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Prognosis and survival for non–small cell lung cancer
People with non–small cell lung cancer (NSCLC) may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a person’s medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognosis is the doctor’s best estimate of how cancer will affect a person, and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together and they both play a part in deciding on a treatment plan and a prognosis.
Non–small cell lung cancer
The following are prognostic factors for non–small cell lung cancer.
Stage is the most important prognostic factor for non–small cell lung cancer. Generally, earlier stages (stage 0 and I) have a more favourable prognosis.
Lymph node status
Lymph node status is part of the staging for non–small cell lung cancer. The location of the lymph nodes where cancer has spread has an effect on the prognosis and survival. Generally, level N1 lymph nodes have a more favourable prognosis than level N2 or N3 lymph nodes.
If the lung tumour can be completely removed (resected) by surgery, the prognosis is more favourable than if it cannot be completely removed.
Sometimes people with tumours that could be removed by surgery cannot have surgery for other medical reasons. These people receive radiation therapy to treat the tumour.
Favourable prognostic factors for inoperable tumours are:
- small tumour size
- Tumours smaller than 3 cm are more easily treated with radiation therapy.
- good lung function
- People who have good lung function are more able to tolerate radiation therapy.
- good performance statusperformance statusThe measure of how well a person is able to perform ordinary tasks and carry out daily activities.
Superior sulcus (Pancoast) tumours
Superior sulcus tumours (Pancoast tumours) are found on the top edge of the lung, very close to the spine and other nerves. These tumours have a less favourable prognosis because they often cannot be removed by surgery.
People with non–small cell lung cancer who have lost weight have a less favourable prognosis.
Women with non–small cell lung cancer have a slightly better prognosis than men diagnosed with the same cancer.
People who have the following lung problems have a less favourable prognosis:
- collapsed lung
- pneumonia (lung infection)
- pleural effusion
Advanced non–small cell lung cancer
The following are prognostic factors for advanced and metastatic non–small cell lung cancer:
- number of metastatic sites
- People with a single metastatic site have a more favourable prognosis than people who have cancer spread to several different sites.
- Single metastases, especially brain metastases, may be removed by surgery.
- type of metastases
- Spread to the bones and adrenal glands have a more favourable prognosis than spread to the brain or liver.
- superior vena cava syndrome
- People who have superior vena cava syndrome have a less favourable prognosis.
- blood chemistry tests results
- Normal levels of lactate dehydrogenase (LDH), albumin and hemoglobin are favourable prognostic factors.
Establishing a national caregivers strategy
The Canadian Cancer Society is actively lobbying the federal government to establish a national caregivers strategy to ensure there is more financial support for this important group of people.