Lung cancer is one of the most common cancers. Stage 1 lung cancer is defined by tumors that are very small and have not spread (metastasized) to other parts of the body. Despite its name, it is actually the second earliest stage of non-small cell lung cancer (NSCLC).
Typically, stage 1 lung cancer does not cause any outward symptoms. Because of this, only 12% to 15% of NSCLCs are detected when they’re still in this stage.
There are a few options for stage 1 lung cancer treatment, with surgery being the most common. With prompt treatment, the prognosis is very good.
An Overview of Staging For Non-Small Cell Lung Cancer
Stage 1 Lung Cancer Symptoms
A stage 1 non-small cell lung cancer tumor is unlikely to cause symptoms. This is because it is small and contained within the lungs.
In the rare instances that stage 1 lung cancer does cause symptoms, they may include:
When lung cancer causes pain, it is often felt in the chest. Because of the size and location of a stage 1 tumor, however, it doesn’t usually cause significant pain or other symptoms common in advanced stages, such as fatigue or unintentional weight loss.
When there is no known risk of lung cancer, healthcare providers can miss subtle signs of this disease. In fact, a third of people who are eventually diagnosed with lung cancer visit their healthcare provider three or more times with symptoms that are related to cancer before being accurately diagnosed.
Causes
All forms of lung cancer occur when the DNA of healthy, normal cells becomes damaged. As a result, the cells undergo mutations and other changes that cause them to grow uncontrollably.
The most common reason cancer cells develop in the lungs is exposure to certain chemicals inhaled while smoking cigarettes. There are more than 60 carcinogens (cancer-causing) substances in cigarettes, including formaldehyde, acrylamide, inorganic lead, and various hydrocarbons.
While cigarette smoking is the number one risk factor for lung cancer, there are others you need to be aware of:
- Age (the median age of people diagnosed with lung cancer is 71)
- Personal history of lung cancer
- Exposure to radon
- Exposure to certain chemicals, metals (e.g., nickel), and fibers (including wood dust and asbestos)
- Secondhand smoke
- Air pollution
- Ionizing radiation or radiation therapy that is directed at the chest (e.g., for Hodgkin disease)
- Lung diseases, chronic obstructive pulmonary disease (COPD) and asthma in particular
Diagnosis
Because it rarely causes symptoms, stage 1 lung cancer is more likely to found incidentally than intentionally. It most often shows up on a chest X-ray or computerized tomography (CT) scan that has been performed for an entirely different reason, such as to diagnose pneumonia.
Early stage lung cancer also can be detected with screening using CT imaging, which the U.S. Preventive Services Task Force recommends for certain people who are or have been smokers and:
- Are between 50 and 80 years old
- Have a 20 pack-year or more history of smoking
- Currently smoke or have quit smoking within the past 15 years
- Are healthy enough overall to undergo treatment for lung cancer if it is diagnosed
The American Cancer Society has the same screening criteria, except they don’t limit screening to 15 years after quitting. They recommend it indefinitely.
Once lung cancer is suspected, other tests, such as positron emission tomography (PET) imaging, sputum or blood test, or biopsy are used to confirm a diagnosis and to stage the cancer.
Stage 1a vs. Stage 1b
Staging is a refinement of a general diagnosis that describes how advanced a cancer is.
Lung cancer is staged based on the TNM system, in which T stands for tumor size, N stands for lymph nodes, and M stands for metastasis.
According to the TNM system, once diagnosed, stage 1 lung cancer can be designated as either stage 1A (which encompasses three sub-stages) or stage 1B.
| Stage | T, N, M Designation | Tumor Size and Lung Involvement |
|---|---|---|
| 1A1 | T1mi, N0, M0 | •Minimally invasive adenocarcinoma no more than 3 centimeters (cm) in size •Portion of tumor in lung tissues is no larger than 0.5 cm |
| T1a, N0, M0 | •No more than 1 cm •Has not grown into membranes surrounding the lungs •Does not affect the main branches of the bronchi | |
| 1A2 | T1b, N0, M0 | •Between 1 cm and 2 cm •Has not reached membranes around the lungs •Doesn’t affect the main branches of the bronchi |
| 1A3 | T1c, N0, M0 | •Between 2 cm and 3 cm •Has not reached membranes around the lungs •Doesn’t affect the main branches of the bronchi |
| 1B | T2a, N0, M0 | •Between 3 cm and 4 cm OR •Meets one or more of the following criteria: 1) Has grown into a main bronchus, irrespective of the distance to the carina 2) Has grown into the membranes surrounding the lungs 3) Partially clogs the airways |
Metastases are not found with any substage of stage 1 non-small cell lung cancer.
