 
  • In other cases, the tumor measures 4 cm or less and meets one of the following criteria: 
    • The cancer has spread to the main bronchus (the large airway connecting the trachea to the lung) but has not spread to the carina (the ridge at the bottom of the trachea that divides the openings of the left and right main bronchi). 
    • The cancer has spread to the innermost tissue that encapsulates the lung. 
    • The cancer has caused a portion or the entire lung to collapse or the patient is diagnosed with pneumonitis (inflammation of the lung). 
    • The cancer has not spread to nearby lymph nodes.  

What Symptoms to Expect for Stage 1 Lung Cancer

Most stage 1 lung cancer tumors are undetectable by symptoms and are often diagnosed due to something a doctor noticed during a routine check-up. Occasionally, stage 1 lung cancer does cause mild symptoms, which might include:

Stage 1 Lung Cancer Treatment Options

There are several treatment options for stage 1 lung cancer. Treatment usually involves multimodal treatment, or a combination of surgery and various types of therapy. Stage 1 patients have more treatment options available and are better candidates for surgery, often leading to remission and lengthy survival.

Surgery

For stage 1 lung cancer patients, surgery is the most common form of treatment. There are a few different surgery options.

The most common surgical approach for stage 1 lung cancer is a lobectomy. During this procedure, the surgeon removes the lobe or lobes of the lung with the tumor. The right lung has three lobes and the left lung has two lobes. Doctors can remove 1-2 lobes from the right lung and one lobe from the left lung.

This is an aggressive surgery and not an option for everyone. Most patients undergoing this operation are healthier and have the ability to survive with one whole lung and one partial lung. 

There are less intense surgical options to treat stage 1 lung cancer, such as a sleeve resection, segmentectomy or wedge resection. These surgical options do not require the removal of a whole lung, or even an entire lobe – only the removal of small pieces of the lobe.

These procedures are generally an option for patients with very minor stage 1 lung cancer or patients with underlying health issues. Partial removal of the lobe offers the best hope for these patients because their bodies cannot usually endure the stress of a lobectomy.  

The wedge resection procedure involves removing a small, triangle-shaped slice of the lung tissue containing the cancerous tumor. During the operation, some of the healthy tissue surrounding the cancer is also removed. 

Segmental resection, also known as a segmentectomy, is a lung cancer surgery performed to remove small portions of the cancer-affected lung lobe. Similar to the wedge resection, non-affected, healthy lung tissue is removed, too. Each lobe contains 2-5 segments, so doctors can remove 1-4 during a segmentectomy depending on which lobe has the tumor.

The final surgical approach to stage 1 lung cancer is a sleeve resection, sometimes called a sleeve lobectomy. This procedure removes the cancerous lobe and part of the main bronchus (airway) connected to the cancerous lung. The unaffected end of the bronchus is connected to an unaffected lobe.

Lung Cancer Therapies: Targeted Therapy, Radiation Therapy and Chemotherapy

There are various factors contributing to a patient’s course of treatment. Sometimes, certain therapies can be suggested when surgery is not possible, or suggested after surgery to enhance the effects.

Chemotherapy is one of the most common lung cancer treatment options. This therapy uses drugs to interfere with cancer cells and stunt their growth and spread, either by killing them or stopping them from regenerating. Chemotherapy can be delivered to the body in different ways such as, by mouth, injection, infusion or on top of the skin, depending on the patient’s condition, and is often combined with other treatments like surgery or radiation.

Immunotherapy is a fast-rising therapy for cancer. The immune system is a force in fighting cancer. However, it needs some help from modern medicine. Immunotherapy can strengthen the immune system or hinder certain aspects of cancer to make the cells more susceptible to the immune system’s forces. Examples are immune checkpoint inhibitors, of which there are a handful approved by the FDA for lung cancer treatment.

For stage 1 lung cancers that are 4cm across, another treatment option is immunotherapy with nivolumab along with chemotherapy before surgery. Additional therapy after surgery might be needed depending on what is found at the time of surgery.”

Radiation therapy is often recommended when surgery is not an option. This type of treatment involves specialized equipment used to distribute powerful radiation waves directly to cancerous tumors over the course of several days. Radiation therapy can be administered in various forms depending on the patient’s condition. 

Targeted therapy is a lung cancer treatment with specialized medications and substances used to target specific genes and proteins involved in the growth of lung cancer. Some targeted therapies block certain enzymes, genes and proteins from contributing to the growth and spread of cancer cells or tumors. Other targeted therapy options help the immune system attack and kill cancer cells or deliver toxic substances straight to the cancer cells and kill them.

Targeted therapies are usually small molecule drugs or monoclonal antibodies. This means the components used to create these targeted therapy drugs exist to target diseased cells.

Prognosis

Stage 1 lung cancer typically has the most promising prognosis as the cancer is in its early stages and has not spread to other tissues and organs. The earlier the cancer is diagnosed, the quicker cancer specialists can start treatment and attack the cancer cells. Typically, there are far more treatment options for stage 1 lung cancer and the possibility for remission is high.

The approach to measuring a patient’s survival after lung cancer treatment is called a 5-year relative survival rate. It compares people with the same type and stage of cancer – in this case stage 1 lung cancer – to people in the general population.

The American Cancer Society relies on information from the Surveillance, Epidemiology, and End Results (SEER) database, maintained by the National Cancer Institute (NCI), to provide survival statistics for cancer patients.

The SEER database analyzes 5-year survival rates for lung cancer patients in the United States. The database does not categorize the survival rates by the typical cancer stages but by how and where the cancer has spread.

Stage 1 lung cancer is the very beginning stage of lung cancer, which means the cancer cells have not spread outside the lungs – meaning the cancer is localized.

According to the SEER database and the 5-year survival rate, patients with localized lung cancer have a 64% survival rate – meaning 64% people diagnosed with stage 1 lung cancer live for at least 5 years after being diagnosed.