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Summary & Participants

Doctors are finding that some patients with advanced non-small cell lung cancer may benefit from radiation, chemotherapy and/or newer treatment combinations.

Medically Reviewed On: July 23, 2008

Webcast Transcript

ANNOUNCER: When doctors diagnose non–small cell lung cancer, they assign it a stage, often on a scale from one to four. This partly is based on how far the cancer has spread from the site of the original tumor, in a sequence that is generally well understood.

FRANK FOSSELLA, MD: Lung cancer, when it starts, originates somewhere within the lung and the way it progresses to other parts of the body, it typically will move into the lymph nodes first and so it may move first into the lymph nodes closest to where the original or what we say the primary tumor is. And then from there, spread to the lymph nodes and what we call the mediastinum, which is the central part of the chest between the two lungs. And then, from there, once it gets into those lymph nodes, then can spread into the blood, into other parts of the body, so then it can spread to the brain or bone or liver, pretty much anywhere in the body.

ANNOUNCER: Cancer in stage I and stage II disease has not spread from the lung with the original tumor to the opposite side of the chest, across the mediastinum. Generally, it can be treated by surgery. And this marks the difference between what doctors call early and advanced disease.

FRANK FOSSELLA, MD: I think a good working definition of early-stage versus advanced-stage non–small cell lung cancer would be whether the cancer is operable or not. And, usually, the cutoff there is going to be, stage I and II non–small cell lung cancer, we generally consider operable. Stage III and IV, for the most part, we consider inoperable and so they are treated primarily with chemotherapy and/or radiation therapy.

ANNOUNCER: The reason surgery is not usually an option in advanced disease is that surgery is only a local treatment.

RAMASWAMY GOVINDAN, MD: If you have a stage III lung cancer, the concern is, if the cancer has gone from the lung to the lymph glands, they could have gone through the bloodstream to other places. So going after the lung and the lymph glands by surgery by itself will not help because there are cells floating in the bloodstream.

ANNOUNCER: But there's a gray area within stage III disease when it comes to surgery.

FRANK FOSSELLA, MD: Now, there are certain subsets of stage III lung cancer that one would consider doing surgery for. These are specifically patients with stage IIIa lung cancer, and IIIa means that the cancer has spread to the lymph nodes on the same side of the mediastinum but has not spread to any other lymph node areas or to any other parts of the body.

ANNOUNCER: Even when surgery is called for with stage IIIa disease, it's not usually the first order of business.

RAMASWAMY GOVINDAN, MD: We tend not to operate on those patients right away. We tend to give them some kind of a treatment before surgery, what we call induction treatment.

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