Upon hearing the term "intermediate stage", many lung cancer patients become uneasy, believing that they are just a short step away from the "terminal stage" and that the hope for surgery is slim
In fact, intermediate-stage lung cancer is not equivalent to locally advanced lung cancer, and there are significant differences in treatment options and prognosis between the two.
For some patients with intermediate-stage lung cancer, radical surgery remains the preferred and feasible treatment option. Even for those diagnosed with locally advanced lung cancer, with the continuous development of diagnostic and treatment technologies, an increasing number of patients are regaining the opportunity for radical surgery through tumor shrinkage and downstaging treatments.
In this issue, we have invited Professor Yang Nong, a specially-appointed expert from Hainan Cancer Hospital/Affiliated Cancer Hospital of Hainan Medical University, to provide professional interpretations on issues of common concern to patients, helping everyone understand their condition scientifically and cope with the disease calmly.
Qustions & Answers
Q: Can lung cancer still be operated on at the intermediate stage?
Many lung cancer patients and their families become extremely anxious upon hearing the diagnosis of "intermediate-stage lung cancer". Clinically, many people confuse intermediate-stage lung cancer with locally advanced lung cancer, but the treatment strategies and prognoses for these two groups of patients differ significantly.
Intermediate-stage lung cancer primarily refers to stage II and some stage III A tumors, where the lesion remains confined within the lungs and the lymph node metastasis is relatively limited. The core characteristic is that it meets the conditions for radical resection. On the other hand, locally advanced lung cancer mostly falls into stage III B to III C, with a larger tumor invasion range and more severe mediastinal lymph node metastasis. Complete resection is difficult to achieve with surgery alone.
Qustions & Answers
Q: What are the standard treatment options for these two conditions?
In the first scenario, radical surgery is the preferred choice for patients with intermediate-stage lung cancer. For patients with stage II and some stage III A lung cancer, radical surgical resection is the first-line treatment as long as their physical condition allows. Some patients may undergo neoadjuvant therapy before surgery to shrink tumor lesions and control lymph node metastasis. Clinical research data indicates that this treatment approach of "shrinking the tumor first, then performing surgery" can significantly improve the 5-year survival rate of patients.
If the postoperative pathology indicates complete tumor removal, which is clinically referred to as complete pathological response, the patient has a higher probability of long-term survival. Postoperatively, doctors will also develop targeted therapy or immunotherapy plans based on the pathological test results to further reduce the risk of tumor recurrence.
In the second scenario, when the lung cancer is assessed as locally advanced stage ⅢB~ⅢC, the tumor has a large invasive area, making complete resection difficult to achieve through direct surgery. The standard treatment plan for such patients involves concurrent chemoradiotherapy followed by immunotherapy consolidation for one year. Additionally, a conversion therapy strategy combining chemotherapy and immunotherapy can also be adopted for locally advanced lung cancer. After tumor shrinkage and downstaging, the surgical feasibility will be reassessed. If the patient has EGFR or ALK sensitive gene mutations, targeted drugs can be used for consolidation therapy after the completion of chemoradiotherapy to delay disease progression.
It is important to emphasize that the diagnosis and treatment plans for intermediate-stage lung cancer and locally advanced lung cancer are highly complex. Each patient's tumor location, lymph node metastasis status, underlying health conditions, and genetic test results vary, making a standardized "one-size-fits-all" approach impossible.
It is recommended that patients undergo a multidisciplinary team (MDT) consultation, where experts from thoracic surgery, medical oncology, radiotherapy, and other disciplines jointly conduct a comprehensive assessment to tailor individualized treatment strategies. Patients should avoid blindly following the treatment experiences of other patients.
Expert Introduction
Yang Nong, Chief Physician, Doctoral Supervisor
Long-term employed experts of Hainan Cancer Hospital and Hainan Chengmei Hospital
He currently serves as Vice President of the Second People's Hospital of Hunan Province, head of the oncology department, and director of the "Yang Nong Famous Doctor Clinic" / "Yang Nong Famous Doctor Expert Team Clinic". He is also a chief expert of the National Major Scientific and Technological Special Project, a member of the Lung Cancer Special Committee of the National Tumor Quality Control Center, the director of the Hunan Provincial Key Laboratory of Precision Diagnosis and Treatment of Lung Cancer, and the director of the Hunan Provincial Respiratory Tumor Clinical Medicine Research Center. He has been dedicated to precision targeted therapy for lung cancer and gastrointestinal tumors, as well as to challenging, recurrent, and drug-resistant clinical cases, scientific research, and teaching for nearly 30 years.
He has been honored with the title of "National Famous Doctor - Excellent Style" in the 6th edition, and has been recommended as "Annual Good Doctor" by patients across the country for 8 consecutive years, as well as being awarded the title of "First Brain Doctor - Famous Doctor". He has authored national guidelines, boasts over 500,000 followers across the internet, and has achieved over 120 million views in cancer prevention and treatment science popularization.
Medical expertise
Specialties: Precision treatment of lung cancer, breakthrough in refractory, recurrent, and drug-resistant cases with brain metastasis; individualized and precise treatment of brain metastases from lung cancer; early diagnosis of pulmonary nodules and lung cancer; personalized and comprehensive diagnosis and treatment of solid tumors; clinical trials of the latest immunotherapy/targeted therapy drugs.
With nearly 30 years of experience in precision immunotherapy for lung cancer, he has led nearly 400 Phase I-III clinical trials of new anticancer drugs (including Class 1 national new drugs), and is particularly skilled in treating complex cases such as refractory, recurrent, and drug-resistant conditions, as well as brain metastases.
He is also proficient in the comprehensive diagnosis and treatment of multiple cancer types, individualized, and interdisciplinary, covering a wide range of solid tumors (such as stomach, intestine, brain, etc.).
[Visit Information]
1. Clinic Hours and Location
July 25th, 08:00-12:00
Sixth Consultation Area of Hainan Cancer Hospital
2. [Appointment registration]
Follow the official account of Hainan Cancer Hospital for "appointment registration"
3. Health consultation
18976324546
[Friendly Reminder]
To help the expert understand your condition quickly, please bring the following:
1. ID card, medical insurance card, and mobile phone
2. Accompanying direct relatives (with decision-making authority)
3. Relevant previous examination results, organized chronologically
4. Paper medical records from previous consultations
5. Surgical case slides, wax blocks, or 20-30 glass slides
6. Pathological diagnosis report
7. Hospitalization medical records
8. Recent relevant examination results
9. The patients current treatment plan
10. The most urgent questions to consult