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

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

66 NCCN Guidelines for Patients ® : Lung Cancer – Non-Small Cell, 2018 Stage II A stage IIA tumor is between 4 cm and 5 cm in size. TNM scores are T2b, N0, M0. Some of these tumors may have invaded the main airway or inner lining of the lung. The tumor may have caused your lung to collapse or swell. Stage IIA hasn’t spread to any lymph nodes. A stage IIB tumor may be as large as 5 cm and spread to the lung’s lymph nodes. TMN scores are T1 or T2, N1, M0. Some of these tumors may have invaded the main airway or inner lining of the lung. The tumor may have caused your lung to collapse or swell. Stage IIB also includes tumors that have not spread to lymph nodes. TMN scores are T3, N0, M0. These tumors are between 5 cm and 7 cm in size, have invaded structures, or have secondary tumors in the same lobe. Invaded structures may include the outer lining of the lung, chest wall, and the heart’s lining. Options for stage II cancers are grouped into four sections. † † T2 or T3 without invasion starts on this page. † † T3 Superior sulcus tumors starts on page 68 † † T3 Other invasive tumors starts on page 68. † † Survivorship plan starts on page 70. T2 or T3 without invasion Guide 10 lists treatment options for all T2 tumors and only T3 tumors without invasion. For initial treatment, options depend on if you are able to have surgery. Initial treatment If lung surgery is an option, removal of the tumor and lymph nodes is advised. The goal of surgery is to cure the cancer. If chemotherapy is likely, you may receive it before surgery to shrink the tumor. You may be unable or refuse to have surgery. Your options depend on if the cancer has spread to your lymph nodes. N0 means the lymph nodes are cancer-free. N1 means there is cancer in the lung’s lymph nodes. For N0 disease, you may be treated with radiation therapy. The goal is to try to cure the cancer. You may receive conventional radiation therapy. Conventional radiation therapy gives radiation in small doses for weeks and targets both the tumor and some normal tissue. One example is 3D-CRT. A newer type of radiation therapy—SABR—is also advised. For N1 disease, you may receive chemoradiation. The two types of treatment should be received at the same time. Adjuvant treatment Adjuvant treatment is given to reduce the chances of the cancer returning. Options are grouped by type of initial treatment. After surgery . For stage IIA, cancer-free margins are often a sign that all the cancer was removed. In this case, you may start your survivorship plan. However, cancer cells may remain for some stage IIA cancers. In these cases, chemotherapy may be received. Cancer likely remains when tumors are larger than 6 Non-metastatic cancer One primary tumor – Stage II

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