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Stage 2 Lung Cancer: What To Expect

Medically reviewed by Mark Levin, M.D.
Written by Emily Wagner, M.S.
Posted on December 29, 2021

Stage 2 lung cancer is diagnosed when a tumor starts to spread to structures close by in the lungs, but it has not spread to the lymph nodes or other parts of the body. This is generally considered an early stage lung cancer, and it has a good prognosis (outlook).

What Is Stage 2 Lung Cancer?

Lung cancer is divided into two groups: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). The staging for each type is different due to differences in the cancer itself. Lung cancer staging helps doctors understand prognosis, choose a treatment plan, and predict outcomes.

The American Joint Committee on Cancer designed a staging system known as the TNM scale. This scale uses Roman numerals to put cancer into one of four stages: stage I (1), stage II (2), stage III (3), and stage IV (4). Staging is based on the answers to three main questions:

  • T (tumor size) — How large is the main tumor, and how much has it spread?
  • N (nodes) — Has the cancer spread into the lymph nodes?
  • M (metastases) — Has the cancer metastasized (spread) to distant organs in the body?

SCLC is rarely staged using the TNM staging system; instead, doctors diagnose cases as either “limited stage” or “extensive stage” SCLC. The stage depends on the size and spread of the cancer.

Non-Small Cell Lung Cancer

Stage 2 NSCLC can be divided into two different stages: 2A and 2B.

In stage 2A NSCLC:

  • The main tumor is larger than 4 centimeters but smaller than 5 centimeters in diameter.
  • The main tumor has grown into a bronchus (main airway) or the visceral pleura (the linings around the lungs), or it is partially clogging an airway.
  • The tumor has not spread into nearby lymph nodes or to other parts of the body.

In stage 2B NSCLC:

  • The main tumor is 3 centimeters or larger in diameter.
  • The main tumor has spread into the main airway, nearby lymph nodes, the visceral pleura, the chest wall, or the lining surrounding the heart.
  • There may be two or more separate tumors within the same lung lobe.
  • The tumor has not spread to other parts of the body.

Small Cell Lung Cancer

SCLC staging is divided into either limited stage or extensive stage disease.

Doctors diagnose limited stage SCLC when the cancer is only in one lung and might have spread into nearby lymph nodes. Limited stage disease can include affected lymph nodes found in the center of the chest and above the collarbone.

Extensive stage SCLC is diagnosed when the cancer has spread to both lungs, the lymph nodes, and distant parts of the body. If the cancer has spread into the visceral pleura, it is also diagnosed as extensive stage disease. About 66 percent of people with SCLC are diagnosed with extensive stage disease.

Symptoms of Stage 2 Lung Cancer

Lung cancer symptoms may occur at any stage, but they are more common if the disease has progressed further. Some common symptoms you may have at any stage include:

  • Coughing
  • Fatigue
  • Shortness of breath
  • Weight loss
  • Chest pain
  • Loss of appetite
  • Repeated infections, such as pneumonia or bronchitis

If your cancer has spread to the lymph nodes, they may become swollen and appear as lumps.

Treatments for Stage 2 Lung Cancer

Lung cancer treatment depends on the stage of the cancer and your overall health. Stage 2 lung cancer is mostly localized to one area of the lung. Surgery and radiation are typically used to treat it.

Treating Stage 2 Non-Small Cell Lung Cancer

For people with NSCLC who are healthy enough, surgery is typically the first treatment option. The type of surgery will depend on the size of the tumor and whether the cancer has spread to nearby structures in the lungs.

Your doctor will refer you to a thoracic surgeon for lung cancer surgery. A sleeve resection or lobectomy can be performed. These procedures remove only a small part of the lung that has the cancer. If there is cancer in more than one part of the lung, a pneumonectomy (removal of the whole lung) will be performed.

After surgery, your doctor will want to make sure there are no lung cancer cells left behind; if there are, these can grow into another tumor. You may have a second surgery, adjuvant (additional) chemotherapy, or radiation to kill any remaining cancer cells.

Treating Small Cell Lung Cancer

Treatment for SCLC depends on whether the cancer is diagnosed as limited stage or extensive stage.

Limited Stage

First-line treatments for limited stage SCLC are chemotherapy and radiation given at the same time (concurrent chemoradiation). This is an intense treatment, and it may cause worse side effects than if either treatment was used alone. Typically, surgery is not a good option. The tumor may be too big, may be in a difficult location to remove, or may have spread too far.

About 50 percent of people with SCLC will also have cancer spread to the brain. To prevent this from happening, you may have radiation therapy to your head, known as prophylactic cranial irradiation.

Extensive Stage

Extensive stage SCLC is cancer that has spread throughout both the lungs and to other parts of the body. With this type of SCLC, surgery and radiation will not be effective treatments. Instead, systemic (whole-body) therapies are needed to treat cancer in multiple parts of the body. These therapies are pills or drugs that are given intravenously to travel through the bloodstream and shrink tumors.

One option is chemotherapy with etoposide and platinum-based drugs. Another option is immunotherapy, such as atezolizumab (Tecentriq) or durvalumab (Imfinzi). These can be combined with chemotherapy. These drugs will shrink tumors significantly. However, in most cases, the cancer will return.

For people whose cancer has spread to the airways, radiation or laser surgery can be used. These treatments can relieve some lung cancer symptoms such as shortness of breath or bleeding.

Stage 2 Lung Cancer Outlook

Survival rates give a general idea of how many people with the same type and stage of cancer live for a specific amount of time. Typically, studies look at the five-year survival rate for cancers. It is important to remember that survival rates are only estimates gathered from several sources. They cannot predict what will happen in any particular case.

People with NSCLC that is localized (has not spread) have a five-year survival rate of 63 percent. In cases of localized SCLC, the five-year survival rate is 27 percent. These statistics do not take into account other factors, such as the lung cancer subtype, your overall health, your age, and any genetic mutations in the cancer.

Fortunately, researchers continue to make advances in lung cancer treatments. Therapies — and outlooks — continue to improve.

Talk With Others Who Understand

MyLungCancerTeam is the social network for people with lung cancer and their loved ones. On MyLungCancerTeam, more than 6,000 members come together to ask questions, give advice, and share their stories with others who understand life with lung cancer.

Are you living with stage 2 lung cancer? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Posted on December 29, 2021
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Mark Levin, M.D. is a hematology and oncology specialist with over 37 years of experience in internal medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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