Early-stage lung cancer: Screening, diagnosis and treatment

Lung cancer is a common cancer and a common cause of death from cancer in the UK, affecting more than 47,000 people every year. While the long-term outlook improves every day from improvements in treatment of advanced disease, detection and treatment of cancer in its earliest stage(s) remains key for prognosis.

Here, Dr Crispin Hiley, highly esteemed consultant clinical oncologist, provides a comprehensive overview of early-stage lung cancer, explaining screening, diagnosis and treatment, among other important points.

What is early-stage lung cancer?

Early-stage lung cancer is the term used to describe types of lung cancers, particularly non-small-cell lung cancer, where the tumour is present in the lungs but it has not spread to any of the lymph nodes. These can either be the lymph nodes adjacent to the heart or those in the mediastinum (the portion of the thoracic cavity that separates the lungs). Generally, these tumours are relatively small, less than five cm in size and often, much smaller, being 1 - 2 cms in size.

Lung cancers are described with a T stage. In early-stage lung cancers, tumours are T1 or T2 lung cancers with no lymph nodes involved.

What are the symptoms of early-stage lung cancer?

The problem with early-stage lung cancer is that it can mostly be asymptomatic. Thus, early-stage lung cancer is often picked up when a patient has a chest X-ray for another reason or when a patient has had a CT scan of the chest for a particular reason.

It is now becoming common, however, for early-stage lung cancer patients to have had CT screening as part of a lung health check, which is a CT scan performed to detect early cancers in people who are at high risk of having lung cancer. This is done routinely in some countries, but in the UK, screening for early lung cancer is starting to be used more frequently for people over the age of 50 who have a smoking history.

Besides incidental findings and being picked up through screening, a small number of early-stage lung cancer cases will be detected after patients present with symptoms such as persistent cough or haemoptysis (coughing up blood). Patients who develop any of these symptoms should visit their GP.

What is the treatment for it?

The treatment for early-stage lung cancer takes two forms.

The first treatment option is surgery in which either a small part of one of the lobes of the lung or the entire lobe of one of the lungs is removed. This is one of the standard treatments for early-stage lung cancers.

The second treatment option is stereotactic radiotherapy, which consists of high doses of radiation therapy administered in a hypofractionated manner over three or five fractions of treatments. According to current guidelines (the UK’s protocols for the management of lung cancer), this treatment should be used as an alternative to surgery for patients who are not able to have surgery or who choose not to have surgery.

Despite the differences in treatment, numerous clinical data show that long-term outcomes for surgery and stereotactic radiotherapy are effectively equal - once we consider that younger patients are generally the ones to undergo surgery and slightly older patients often have stereotactic radiotherapy to the lungs.

What is the survival rate and life expectancy of early-stage lung cancer?

The great thing about early-stage lung cancer is that it is a very treatable type of cancer, both with surgery and with stereotactic radiotherapy. The five-year overall survival is in the 90 per cent range, so the ability to control the tumour either by resecting it with surgery or by ablating it with stereotactic radiotherapy is very high.

There is a very small chance that some patients may develop distant metastatic disease despite having treatment for an early lung cancer, but this is a very small proportion of patients. In fact, data suggests that the small number of patients who do not survive the five-year mark following treatment, particularly when patients are older with other health problems, often die of another cause that is not cancer-related. For the most part, the majority of patients with early lung cancer will be cured of their cancer after receiving treatment.

Is early-stage lung cancer curable, why or why not?

Early-stage lung cancer is very curable, either with stereotactic radiotherapy or with surgery. Local control rates are over 90 per cent with either treatment modality, and this is very different from locally advanced or metastatic cancer, where the cancer has spread to the lymph nodes or to a distant site.

There is a real benefit in detecting lung cancer early, and this is why CT-based screening for patients who are at high risk of lung cancer (for example, patients over the age of 50 who have a smoking history) is becoming more and more popular and likely to become more widespread. In addition, going to see your doctor is also important for patients who have symptoms that might be caused by early lung cancer, such as a persistent cough or haemoptysis.

There is no need for additional treatments following surgery or stereotactic radiotherapy for early lung cancers, which means that the overall burden of treatment is less with fewer side effects and treatment is completed in a shorter period.

On the other hand, when cancers become more advanced (locally advanced or metastatic), they are more difficult to treat and the burden of treatment is greater, involving more weeks of treatment and more chemotherapy. That is why, for many patients, early detection and treatment are key.

Dr Crispin Hiley is a highly esteemed consultant clinical oncologist who specialises in the treatment and management of all the different types of lung cancer.

If you have symptoms or have recently been diagnosed with early-stage lung cancer and you wish to receive the utmost quality clinical oncology care, don’t hesitate to visit Dr Hiley’s Top Doctors profile today.