Stage 2 non-small cell lung cancer (NSCLC) is a type of cancer that develops in one lung or the lymph nodes on the same side of the chest as the original tumor.

Doctors use staging to determine prognosis and determine the best treatment plan.

NSCLC is the most common form of lung cancer. Between 80-85% of all lung cancer diagnoses are NSCLC. Staging for NSCLC involves 4 stages with various substages.

In this article, we look specifically at stage 2 NSCLC, whether it is curable, symptoms, diagnosis, treatment options, and more.

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NSCLC occurs in the cells of the lung when abnormal cells start to quickly reproduce. The cancer grows in the airways, including the bronchi, bronchioles, and alveoli.

Smoking is the strongest risk factor for developing NSCLC, followed by:

  • second-hand smoke exposure
  • exposure to carcinogens at work
  • radiation exposure
  • environmental pollution
  • genetic causes
  • a history of HIV

There are three main types of NSCLC:

Doctors identify the type of NSCLC by examining how cells appear under a microscope. The treatment and prognosis for these three types are similar.

Once doctors diagnose stage 2 NSCLC, they will also classify it as stage 2a or 2b.

Stage 2a

A stage 2a NSCLC tumor is greater than 4 centimeters (cm) but smaller than 5 cm. At this stage, the cancer has not spread into surrounding lymph nodes. Additionally, one or more of the following may occur:

  • cancer has spread to the bronchus, not reaching the carina
  • cancer has spread to the inner layer of tissue of the lung
  • partial or entire lung collapse
  • pneumonitis

Stage 2b

A stage 2b NSCLC tumor is 5 cm or smaller, and the cancer has spread into the surrounding lymph nodes near the bronchus. These lymph nodes are on the same side of the chest as the primary tumor. Additionally, one or more of the following may occur:

  • cancer has spread to the bronchus, not reaching the carina
  • cancer has spread to the inner layer of tissue of the lung
  • partial or entire lung collapse
  • pneumonitis

Alternatively, the tumor is between 5–7 cm in size and:

  • there are one or more unique tumors in the same lobe of the lung
  • cancer has spread to the membrane of the chest wall, the chest wall itself, the nerve controlling the diaphragm, or the pericardium

According to the American Lung Association, the 5-year survival rate for lung cancer in the United States is low, at 18%. With early diagnosis, the 5-year survival rate is higher at 56%. Stage 2 is an early stage of lung cancer.

When lung cancer has metastasized to other organs, the 5-year survival rate drops to 5%.

When a person is otherwise healthy but receives a diagnosis of stage 2 NSCLC, doctors will typically recommend surgery to remove the tumor. Surgery may involve a lobectomy, sleeve resection, or removing the entire lung, if necessary. Affected lymph nodes should also come out during the same surgery.

If, after analyzing the removed tissue, doctors find cancer cells around the edges of the tissue, called the margin, it could mean some cancer remains in the body.

A surgeon may recommend a second surgery, along with follow-up chemotherapy, radiation, or immunotherapy. And certain people with a mutation in the EGFR gene may benefit from targeted therapy treatment with osimertinib.

Stage 2 NSCLC may not cause any symptoms at all. Doctors may find it during a routine scan. Some symptoms may include:

  • a cough that does not clear up
  • chest pain or discomfort
  • breathing problems
  • wheezing
  • blood in mucus
  • hoarseness
  • loss of appetite
  • weight loss for unknown reasons
  • fatigue
  • trouble swallowing
  • swelling in the face or neck

A doctor will take a complete medical history, including family history and ask about symptoms and risk factors. The doctor will also conduct a physical examination, such as listening to the lungs and heart to evaluate overall health.

If the results of this initial evaluation bring up concerns about lung cancer, further tests may include imaging such as:

The doctor may also order lab work to look for specific blood values.

If they suspect lung cancer, they may order a fine needle biopsy of the lung to test cells for cancer. During this outpatient procedure, a medical professional aspirates cells from the lung to view under a microscope.

Other tests may include:

Surgery is the first-line treatment option for people who are in overall good health. During surgery, a surgeon removes cancerous tissue and lymph nodes. This may involve removing part or all of the lung.

Doctors will analyze any tissue removed during surgery under a microscope to check for cancer cells on the edges of tissue. If they find cancerous tissue in this area, they may recommend follow-up surgery.

Other treatment options for stage 2 NSCLC may include:

  • chemotherapy
  • radiation
  • immunotherapy

If doctors find no cancer cells on the edges of removed tissue, they will likely recommend follow-up chemotherapy.

When stage 2 NSCLC is larger than 4 cm, doctors may recommend immunotherapy with the medication nivolumab alongside chemotherapy before surgery.

If traditional treatment options are not suitable, a person may wish to participate in a clinical trial for developing treatments.

According to the National Cancer Institute, NSCLC is less responsive to treatments such as chemotherapy and radiation than other forms of lung cancer like small cell lung cancer (SCLC). People whose cancer is gone after surgery or who receive chemotherapy after surgery have the best outcomes.

People with inoperable cancer that has spread only locally (within the same lung as the original tumor) can have good outcomes with a combination of chemotherapy and radiation.

Additionally, people whose cancer has metastasized into both lungs or outside the lungs may have better survival rates and improved symptom relief through a combination of chemotherapy, targeted medications, and other supportive care.

There is no reason to face lung cancer alone. Support groups are available.

A few that exist online and via phone are:

The leading cause of cancer deaths in the U.S. is lung cancer. If a person has symptoms or known risk factors, it is important to discuss them with a doctor.

Risk factors include:

  • being between 50 to 80 years of age
  • a 20-pack-per-year history of smoking (1 pack a day for 20 years, equivalent to 2 packs a day for 10 years or 3 packs a day for 5 years)
  • being a current smoker or having quit within with last 15 years

If a person is in any of these risk categories and is experiencing any of the following symptoms, they should contact a doctor immediately:

  • a cough that does not clear up
  • chest pain or discomfort
  • breathing problems
  • wheezing
  • blood in mucus
  • hoarseness
  • loss of appetite
  • weight loss for unknown reasons
  • fatigue
  • trouble swallowing
  • swelling in the face or neck

Non-small cell lung cancer is the most common form of lung cancer. While lung cancer does not have a high 5-year survival rate, stage 2 NSCLC is an early diagnosis, which provides more options for treatment.

Upon diagnosis of stage 2 NSCLC, doctors will stage the tumor into subtype 2a or 2b, depending on how far it has spread into the lung and surrounding areas. Treatment depends on the subtype and where the cancer is.

The most commonly recommended treatment is surgery to remove the tumor and sometimes part or all of the lung. Additional surgery may be necessary, along with chemotherapy, radiation, or immunotherapy.