Treating Stage One Lung Cancer

Cancer that is localized to the lung and has not spread to lymph nodes or other organs throughout the body is known as early-stage lung cancer and typically refers to stages 1 and 2. The goal of treatment for early-stage lung cancer, especially stage 1 lung cancer, is the surgical removal of the tumor by using a procedure called a lobectomy.

 Surgery to remove the cancer is considered the gold standard for stage one lung cancer, says Dr. Joseph Friedberg, Thoracic Surgeon-in-Chief at Temple University Health.

After the cancer has been removed a definitive staging takes place. Once the cancer is removed a doctor known as a pathologist will take a closer look at the surgical specimen (what was removed during surgery) to evaluate several specific components that will help your doctors know what steps (if any) may be needed next.

After the Cancer is Removed the Tissue is Examined by a Pathologist.

First, the pathologist will examine the tissue to make sure the doctor was able to surgically remove 100% of the cancer. This is known as surgical margin status and the goal is to have a negative margin. This simply means there is non-cancerous tissue surrounding the tumor and that your surgical team was able to remove all of the cancer. If you are reading your pathology report and you see the term “negative surgical margins” this is a good factor.

Next, the pathologist will check the lymph nodes and any other tissue the surgeon removed to ensure the cancer has not spread to other areas in the lung. This is known as pathologic staging and is more accurate compared with the staging completed before surgery. In cases of stage 1 lung cancer, rarely, the pathologic and clinical (staging done before surgery using imaging) stages will be different, but the pathologist will check the tissue to ensure the cancer was not more extensive than previously thought.

Finally, the pathologist may perform additional biomarker testing to see if your type of lung cancer may benefit from additional therapies or treatment known as adjuvant treatment. Typically, stage 1 lung cancer that has been completely removed by surgery does not require any additional treatments. However, studies are being conducted to see if patients with certain biomarker profiles may benefit from additional therapies or medications after surgery. It is becoming more routine that early-stage cancers are tested for these biomarkers.

Not everyone who is diagnosed with stage one lung cancer is an appropriate candidate for surgery, says Dr. Friedberg.

SBRT is also a Great Option.

For individuals with stage 1 cancer who can't have surgery because of underlying health conditions, the current standard of care is stereotactic body radiation therapy (SBRT), which directs extremely high doses of radiation to the tumor and minimizes the dose to nearby structures, reducing the risk of damage to healthy organs. This type of treatment is becoming much more common and is being used more frequently even in patients who are healthy enough for surgery but who choose to have SBRT as a non-invasive option after an informed discussion with their treating teams. Although surgery remains the current gold standard for treating stage 1 lung cancer because of the excellent outcomes seen with SBRT there are currently trials comparing these two approaches head-to-head to determine which is best for patients. For now, surgery remains the best option, but if you or a loved one is not able to have surgery, SBRT is an excellent alternative with tumor control rates approaching those seen with surgical resection.

What you should know.

Stage 1 lung cancer is curable and surgery remains the best treatment approach. If you are unable to have surgery SBRT offers an excellent alternative. Although stage 1 lung cancer is curable the treatment requires a skilled team of surgeons and oncologists. We recommend you get treatment at an experienced center where a high volume of lung cancer surgeries are performed. As with any cancer, it is always good to get a second opinion if you have questions or you wish to hear more options. Remember to be your own advocate and SurvivorNet will be with you every step of the way.

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