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Treatment choices for non–small cell lung cancer

The choice of treatment and the long-term outcome (prognosis) for people who have non–small cell lung cancer depends on the stage of the cancer. Your doctor will determine the stage by looking at the size and location of the original tumor (T for tumor), the involvement of lymph nodes near the tumor (N for node), and whether the cancer has spread to another place in the body (M for metastasis). Your age, overall health, and quality of life must also be considered. Research studies are ongoing to determine the best treatment choices or combination of treatments that increase survival rates without affecting your quality of life.

There are many combinations of surgery, chemotherapy, and radiation therapy used to treat lung cancer. The following table summarizes standard treatment options as described by the National Cancer Institute.¹ Treatment options and combinations are always being studied.

**Treatment choices by stage**
Stage		Treatment choices
IA IB	T1N0M0 T2N0M0	Surgery. If surgery is not a choice because of other medical problems, radiation therapy may be recommended. Chemotherapy or radiation therapy may be recommended after surgery.
IIA IIB	T1N1M0 T2N1M0 T3N0M0	Surgery. If surgery is not a choice because of other medical problems, radiation therapy may be recommended. Chemotherapy after surgery, with or without other treatment such as radiation therapy, may be recommended.
IIIA	T1N2M0 T2N2M0 T3N1M0 T3N2M0	If the lung cancer can be removed, chemotherapy followed by surgery will most likely be recommended. Surgery may be followed with radiation and/or chemotherapy if there was no chemotherapy before surgery. If the lung cancer cannot be removed, chemotherapy with radiation at the same time, chemotherapy followed by radiation, or radiation or chemotherapy alone may be recommended.
IIIB	Any T, N3M0 T4, any N, M0	Chemotherapy, chemotherapy with radiation at the same time, or radiation therapy alone is most common. If the lung cancer can be removed, chemotherapy with radiation therapy at the same time, followed by surgery, may be recommended. If the lung cancer cannot be removed, chemotherapy with radiation at the same time or chemotherapy followed by radiation may be recommended. If a pleural effusion caused by the cancer is present, treatment is usually similar to treatment of stage IV cancer.
IV or recurrent cancer	Any T, any N, M1	Palliative chemotherapy may be recommended. Palliative radiation therapy may be done to relieve pain that is caused by the spread of cancer to areas such as the throat, brain, spinal cord, or bones. Laser therapy, or brachytherapy may be done for cancer that is growing inside the bronchial tubes. Surgical implantation of devices to keep airways open may be needed.

People who are not cured with standard treatments-or who have more side effects than desired-may want to participate in clinical trials. Clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the world for all stages of lung cancer.

Citations
National Cancer Institute (2007). Non–Small Cell Lung Cancer PDQ: Treatment-Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/non-small-cell-lung/healthprofessional.

Author	Bets Davis, MFA
Editor	Maria Essig
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	Michael Seth Rabin, MD - Medical Oncology
Last Updated	June 4, 2008

WebMD Medical Reference from Healthwise

Last Updated: June 04, 2008

This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.