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

72 NCCN Guidelines for Patients ® : Lung Cancer – Non-Small Cell, 2018 Stage III Stage III is often defined by cancer spread to lymph nodes far outside the lungs. N2 nodes are between the lungs but next to the lung with cancer. Some are right below the windpipe. N3 nodes are between the lungs close to the lung without cancer. Other N3 nodes are near the collarbone or in the neck. Some stage IIIA cancers have not spread far among lymph nodes. The N stage for these cancers is either N0 or N1. Instead, there may be a primary and secondary tumor in the same lung. Or instead, the tumor may have invaded the chest wall, bronchus, or mediastinum. Options for stage III cancers are grouped into four sections. † † N0 or N1 disease starts on this page. † † N2 disease starts on page 75 † † N3 disease starts on page 76. † † Survivorship plan starts on page 76. N0 or N1 disease Guide 16 lists options for initial treatment for N0 or N1 disease. N0 means that no cancer has been found in lymph nodes. N1 means that cancer has been found in peribronchial, intrapulmonary, or hilar nodes of the lung with the primary tumor. Tumors without invasion These tumors have not grown into the chest wall, bronchi, or mediastinum. For initial treatment, options depend on if you are able to have surgery. Surgery . 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. After surgery, adjuvant treatment will be given. This treatment is given to reduce the chances of the cancer returning. Chemotherapy is advised if the surgical margins are cancer-free. When the margins have cancer, chemoradiation is an option. These two types of treatment can be given at the same time. They may also be given back-to-back if cancer in the margins can only be seen with a microscope. Chemoradiation . You may be unable or refuse to have surgery. In this case, chemoradiation is an option. These two types of treatment should be received at the same time. If the cancer does not worsen after 2 or more cycles of chemoradiation, durvalumab may be received. It may also slow down the growth of the cancer. 6 Non-metastatic cancer One primary tumor – Stage III