Lung cancer has a reputation as an always-fatal disease, but prognosis depends on the type of tumor and when it’s diagnosed.

By Amanda MacMillan
July 23, 2019

Lung cancer’s grim survival rate, compared with other types of cancer, doesn’t tell the whole story about how any one individual will fare after a diagnosis—or about the efforts underway to improve prognosis and provide new hope for patients and their loved ones.

The disease is expected to kill more than 140,000 people in 2019—that’s about 27% of all cancer deaths in the United States, according to the Lung Cancer Foundation of America. But the good news, says Rafael Santana-Davila, MD, a medical oncologist at Seattle Cancer Care Alliance and associate professor at the University of Washington School of Medicine, is that when lung cancers are discovered earlier, survival rates are much improved.

One reason for lung cancer’s high death rate is that it can be very aggressive, and spread to other organs before symptoms become noticeable. Because of that, most cases of lung cancer are only diagnosed in the later stages of the disease, when surgery is no longer a realistic option.

But scientists are working hard to find new ways to identify lung cancer earlier, when it’s still curable. And in recent years, new treatments have made life after a lung cancer diagnosis a realistic goal for many patients—even those in later stages of the disease. Here’s a look at the numbers, and what else affects lung cancer prognosis.

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Cancer Stage Matters

Overall, only 19.4% of people who have been diagnosed with lung cancer are still alive five years later, according to National Cancer Institute (NCI) data from 2009 through 2015. That percentage varies greatly, though, depending on when people’s cancers are diagnosed.

When a lung cancer tumor is discovered in Stage 1, it is still very small and easy to remove via surgery, since it has not invaded any major parts of the lungs or other organs. “In Stage 1, the majority of patients are cured—somewhere between 60% and 80% of patients go into remission,” says Dr. Santana-Davila.

Tumors in Stage 2 are slightly larger or have spread to parts of the lungs that are slightly harder to operate on. But even in Stage 2, says Dr. Santana-Davila, between 50% and 60% of patients are cured.

Cancers that have not spread to nearby lymph nodes are also known as “localized.” The estimated 5-year survival rate for localized cancers is 57.4%, according to the NCI. Unfortunately, because localized lung cancer rarely has symptoms, only 16% of cases are diagnosed at these early stages.

When lung cancer spreads to nearby lymph nodes, this is known as “regional.” This often correlates with Stage 3 cancer, and it makes up about 22% of lung cancer diagnoses. The estimated 5-year survival rate for regional lung cancer is 30.8%.

Then there’s metastatic lung cancer, also known as “distant” or Stage 4 cancer. This is when the majority of lung cancer cases—57%, according to the NCI—are diagnosed. It also has the worst survival rate: Only 5.2% of patients diagnosed at this stage are still alive five years later.

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That’s slowly starting to shift, however, says Dr. Santana-Davila. “With the advent of new treatments like immunotherapy, we’re seeing more patients with long-term survival,” he says. “The goal of treatment isn’t to cure them—because we know that’s impossible in the majority of Stage 4 cases—but it’s to manage their symptoms and help them live as long as possible and as comfortably as possible.”

When faced with a lung cancer diagnosis and aggressive treatment options such as surgery, chemotherapy, and radiation, patients may wonder what their likelihood of survival is without any type of intervention. In a 2013 study of prior studies, researchers from the University of South Florida looked into this question and found that “mortality is very high” for non-small cell lung cancer without treatment. Overall, untreated lung cancer patients in their analysis lived for an average of just over 7 months.

What else affects lung cancer prognosis?

Statistics like 5-year survival rates can help patients and their loved ones better understand the disease they’re facing, their expectations for the future, and their options for treatment. But it’s important to remember that every lung cancer case is different, says Dr. Santana-Davila, and that these numbers can’t be used to predict how individual patients will fare, or whether they will die from their disease.

The type of lung cancer can also make a difference in prognosis: Of the two main types of lung cancer, small cell carcinoma is less common; it only makes up about 15% of all lung cancer cases. But it also grows much faster and spreads more quickly than the more common non-small cell lung cancer.

While most lung cancers are smoking-related, some have a genetic component. In these cases, says Dr. Santana-Davila, doctors can use medications to target specific gene abnormalities. “It’s not that one type is more treatable than the another,” he says, “but at least in this case we have an additional pathway that may be able to stop the cancer cells from proliferating.”

Age matters, too. Most people who die of lung cancer are middle-age and older, and the percentage of lung-cancer deaths is highest among people 65 to 74. Overall health can also make a difference: Staying physically active and avoiding tobacco smoke after lung cancer treatment can lower the risk of getting cancer again, according to the CDC.

Improving lung cancer survival rates

Until a few years ago, there were no criteria in place for screening people who were at risk for lung cancer—which is one reason why, historically, so few cases have been diagnosed in early stages. But in 2013, the US Preventive Services Task Force recommended annual low-dose CT screenings for adults with certain lung-cancer risk factors.

The screening guidelines apply to adults ages 55 to 80 who smoked a pack of cigarettes a day for 30 years, or the equivalent in pack-years. The Task Force’s research found that deaths from lung cancer decreased up to 20% among high-risk individuals who were screened with CT scans, compared to those who received chest X-rays only.

The results of better screening practices—and better treatments—seem to be paying off. Death rates for lung cancer have been falling nearly 3% on average each year between 2007 and 2016, NCI reports, and five-year survival rates have been slowly increasing.

“No matter what stage a cancer is diagnosed, I want people to know that we have a lot of options,” says Dr. Santana-Davila. “There’s a lot of hope that the patient in front of me will do well, despite the ugliness of the disease.”

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