Non-Small Cell Lung Cancer

What is Non-Small Cell Lung Cancer?

NSCLC is the most common form of lung cancer. In the United States, 85 percent of lung cancers are non-small cell lung cancers.

Types of NSCLC

There are three major types of NSCLC:

  • Accounts for about 40 percent of all lung cancers in the United States
  • Is the most common lung cancer diagnosed in women
  • Usually starts in cells that make mucus near the outer edges of the lungs
  • May occur in those with a history of smoking, but is the type most often found in those who never smoked
  • Accounts for about 30 percent of all lung cancers in the United States
  • Usually starts in the thin, flat cells in the lung’s airways
  • Is strongly associated with smoking
  • Accounts for about 5 to 10 percent of all lung cancers in the United States
  • May start in any part of the lung 
  • Is often the diagnosis when other types of lung cancer have been ruled out

Staging

Your doctor will recommend the treatment type and approach based on your cancer’s stage. Non-small cell lung cancer has the following stages:

  • This very early stage is marked by abnormal cells only in the air passages.
  • The tumor is small and cancer has not spread to the lymph nodes. 
  • In Stage IA, the tumor is 3 cm or less. In Stage IB, the tumor is between 3 and 4 cm.
  • In Stage IIA, the tumor is between 4 and 5 cm. It has not spread to the lymph nodes. 
  • In IIB, the tumor is smaller than 5 cm and cancer has spread to the lymph nodes on the same side of the chest as the tumor. 
  • The tumor may be larger than 5 cm but has not spread to the lymph nodes.
  • Cancer has spread to the lymph nodes. It has not spread to other parts of the body. 
  • The tumor may be bigger or the cancer may be in an area that is harder to reach than cancers in earlier stages. Stages IIIB and IIIC are often treated more like Stage IV cancers.

Cancer has spread beyond one lung. It is in the other lung, the fluid near the lungs (the pleura) or heart (pericardium), or another part of the body. When it spreads, lung cancer often moves to the brain, bones, liver, kidneys, or adrenal glands

If your cancer spreads to the bone, visit our bone metastases page.

Biomarker Testing for NSCLC

Biomarkers are features of your tumor that can be measured to help guide your therapy. This is called biomarker testing. Biomarker testing is often also called molecular testing, genetic testing, or genomic testing.

If you have advanced non-small cell lung cancer (NSCLC), ask to have your tumor tested for biomarkers including EGFR, ALK, BRAF, ROS1, NTRK, MET, RET, and PD-L1. A positive test may open the door to more treatment options. Testing can be done in one, multi-panel test. This test will also look for other biomarkers that are being studied in clinical trials. Learn more about biomarkers for lung cancer and the treatments that target them.

Learn more about lung cancer treatments and side effects in our Frankly Speaking About Cancer: Treatment for Lung Cancer booklet.

Treatments

 There are many possible treatments for non-small cell lung cancer. They work in different ways and have different side effects. Be sure to ask about the side effects before you start treatment. Your treatment options will depend upon the stage of your lung cancer.

Learn more about lung cancer treatments and side effects in our Frankly Speaking About Cancer: Treatment for Lung Cancer booklet.

Surgery

If your cancer has not spread to other tissues, your doctor may recommend surgery to remove the tumor. The following surgical procedures may be used:

  • Wedge or segmental resection – Surgery to remove a small part of the lung 
  • Segmentectomy – Surgery to remove one or more segments of the lung 
  • Lobectomy – Surgery to remove an entire section (lobe) of the lung 
  • Bilobectomy – Surgery to remove two lobes in the same lung
  • Pneumonectomy – Surgery to remove an entire lung 
  • Thoracotomy – Surgical approach in which a cut is made across the chest and the ribs are spread apart so that the surgeon can reach the lung
  • Video-assisted thoracic surgery (VATS) – Surgical approach that uses a tiny video camera to guide the surgeon, making a smaller cut to reduce recovery time 
  • Robotic Surgery – Surgical approach that uses a machine with remote-controlled robotic arms and miniature instruments, making a smaller cut to reduce recovery time.

Chemotherapy

Chemotherapy (also called chemo) uses drugs to attack and kill cancer cells. These drugs attack fast-growing cells like cancer. Most chemotherapy drugs are given by IV (through a vein). Some chemotherapy drugs can be taken orally, as a pill. Because the drugs continue to work for days or weeks after they are taken, a period of rest and recovery follows each dose or cycle. Chemotherapy is given as a single drug or as a combination of drugs. Chemo also may be given at the same time as immunotherapy, radiation, or targeted therapy. Sometimes chemo and radiation are given on different days. The following chemotherapy drugs are used most often to treat non-small cell lung cancer (NSCLC) as of June 2020.

Chemotherapy drugs for lung cancer

Common Side Effects of Chemotherapy

Chemotherapy works by destroying fast-growing cancer cells. It may harm fast-growing normal cells as well. This can cause side effects. Keep in mind that you may not have all or even most of these side effects. Most side effects are only short-term and most can be treated.


Side effects of Chemotherapy


Chemotherapy works by destroying fast-growing cancer cells. It may harm fast-growing normal cells as well. This can cause side effects. Keep in mind that you may not have all or even most of these side effects. Most side effects are only short-term and most can be treated.

