This intermediate stage of cancer, in which the malignancy has begun to extend from the primary tumor to surrounding tissues, is still highly treatable. And just as there are factors that can negatively impact survival, there are others that can have a positive effect.
Knowing which risk factors are modifiable can help you make lifestyle changes to improve your chances of remission or disease-free survival.
Characteristics of Stage 2 Lung Cancers
Lung cancer staging is a process used to classify the severity of the disease. The staging of non-small cell lung cancer (NSCLC) utilizes the TNM system, which determines the cancer stage based on the tumor’s size and extent (T), whether nearby lymph nodes have cancer cells in them (N), and if there is evidence of the spread of cancer, also known as metastasis (M).
Stage 2 NSCLC is broken down into two substages:
Stage 2a lung cancer indicates a tumor size of between 4 and 5 centimeters (roughly 1½ inch and 2 inches, respectively). The tumor may also have grown into an airway or tissues surrounding the lungs. However, no lymph nodes will be affected, and there will be no evidence of metastasis. Stage 2b lung cancer indicates that the tumor is either less than 3 centimeters (1¼ inch) in diameter and has spread to nearby lymph nodes, or that the tumor is between 3 and 5 centimeters or may have spread into the airways or surrounding tissues as well as nearby lymph nodes. There will also be no evidence of metastasis.
NSCLC is staged differently than small cell lung cancer (SCLC), a less common form of the disease that is classified as either limited-stage or extensive-stage.
Stage 2 Survival Statistics
Cancer survival is typically described in terms of five-year survival rates. This is the percentage of people who live for at least five years following their diagnosis.
Epidemiologists and health authorities calculate survival in different ways. Some do so based on the TNM stage, while others calculate life expectancy based on how extensively cancer has spread. Both methods have their advantages and disadvantages.
While survival rates are helpful in many ways, it is important to remember that they are only broad estimates of what to expect.
Survival Rates by TNM Stage
Estimating survival based on the TNM stage is an intuitive approach that “matches” stage to survival. Based on recent revisions to the TNM classification system, the five-year survival rate of stage 2 NSCLC breaks down as follows.
The drawback of the TNM approach is that certain basic factors—such as the location of the tumor and the degree of airway obstruction—can impact survival times and are not reflected in these estimates.
Survival Rates by Disease Extent
The National Cancer Institute utilizes a different approach to survival estimates under its Surveillance, Epidemiology, and End Results (SEER) Program.
Rather than basing five-year estimates on the disease stage, the SEER program does so based on how extensively the cancer has spread. This is categorized in one of the following three ways.
Localized: No sign of cancer outside of the lung Regional: Cancer that has spread to nearby lymph nodes or structures Distant: Cancer that has spread to distant organs (metastatic disease)
Under the SEER classification system, the five-year survival rate for stage 2a lung cancer is 59%, while the five-year survival rate for stage 2b lung cancer is 31.7%.
After the introduction of immunotherapy, 5 year survival of lung cancer improved: for example, the survival of 5-year survival of patients with distant disease receiving immunotherapy exceeds now 10%. Also new approaches like neo-adjuvant immunotherapy plus or minus chemotherapy improved the overall survival of patients with stage 2 NSCLC.
There are six distinct factors that are known to impact survival times in people with NSCLC in general and, in some cases, stage 2 NSCLC specifically.
Age
Survival times in people with NSCLC in general tend to decrease in tandem with advancing age. This is in part because of diminishing overall health.
After the age of 60—the period in which most people with lung cancer are diagnosed—the five-year survival rate begins to drop precipitously.
Over time, the disparity becomes even more apparent. With NSCLC in general, the five-year survival rate in women is 20% greater than that in men (19% vs. 13.8%, respectively), while the 10-year survival rate in women is nearly 40% greater than in men (16.2% vs. 19.5%, respectively).
Performance Status
It is no surprise that your general health at the time of an NSCLC diagnosis impacts how well you respond to treatment and how long you are likely to survive. People who are fit and active in their 70s, for example, are almost invariably more likely to do better than those in their 60s who are disabled due to their symptoms.
The ability to function in daily life with cancer is referred to as performance status (PS). It can be measured using one of two classification systems:
Eastern Cooperative Oncology Group (ECOG) Performance Status is a cancer-specific system that rates PS on a scale of 0 to 5 (0 being fully functional and 5 being dead). Karnofsky Score is a generalized measure used in oncology and other diseases that rates PS on a scale of 0% to 100% (0% being dead and 100% being fully functional).
Based on the ECOG system, the five-year survival rate for overall NSCLC is delineated by the PS but is also described by median survival times (the period of time in which 50% of people with NSCLC are still alive).
A 2010 review of studies in the British Medical Journal concluded that smoking after the diagnosis of early-stage lung cancer (defined as stages 1 and 2a) reduces the five-year survival rate to 33%. This translates to a greater than 50% reduction in overall survival times for people with stage 2 NSCLC.
By contrast, quitting cigarettes increases five-year survival rates to around 70% independent of all other risk factors.
Type of Lung Cancer
Not all lung cancers are the same. With NSCLC in general, some types are more aggressive than others or may inhabit different, more vulnerable parts of the lungs. The following are the three most common types.
Lung adenocarcinoma: A type of NSCLC that develops in the outer edges of the lung and accounts for around 40% of all lung cancer diagnoses. Squamous cell lung carcinoma: A type that mainly affects the airways and accounts for 25% and 30% of all cases. Large cell lung carcinoma: A rare and typically aggressive form of NSCLC that can develop in any part of the lung.
Each of these cancer types has different estimated survival rates, with lung adenocarcinoma generally being the most promising and large cell carcinoma being the least.
Wedge resection: Involves the removal of a wedge-shaped section of the lung; usually pursued if the tumor is small or there is a concern about lung function Lobectomy: The preferred surgical method of surgery, involving the removal of one of the five lobes of the lungs Sleeve resection: Involves the removal of a part of the lung as well as a part of the main airway Pneumonectomy: Involves the removal of an entire lung if the tumor’s location prevents less invasive surgeries
How a person is treated after surgery also influences survival times. With respect to stage 2 NSCLC specifically, the use of adjuvant chemotherapy (used to clear any remaining cancer cells) results in a 53% lower risk of death over the ensuing five years compared to people who do not undergo chemotherapy following surgical resection.
A Word From Verywell
The survival time for people with lung cancer is rapidly improving compared to earlier generations. Back in the 1970s, the one-year survival rate for cancer was only 16%, increasing to 32% by 2011. Today, the rate is as high as 44%, with one in 10 women and one in 12 men living for 10 years or more.
Early diagnosis is key to improving outcomes. With stage 2a and 2b NSCLC, curative treatment is possible, affording survival times comparable to those of stage 1 NSCLC. And by quitting cigarettes, exercising regularly, and pursuing a generally healthier lifestyle, you may not only be better equipped to cope with treatment, but extend your life expectancy as well.
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