NCCN Guidelines for Patients® | Non-Small Cell Lung Cancer - page 59

NCCN Guidelines for Patients
: Non-Small Cell Lung Cancer
Version 1.2014
Part 7: Treatment by cancer stage
Par t 1
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Par t 4
Par t 5
Par t 6
Par t 7
Par t 8
Par t 9
The airway that
enters the lung
Chest wall:
A layer of
muscles and ribs
A clearly seen
division in a lung
lymph node:
A group of
disease-fighting cells
A period of
testing for signs of cancer
surgical margin:
normal-looking tissue
around a tumor
Read Part 6 for a
description of lung
cancer treatments.
If you are able to have surgery, removal of the tumor and lymph nodes is
recommended. During surgery, your doctors may find more cancer than first
thought. This may change the stage of the cancer. If the cancer is upstaged, go
back to page 55 to find out which pages to read.
If the cancer remains stage II, you may receive adjuvant treatment depending on
the surgical results. For stage IIA cancer, treatment options depend on whether
the cancer has spread to your lymph nodes. Lymph nodes without cancer are
scored N0 and lung nodes with cancer are scored N1. Cancer in the surgical
margin also affects treatment options for stages IIA and IIB.
For stage IIA with N0 disease, a cancer-free margin is often a sign that all the
cancer was removed. In this case, observation is recommended. However,
the chance of remaining cancer is higher for some stage IIA cancers. In these
cases, chemotherapy may be received. When cancer is in the margins, a second
surgery with or without chemotherapy is preferred. However, radiation therapy
with or without chemotherapy is another option.
For stage IIA with N1 disease and stage IIB cancer, chemotherapy is
recommended when the margins are cancer-free. When the margins have
cancer, treatment options are based on whether the cancer can’t be seen with
the naked eye (microscopic) or can be seen (macroscopic). Microscopic cancer is
found with a microscope.
In either case, a second surgery followed by chemotherapy is an option. The
second option for cancer not seen with the naked eye is chemoradiation.
Chemotherapy may be given at the same time as radiation (concurrent) or
beforehand (sequential). Concurrent chemoradiation is the second option for
cancer seen with the naked eye.
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