What is Early-Stage Non-Small Cell Lung Cancer?

Danielle Hicks: I'm Danielle Hicks, chief patient officer at GO2 for Lung Cancer. My organization has received funding from Bristol Myers Squibb on a number of initiatives to support patient education and I'm a paid consultant for Bristol Myers Squibb (BMS) for this activity, as well as each member of the panel is a paid consultant for BMS. I'll be your moderator today and I'll also provide a patient advocacy and caregiver perspective. I was actually a caregiver to my mom who had lung cancer, and we'll get into that a little later.

Dr. Nisha Mohindra: I'm Dr. Nisha Mohindra, I'm a medical oncologist and an associate professor of medicine at the Northwestern Feinberg School of Medicine.

Dr. Christopher Towe: I'm Chris Towe a board-certified thoracic surgeon and associate professor in the Division of Thoracic and Esophageal Surgery at Case Western Reserve School of Medicine and University Hospitals in Cleveland, Ohio.

Danielle Hicks Great, let's get started, shall we? What is non-small cell lung cancer and what does it mean when a non-small cell lung cancer is referred to as early-stage? Dr. Mohindra.

Dr. Nisha Mohindra: There are two main types of lung cancer, non-small cell lung cancer and small cell lung cancer. Non-small cell lung cancer is the most common type of lung cancer that we see in the U.S. It accounts for about 80 to 85 percent of the cases. Typically someone with an early-stage non-small cell lung cancer may either have no symptoms or may have minimal symptoms such as a cough, coughing up blood, chest pain, or even unexplained weight loss. While these are some of the symptoms patients may have, it's important to know that this is not the spectrum of what patients may experience. Any concerning symptoms should be discussed with their healthcare team.

Dr. Christopher Towe: You know, it's interesting, in my practice we're seeing more and more patients whose cancers are detected on lung cancer screening. These could be screens performed for patients who have a history of smoking, or sometimes cancers were even detected incidentally. And, we certainly see a lot of that in my practice these days. To answer your question about stage, stages aren't things where actors perform on Broadway. They're groups or categories that we give cancers to understand how much they've spread. Stage is a group of four categories where one is the least spread and four is spread to other parts of the body. Early-stage, specifically refers to stages one, two, and three. And again, as a rule of thumb, the smaller the number, the lower the stage, the less spread. And this is a broad group of cancers. For example, in stage IB, the tumor could be three or four centimeters in size without spread to lymph nodes, which are immune system glands in the chest. And in stage IIIA, the cancer could be up to five centimeters in size with spread to lymph nodes on the same side of the chest. And again, I don't want people to get too caught up on the details, clinical stage, pathologic stage. It's important to talk to your doctor and be sure that they're getting the right tests to be sure that their stage is accurate. These tests can include imaging tests and even a biopsy.

Danielle Hicks: Dr. Towe, you use the word “biopsy.” Can you talk a little bit about what a biopsy is?

Dr. Christopher Towe: A biopsy is a procedure where samples of tissue are removed to determine if cancer is present and where it is. This is taken to a lab where they're analyzing not just the type of tumor, but also the genetic characteristics of the tumor, which can be used to guide treatment. Additionally, patients may get scans, PET scans or CAT scans, which take complex images of the inside of the body to help providers understand where cancer is in the body, and this folds into this concept of stage. This information is used by doctors to determine the best course of treatment.