  • Diarrhea or constipation
  • Fatigue
  • Flu-like symptoms
  • Hair loss
  • Loss of appetite or weight
  • Mouth sores
  • Nausea and vomiting
  • Neuropathy (numbness, tingling, or pain in the hands or feet)
  • Low blood counts and risk of infection or bleeding
  • Nail and skin changes
  • Pain
  • Taste changes
  • Hearing changes

Radiation

Radiation uses high-energy rays to kill cancer cells. It works by damaging the genetic material in cells. After radiation treatment ends, cancer cells can keep dying for days or even months. Ask about different kinds of radiation, such as photons, protons, CyberKnife, GammaKnife, and others.

Chemoradiation

This is a combination of chemotherapy and radiation therapy. It can be more effective than either alone in treating locally advanced NSCLC.

Immunotherapy

Immunotherapy is a type of cancer treatment that uses the body’s natural defenses (the immune system) to identify, attack, and kill cancer cells. Immunotherapy drugs approved to treat lung cancer belong to a class of drugs called checkpoint inhibitors. They most often target proteins called PD-1 or PD-L1. New research is looking at other kinds of immunotherapy to treat lung cancer. These include vaccines or T-cell therapy. Ask your doctor about clinical trials. Checkpoint inhibitors are given by IV (through a vein). Treatments usually take place at your doctor’s office or an infusion clinic. The following immunotherapy drugs are used to treat non-small cell lung cancer (NSCLC) as of June 2020.

Side Effects of Immunotherapy

Keep in mind that not all people get all side effects, and some people have few side effects. Immunotherapy side effects most often show up weeks or months after you start treatment, but may recur even years later. Most side effects can be managed if treated early. If you are on immunotherapy, it is very important to let your health care team know right away about any changes in side effects or symptoms.

Common side effects include:

  • Diarrhea or Constipation
  • Cough
  • Decreased appetite
  • Fatigue
  • Fever
  • Hair loss
  • Headache
  • Infection or swelling around the lungs
  • Nausea
  • Pain in muscles, bones, joints, or stomach
  • Shortness of breath
  • Skin rash or itching
  • Urinary tract infection

Rare but serious side effects may include:

  • Hepatitis (inflammation of the liver)
  • Colitis (inflammation of the colon)
  • Inflammation in the lungs
  • Severe infections
  • Severe skin problems
  • Problems in the kidneys, hormone glands, or other organs
  • Hormone gland problems (especially thyroid, pituitary, adrenal glands, and pancreas)
Immunotherapy drugs for lung cancer

Targeted Therapy

Targeted therapy is a newer form of cancer treatment. It may be used to treat advanced NSCLC. Targeted therapies block the action of certain genes, proteins, or molecules that cause cancer to grow and spread. Your doctor will need to test your tumor for biomarkers to find out if targeted therapy is right for you. Most lung cancer targeted therapies are taken by mouth as a pill. Treatments usually take place at home once or twice a day. A few targeted drugs are given by IV (through a vein), sometimes in combination with chemotherapy. If this is the case, you may have to go into the hospital every 3 to 4 weeks for treatment. These are the targeted therapy drugs that are available as of June 2020.

Approved targeted therapies by biomarker
Approved therapies by biomarker
Side effects by drug type
Side effects by drug type
Side effects by drug type

Clinical Trials

Learn More About Clinical Trials for Lung Cancer

Managing Treatment Side Effects

An important step in managing your cancer and its treatment is to be informed. Cancer is a complex and challenging disease that is treated in many different ways.

immunotherpy_side_effects.jpg

Ablation therapy

Radio-frequency ablation (RFA) uses heat made by radio waves to kill cancer cells. Cryotherapy uses freezing to do the same thing. Either approach may be used in people with early-stage NSCLC who can’t have surgery. These treatments involve a small probe (like a needle) that goes through the chest and directly into the tumor.

Palliative care

Maintaining your best possible quality of life is an important goal. Some care you receive may not treat your cancer. Instead, it will address possible symptoms caused by your cancer or side effects from treatment, such as pain. It may help you with social, emotional, or spiritual concerns. This kind of care is called palliative care or supportive care.

Many hospitals offer palliative care at the same time as cancer treatment. It is often provided by a palliative care specialist. This person is a doctor or nurse who focuses on symptoms, side effects, and emotional needs of patients. If you are not referred to a palliative care specialist soon after you learn you have lung cancer, ask to see one.

Coping with NSCLC

A lung cancer diagnosis comes with challenges such as: coping with stigma/blame/shame, difficulty breathing, and lung inflammation.

Learn About Coping with Lung Cancer

Would you like a print copy of these educational materials?

We can mail our Frankly Speaking About Cancer pieces to you. Shipping is free for up to 20 pounds.

Frankly Speaking About Lung Cancer: What You Should Know
Play video
Dr. G: Communicating with your Health Care Team
Play video
Addressing the Needs of Lung Cancer Caregivers - Webinar
Play video
Frankly Speaking About Cancer Making Treatment Decisions 20161121 2330 1
Play video
Frankly Speaking About Cancer Coping With Anxiety and Depression 20161130 1900
Play video