Treatment
Treatment options for stage 1 lung cancer range from surgery to chemotherapy to radiation. Which route you take depends on a variety of factors, including overall health, if it’s progressed to stage 1B, and personal choice. Talk to your healthcare provider about the best options for you.
Surgery
Surgery to remove the tumor is the most common treatment of choice for stage 1 lung cancer.
There are three procedures for doing this:
- Wedge resection (segmental resection): This involves the removal of a wedge-shaped portion of the lung that includes the entire growth along with some surrounding tissue.
- Lobectomy: The right lung has three lobes and the left lung has two lobes. A lobectomy involves removing one of the five. It’s the most common surgery used to treat lung cancer.
- Segmentectomy: The lobes of the lung are divided into segments. One of these segments may be entirely removed along with a tumor to ensure the cancer cells are eradicated.
Surgery to remove a lung tumor may be performed with an open chest thoracotomy in which a large incision is made in the chest and the ribs are pulled out of the way to give the surgeon direct access to the lungs.
A video-assisted thoracoscopic surgery (VATS) is a less invasive procedure. Small incisions are made and video-equipped instruments are inserted for removal of the tissue without fully opening the chest.
Recovery is quicker with VATS, which is an advantage. However, not all healthcare providers perform this type of surgery, and VATS instruments may not reach the tumor if it isn’t accessible via a small incision.
Chemotherapy
For people with stage 1 lung cancer, chemotherapy may be used after surgery to improve the chances that all cancer cells have been destroyed. It’s mostly used in cases where someone has stage 1B non–small cell lung cancer. A combination of cisplatin and vinorelbine is the most common drug option.
However, chemotherapy following surgery as a stage 1 lung cancer treatment remains controversial because the benefits are not very high and it may put you at risk for other health issues.
Radiation
For someone who isn’t healthy enough to tolerate surgery or if a tumor is inoperable—for example, situated in a way that makes it hard to access—radiation therapy may be used. This involves aiming high-energy radiation toward the cancer cells to kill them and shrink tumors.
For people with stage 1 lung cancer, a specialized type of radiation therapy known as stereotactic body radiotherapy (SBRT), also called a cyberknife procedure, may be an option as it can target small areas with high doses of radiation.
Radiation therapy to the lungs may cause side effects such as a cough or shortness of breath.
Prognosis
Studies have shown that anywhere from 70% to 92% of people with stage 1 NSCLC are expected to live at least five years following their diagnosis.
Stage 1 lung cancer survival rates are better for people who are able to undergo surgery to remove all of their cancer. For stage 1, the five-year survival after surgery is around 80%, versus about 40% for SBRT alone.
Survival rates may be better for those whose cancer is not causing symptoms and is first found via a CT screening. Thus, efforts to improve early screenings could help ensure a better prognosis for lung cancer patients.
Stage 1 Lung Cancer Recurrence Rate
It’s estimated that lung cancer will recur in 30% to 50% of patients who were treated for stage 1 lung cancer. This can happen locally or in distant sites in the body, even with successful surgery.
Most often, recurrent cancer will not appear at the same site as the primary tumor. Lung cancer often spreads first to the lymph nodes in the lungs and airways. It may also spread to other locations such as the brain, bones, or liver. The prognosis is much worse if lung cancer spreads in this way.
In those who have smoked in the past, there is also a risk of developing a second primary tumor that’s related to smoking, either in the lungs or in other regions of the body.
Summary
A lung cancer diagnosis, regardless of stage, is cause for concern. That said, the prognosis for stage 1 non-small cell lung cancer is excellent once the tumor has been removed.
Smoking is the primary risk factor, but exposure to radon, air pollution, and certain chemicals also contribute. Treatment typically includes surgery, with options like lobectomy or less invasive methods like VATS; radiation or chemotherapy may be alternatives for inoperable cases.
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