NCCN Guidelines for Patients® | Non-Small Cell Lung Cancer - page 63

NCCN Guidelines for Patients
: Non-Small Cell Lung Cancer
Version 1.2013
Part 7: Treatment by cancer stage
Par t 1
Par t 2
Par t 3
Par t 4
Par t 5
Par t 6
Par t 7
Par t 8
Par t 9
Stage III tumors without invasion
N0 or N1 disease
This chart maps the treatment for stage III (N0 or N1)
tumors without invasion. These tumors have not grown into
surrounding structures, such as the chest wall. There may
be secondary tumors in the lung with the primary tumor.
Lymph nodes without cancer are scored N0. Cancer in
intrapulmonary, peribronchial, or hilar lymph nodes is
scored N1. Surgery may be a treatment option for these
stage III cancers that haven’t spread to the mediastinal
nodes. Otherwise, chemoradiation is an option.
If you have surgery, adjuvant treatment is based on
the surgical results. If the surgical margins are cancer-
free, chemotherapy is recommended. If cancer is in the
margins, 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. For cancer not seen by the naked eye,
chemotherapy may be given at the same time as radiation
(concurrent) or beforehand (sequential). Concurrent
chemoradiation is the option for cancer that can be seen
with the naked eye.
Primary treatment
Test results
Adjuvant treatment
Margin status
T3, N1
T4, N0
T4, N1
Lung tumor and
lymph node surgery
No cancer in margins
Cancer not seen with naked eye
Cancer seen with naked eye
Concurrent or sequential chemoradiation
Concurrent chemoradiation
Unable or
refuse to
have surgery
7.3 Stage III treatments
You may have stage III lung cancer based on the staging
tests. Or you may have been upstaged to stage III after
surgery. Stage IIIA is often defined by cancer spread to
mediastinal nodes, presence of secondary tumors, or tumor
growth into the mediastinum, neck, or spine. Stage IIIB is
often defined by cancer that has spread to lymph nodes in
or near the other lung or above the collarbone. Treatment
options in Part 7.3 are presented by means of two main
groups. These two groups are divided by primary tumors
that have and have not invaded surrounding tissue.
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