Answer
Most patients with stage I and stage II disease require preoperative or intraoperative mediastinal dissection for accurate staging prior to lung resection. The overall surgical mortality rate following lung resection is 3.7%. The mortality rate is higher (6-9%) in patients requiring pneumonectomy and in patients older than 70 years. The overall 5-five year survival rate may depend on whether the tumor is stage T1 or stage T2. The overall 5- and 10-year survival rates are 75% and 67%, respectively, in patients who undergo resection for stage I disease.
Patients with stage IA (T1 N0) disease have a significantly higher survival rate (82% at 5 yr) compared with those with stage IB (T2 N0) disease (68% at 5 yr and 60% at 10 yr). [8]
Patients with stage IIA (T1 N1) tumors have a survival rate of approximately 50% at 5 years, whereas patients with stage IIB (T2 N1 and T3 N0) tumors have a 40% survival rate.
Patients with stage IIIA (T1 or T2 N2) tumors have been reported to have a 5-year survival rate of 29%. The 5-year survival rate in patients with complete resection of stage IIIB tumors is 49% in T3 N0 disease, 27% in T3 N1 disease, and 15% in T3 N2 tumors. For patients with stage IV disease, the median survival is 8.5-21 weeks, and the 1-year survival rate is 10%.
See Non-Small Cell Lung Cancer Staging for summary tables.
The overall 5-year survival rate is grim because most patients with NSCLC present with locally advanced or metastatic disease. Approximately 65-80% of patients present with unresectable disease. At present, the National Cancer Institute and other medical associations and regulatory bodies do not recommend early screening for lung cancer as part of a periodic health examination.
A number of studies are currently under way to find improved treatments for non-small cell lung cancer. [9, 10, 11]
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Non–small cell lung cancer. Bronchoscopy. A large central lesion was diagnosed as non–small cell carcinoma.
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Non–small cell lung cancer. Left pleural effusion and volume loss secondary to non–small cell carcinoma of the left lower lobe. The pleural effusion was sampled and found to be malignant; therefore, the lesion is inoperable.
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Non–small cell lung cancer. Left upper collapse is almost always secondary to endobronchial bronchogenic carcinoma.
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Non–small cell lung cancer. Complete left lung collapse secondary to bronchogenic carcinoma of left mainstem bronchus.
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Non–small cell lung cancer. A cavitating right lower lobe squamous cell carcinoma.
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Non–small cell lung cancer. CT scan shows cavitation and air-fluid level.
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Non–small cell lung cancer. Patient has right lower lobe opacity. This is not well circumscribed and was found to be a squamous cell carcinoma.
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Non–small cell lung cancer. Right upper lobe lesion diagnosed as adenocarcinoma on percutaneous biopsy.
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Non–small cell lung cancer. Right upper lobe collapse with the S sign of Golden secondary to underlying non–small cell carcinoma of the bronchus.
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Non–small cell lung cancer. Comparative characteristics of the primary tumor are shown in the vertical columns. Horizontal columns refer to lymph node involvement. The different stages are color coded and can be found at the intersection of appropriately matched horizontal and vertical columns. Stages with unique characteristics, such as stages 0 and IV, are defined in separate boxes. Courtesy of Lababede et al (Chest 1999; 115(1): 233-5).
