How Is Non-Small Cell Lung Cancer (NSCLC) Treated?

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for more than 80% of lung cancer cases.

The treatment plan and goal of treatment depend on the stage of your NSCLC, or how much the cancer has spread. Options for treatment include chemotherapy, surgery, radiation, targeted therapy, immunotherapy, or a combination of these.

For earlier stages of NSCLC—when the cancer has not yet spread, or at least not spread as widely—the goal is to cure your cancer. This may be done by surgically removing your tumors and receiving drug treatment to prevent the cancer from recurring.

For later stages of NSCLC—when your cancer has spread through your body—the treatment goal is to shrink and remove your tumors if you are healthy enough for surgery. If surgery is not possible, the goal is to shrink your tumors and treat your symptoms. Sometimes, a cure is not possible, and improving your quality of life in the time you have left is the main treatment goal.

Treatment by Stage

How your non-small cell lung cancer is treated depends on the stage of your cancer, so your healthcare provider needs to identify the stage before setting a treatment plan. There are five stages of NSCLC:

• Stage 0: Precancerous or cancer cells in the lining of your lungs, but they have not spread anywhere else
• Stage 1: One tumor smaller than 3 centimeters (cm), and the cancer has not spread to your lymph nodes
• Stage 2: One or more tumors that are 3-5 cm, and the cancer has not spread to your lymph nodes but has spread into your chest wall
• Stage 3: One or more tumors that are 5-7 cm, and the cancer has spread to a lymph node near your lungs
• Stage 4: One or more tumors of any size, and the cancer has spread to multiple distant lymph nodes and organs

Treatment for Stage 0

In stage 0, the abnormal cells are in the cells lining your lungs. The affected part of your lung is surgically removed, or resected. Surgery is usually the only treatment at stage 0. No additional treatment is typically necessary because your cancer has not spread to the surrounding lung tissue.

Surgery is a good option for early-stage NSCLC compared to later stages because you have to be in relatively good health to undergo surgery.

The risks and side effects of surgery include a reaction to anesthesia, excessive bleeding, scarring, blood clots, and infections. The recovery from surgery may be lengthy.

Treatment for Stage 1

With one small tumor in stage 1 NSCLC, you have several options for treatment. You may undergo surgery to remove the tumor and surrounding lung tissue. Some lymph nodes may also be removed.

If your NSCLC has a higher risk of returning, your healthcare provider may recommend additional therapy after the surgery. This could include:

• Chemotherapy: One or more chemicals to kill your cancer cells are delivered by intravenous (IV) injection to reach your whole body.
• Immunotherapy: A drug targeting a part of your immune system is injected by IV.
• Targeted therapy: The genetic mutation responsible for your cancer is identified, and a drug specifically targeting cancer cells with this mutation is given by IV.

If other health problems prevent you from undergoing surgery, you might receive a type of precise radiation therapy called stereotactic body radiation therapy (SBRT) as your main treatment. With this, a source of radiation is applied to the cancerous area outside the body.

You have to be in relatively good health for radiation therapy because the side effects can be harsh. These can include fatigue, nausea, vomiting, loss of appetite, weight loss, skin changes in the area being treated, and hair loss where the radiation enters the body.

Providers might also use ablation as a treatment method. Ablation is when small tumors are destroyed by extreme heat or cold.

Treatment for Stage 2

There are several treatment options for stage 2 NSCLC. The types you receive can depend on the size of your tumors, where they are located, and whether you are healthy enough for surgery.

People often undergo chemotherapy before surgery. Chemotherapy may be done in conjunction with immunotherapy.

Both treatments can cause side effects. Chemotherapy can cause mouth sores, loss of appetite, weight loss, nausea, vomiting, diarrhea, and constipation. The side effects of immunotherapy depend on the specific drug being used, but common symptoms include fatigue, nausea, skin rash, loss of appetite, constipation, joint pain, diarrhea, and muscle and bone pain.

Once that initial treatment—known as neoadjuvant or pre-operative treatment—is done, surgery is then performed for people healthy enough to undergo it. The affected area of the lung and lymph nodes are removed. Sometimes, the entire lung needs to be removed.

If, after testing, the healthcare providers determine cancer cells are still in the lung, they might perform another surgery to remove the remaining cancer. Treatment with chemotherapy or immunotherapy may then be used.

Targeted therapy is another potential option after surgery. The side effects of targeted therapy vary depending on the drug, but common symptoms include diarrhea, nausea, vomiting, muscle pain, fatigue, skin and nail changes, nerve damage, and decreased white blood cell and red blood cell counts.

Treatment for Stage 3

Treatment for stage 3 NSCLC is grouped by whether surgery is an option. A cancer specialist, known as an oncologist, works with your surgeon to decide if you are healthy enough for surgery. If surgery is part of your treatment, your options may be:

• Chemotherapy followed by surgery
• Chemotherapy and radiation therapy followed by surgery
• Combined immunotherapy and chemotherapy followed by surgery
• Surgery followed by chemotherapy
• Surgery followed by targeted therapy
• Surgery followed by immunotherapy
• Surgery followed by a combination of chemotherapy and radiation therapy
• Surgery followed by radiation therapy
• A clinical trial of a different combination of treatments

If surgery cannot be done, your options may be:

• Chemotherapy and radiation therapy
• Combined chemotherapy and radiation therapy followed by immunotherapy
• Radiation therapy
• Laser surgery
• A clinical trial of a different combination of non-surgical treatments

Treatment for Stage 4

Because the cancer has spread in your body in stage 4, surgery is usually not one of your first treatment options. Treatment options for stage 4 NSCLC include:

• Combination chemotherapy
• Combination chemotherapy with targeted therapy
• Combination chemotherapy followed by additional chemotherapy
• Targeted therapy
• Immunotherapy with or without chemotherapy
• Laser therapy and/or radiation therapy
• Radiation therapy
• Surgery to remove tumors in your lung
• Surgery to remove tumors that have spread to your brain, followed by radiation therapy targeting your brain
• Treatment being researched in a clinical trial

If your NSCLC has spread to other organs, your treatments focus more on relieving your symptoms and improving your quality of life than curing your cancer.

Prognosis and Life Expectancy

Most newly diagnosed cases of NSCLC are at a stage where your cancer has spread from your lungs. The five-year survival rate at these stages is just under 9%. However, if your cancer is localized to your lungs, the survival rate is almost 60%. The overall five-year survival rate for lung cancer is about 30%.

Your age plays a big role in your prognosis with NSCLC. Most people who are diagnosed with NSCLC are at least 65 years old. The older you are at the time of your diagnosis, the higher the mortality rate.

Living With and Managing Non-Small Cell Lung Cancer

No matter what treatment plan you and your healthcare provider decide on, you will experience side effects such as nausea, fatigue, and pain during and after treatment. Be honest about your symptoms so that you can get help in managing them.

After your treatment is done, you will need to follow up with your healthcare provider. The frequency of follow-ups and for how long you go to them depends on your diagnosis. Typically, follow-ups will be for at least two to three years every three to four months. These follow-ups will likely include computed tomography (CT) scans and blood tests.

Keep tabs on your overall health, including returning or new symptoms, as well as your emotional and mental health. Let your healthcare provider know about any concerns.

Once you are diagnosed with cancer, you may become concerned about a few things, including:

• Treatment
• Medical costs
• Side effects
• Cancer recurrence
• Effect on family

It is important to create a network of support after your diagnosis. This includes your healthcare providers, family, and friends. You may want to seek additional healthcare providers or support groups to help with emotional and mental support.