Stage 3 Lung Cancer

What Is Stage 3 Lung Cancer? 

Stage 3 lung cancer is the first stage that’s considered advanced cancer. In this stage the cancer has spread regionally, or to areas near the original tumor, classifying this stage as “locally advanced.” Stage 3 lung cancer characteristics can appear in various forms.

The beginning stages of advanced lung cancer are classified by 3A, 3B and 3C. These stages apply only to cases of non-small-cell lung cancer, which is the type in 80% of lung cancer cases.

• Stage 3A may present itself as:
  • The tumor is 5cm and has spread to the lymph nodes in the mediastinum (the center of the chest) on the same side of the body the tumor was originally detected.
  • The tumor is between 5cm and 7cm. Multiple tumors have been found in the same lobe of the lung, or it has spread to areas outside of the lung but still very near.
  • The tumor is larger than 7cm. It has spread to areas outside the lung but not the lymph nodes. 
  • The tumor has spread to more than one lobe of the same lung and potentially the lymph nodes. 
    • Other areas of the body at risk for infection are the chest wall (ribs, muscle or skin), the phrenic nerve (the nerve closest to the lung), the mediastinal pleura and parietal pericardium (the layers of tissue covering the heart), the diaphragm (muscle under the lungs), esophagus (food pipe), trachea (windpipe), carina (where the trachea splits), recurrent laryngeal nerve (the nerve going to the voice box), chest, heart, a main blood vessel or the spine. 
• Stage 3B may present itself as:
  • The tumor is 5cm or smaller and has spread to the lymph nodes in the chest on the other side of the originally affected lung, the neck or above the collarbone.
  • The tumor is between 5cm and 7cm and has spread to the lymph nodes in the mediastinum (the center of the chest). 
  • The tumor is more than 7cm and has spread into the lymph nodes in the mediastinum (the center of the chest) or another major structure in the chest. 
  • The tumor has spread to the lymph nodes in the chest wall, diaphragm or the layers of tissue covering the heart.
    • Other areas of the body at risk for infection are the heart, trachea, esophagus or a main blood vessel. 
• Stage 3C may present itself as: 
  • The tumor is either between 5cm and 7cm or it has spread to the nerve near the lungs or the layers of tissue covering the heart. The tumor has also spread to the lymph nodes in the mediastinum (the center of the chest) on the opposite side of the originally affected lung, at the top of either lung or above the collarbone.
  • The tumor is larger than 5cm, and tumors have been found in more than one lobe. 
  • The tumor is either bigger than 7cm or it has spread to other areas near the

What Symptoms to Expect for Stage 3 Lung Cancer

Most stage 3 lung cancer tumors are detectable by increasingly severe symptoms. Lung cancer is often diagnosed in the later stages due to the cancer spreading to other organs and tissue, making the symptoms more noticeable. Stage 3 lung cancer does usually cause more severe symptoms, which might include:

• Bone pain
• Headache
• Arm or leg weakness or numbness
• Dizziness or problems balancing 
• Seizures
• Yellowing of the skin and eyes (jaundice) 
• Swollen lymph nodes

Stage 3 Lung Cancer Treatment Options

Although stage 3 lung cancer is considered advanced, there are still many treatment options available to patients. Treatment options for stage 3 lung cancer include surgical procedures, multimodal treatment with different types of therapies, and clinical trials. 

The course of treatment for stage 3 lung cancer is dependent upon the size of the tumor, the location of the tumor, the patient’s overall health and how well the patient responds to treatment. Each of these treatment options is selected and tailored to fit the patient’s needs. Lung cancer specialists will examine the patient’s cancer status and determine the best course of treatment.

Stage 3 Lung Cancer Therapies

As stage 3 lung cancer is considered locally advanced, specialists often recommend therapies for initial treatment. There are various lung cancer therapies used to treat stage 3 lung cancer, such as chemotherapy, radiation therapy, immunotherapy and targeted therapy. Each of these forms of treatment is administered based on the patient’s status. Some patients are eligible for certain treatments, while others are not.  

Most commonly, stage 3 lung cancer treatment starts with chemotherapy combined with radiation therapy, also known as chemoradiation or chemoradiotherapy.

Chemotherapy uses drugs to attack cancer cells and stop them from growing or spreading to other organs, either by killing them or blocking them from reproducing. Chemotherapy is often combined with other modes of treatment like surgery or radiation.

Radiation therapy is often recommended when the patient is not eligible for surgery. This treatment involves specialized equipment to administer strong radiation waves straight to the cancerous tumors over the course of a week or several days. The powerful radiation therapy waves target cancer by damaging the genes of cancer cells, so they cannot grow or reproduce and eventually die. 

Immunotherapy boosts the compromised immune system and attacks cancer cells. The most common drugs used for immunotherapy are checkpoint inhibitors. Cancer cells often send signals that trick the immune system into thinking the cancer cells are healthy cells.

Checkpoint inhibitors can detect these fake signals and alert the immune system, causing the body to naturally attack the cancer cells. Common checkpoint inhibitor immunotherapy drugs are ipilimumab (Yervoy®), pembrolizumab (Keytruda®), nivolumab (Opdivo®) and atezolizumab (Tecentriq®).

Targeted therapy is a common lung cancer treatment involving specialized drugs that target certain genes and proteins driving the growth and spread of lung cancer. Targeted therapies are typically small molecule drugs or monoclonal antibodies. This means the elements used to formulate targeted therapy drugs exist solely to kill or shrink diseased cells. 

Stage 3 Lung Cancer Surgery

For stage 3 lung cancer patients, surgery is not typically for the first option of treatment. Because the cancer has grown in size or spread to other parts of the body, surgery is often  difficult and complex. Lung cancer treatment is specialized for each patient, so there may be specific circumstances allowing for lung cancer surgery. 

The most common surgical approach for lung cancer is a lobectomy. During this procedure, the surgeon removes the lobe or lobes of the lung with the tumor. A lobectomy is only recommended for healthier patients with the ability to survive after surgery.

This approach is not very common for stage 3 lung cancer patients because the cancer has usually spread, meaning the patient is not in a healthy condition, and the removal of a lobe or two will not remove all of the cancer.

Other lung cancer surgical options include 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 (segments or wedges) of the lobe.

These procedures are generally not an option for patients with stage 3 lung cancer or patients with underlying health issues. Stage 3 lung cancer usually means the cancer has spread and affected other parts of the body, worsening the patient’s condition. The patient is not healthy enough to withstand the surgery and its lasting effects, and the surgery will most likely not remove all the patient’s cancer.

The last surgery for stage 3 lung cancer is a pneumonectomy. This removes the entire lung, which might be necessary in this stage. However, the patient’s health must be considered since they’ll only have one lung left.

Stage 3 Lung Cancer Survival Rate

Stage 3 lung cancer is on the brink of advanced stage lung cancer. The prognosis for stage 3 lung cancer is entirely dependent upon the subcategory (3A, 3B or 3C) the cancer has been categorized. During stage 3 lung cancer, the cancer can display varying characteristics, so much so that each subcategory has vastly different survival rates. 

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 3 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.

According to the American Cancer Society, if non-small cell lung cancer is confined to one lung (localized), the 5-year relative survival rate is 64%. However, if the cancer has spread to areas around the lung, the 5-year survival rate is 37%. If the cancer has spread to more distant parts of the body, the 5-year survival rate is 8%.