Early Non-Small-Cell Lung Cancer

Medically Reviewed by Neha Pathak, MD on August 25, 2021
Written by Susan Bernstein
7 min read

Non-small-cell lung cancer (NSCLC) is the most common form of lung cancer. Early NSCLC is when your disease is in its earliest stages, or stages I-II.  That means that your lung tumor has grown and may have spread to your lymph nodes, but it hasn’t spread to other organs outside your lungs.

There are three main types of early NSCLC based on the specific cells of your tumor and where the disease is located inside your lungs:

  • Adenocarcinoma: Cancer cells line air sacs called alveoli.
  • Squamous cell carcinoma: Cancer cells line your bronchi, the two tubes that branch off of your windpipe into your lungs to carry air.
  • Large cell carcinoma: Cancer cells form from any larger cells inside your airways.

Smoking is a major cause of lung cancer. Inhaled smoke can damage cells that line your lungs and cause cancer. It can affect smokers or people exposed to secondhand smoke.

But some people get NSCLC even when they’ve never smoked. Breathing in substances like radon, exposure to asbestos, a family history of lung cancer, or radiation therapy for other cancers can make people more likely to get the disease.

Sometimes, early non-small-cell lung cancer has no symptoms. Signs of the disease may not show up until the cancer has grown and spread.

But when symptoms do appear early on, they can include:

  • Nagging cough
  • Coughing up blood or red-colored mucus
  • Shortness of breath
  • Chest pain when you cough or take deep breaths
  • Pain in your upper back
  • Weight loss you can’t explain otherwise
  • Wheezing
  • Recurring lung infections like bronchitis or pneumonia

These are vague symptoms that may not mean you have cancer. They could be caused by other conditions like asthma, COPD, or pneumonia. But if you notice these symptoms and they don’t go away, see your doctor. If your NSCLC is diagnosed early, you can start treatment as soon as possible for better results.

While early non-small-cell lung cancer often doesn’t cause symptoms, your diagnosis may begin during a routine screening with a CT scan. This scan shows areas of your lungs that could have early cancer.

Doctors recommend that people at higher risk for lung cancer get screened for the disease each year even if they don’t have symptoms. That includes people between ages 55 and 74, who are in good health overall, and are:

  • A current smoker
  • A former smoker who quit during the past 15 years and have a 30-pack year history of smoking, which is measured by the number of years you smoked multiplied by the packs of cigarettes you smoked per day. (For example, someone who smoked two packs a day for 10 years has a 20-pack year history.)

If your doctor suspects that you have early NSCLC, they can order some tests to diagnose you with cancer or to rule out another condition that may be causing your symptoms:

  • Low-dose CT scan or chest X-ray, imaging tests that can help your doctor see the structures inside of your lungs
  • Sputum cytology, which can test any mucus from a hacking cough for signs of cancer
  • Blood tests to look for results that suggest cancer, such as high levels of white blood cells
  • Tissue biopsy, when your doctor removes a small sample of lung tissue to send to a lab to check it for cancer cells

If your doctor recommends a biopsy to diagnose you, there are a few different ways they might take the tissue sample:

  • Bronchoscopy: They insert a small tube down your throat and deep into your lung.
  • Mediastinoscopy: They make a small cut at the base of your neck to get access to your lung.
  • They insert a needle through your chest and into your lung, using a CT scan to guide them to the right area.

They’ll remove both the lung tissue and nearby lymph nodes to see if cancer has spread.

If test results show NSCLC, your doctor will find out what stage your cancer is in. Staging shows how much your lung cancer has spread so you and your doctor can plan the right treatment. To figure out the stage, your doctor will use tests like a CT scan, MRI, PET scan, or a bone scan. If your cancer is in stage I or II, you have early NSCLC.

If you’re diagnosed with early non-small-cell lung cancer, you’ll probably have a lot of questions.  It may be hard to think of everything to ask right away, but after you’ve had time to gather your thoughts, you may want to cover topics like:

  • What does my cancer stage mean?
  • Will I need more tests to plan my treatment for cancer, such as genetic testing?
  • What treatments do you recommend for my early non-small-cell lung cancer?
  • What side effects could my cancer treatments have?
  • What are the goals for my treatments?
  • What are my chances of survival with this type of lung cancer?

For stage I non-small-cell lung cancer, your only treatment may be surgery to remove your tumor and nearby lymph nodes.

Doctors use a few different types of surgery for stage I early NSCLC, including:

  • Wedge resection: removal of the tumor and a small area of healthy tissue nearby
  • Segmentectomy: removal of the tumor and a larger area of healthy tissue around it
  • Sleeve resection or sleeve lobectomy: removal of the tumor and bronchi nearby
  • Lobectomy: removal of the lobe of one lung where your tumor is located

If your tumor is very small, you may only need to remove part of a lobe of your lung unless your doctor thinks removing the whole lobe is the only way to be sure all the cancer is removed.

After your surgery, your doctor will examine the tissue that was removed for signs of cancer cells at the edges, called positive margins. If you have positive margins, you may need an additional surgery to remove the rest of the cancer tissue or radiation therapy to kill off the cancer cells that the surgery didn’t get.

If your tumor is larger and at risk for growing back, your doctor may prescribe chemotherapy drugs after your surgery.

Newer genetic tests can help show which cancers are more likely to come back and require chemo. People with a mutation in a gene called EGFR may be able to use a new targeted cancer drug, osimertinib (Tagrisso), to treat their disease.

Radiation therapy

Radiation therapy can kill cancer cells left behind after surgery. If you have health problems that make it too risky for you to have a lung operation, you may have radiation as your main treatment for early NSCLC in stages I or II.

Radiation therapy for early non-small-cell lung cancer includes:

  • Stereotactic body radiotherapy, where intense beams of radiation are aimed at different areas of your body where cancer cells may be located
  • Radiofrequency ablation, when a small needle delivers radiofrequency waves to a tumor. It may be an option for very small tumors in the outer areas of your lung

To treat stage II NSCLC, you’ll probably start with surgery like sleeve resection, lobectomy, or pneumectomy, where your whole lung is removed. Your doctor will also remove nearby lymph nodes to see if your cancer has spread.

If you have positive margins on the tissue removed during surgery, you may then have a second surgery, chemo, radiation therapy, or a combination of these treatments to destroy the remaining cancer cells. If you have certain genetic mutations, you may benefit from targeted drug therapy like osimertinib.

During your early non-small-cell lung cancer treatment and recovery, you need to take care of yourself. Get plenty of rest. Save your energy for the things you really need to do. Don’t try to do too much. Remember that it’s OK to ask family and friends for help with everyday tasks and chores.

If you have shortness of breath because of your lung cancer, it may feel scary to not be able to get as much air into your lungs. The key is to try to relax, find comfortable seated positions, and focus on slow, gentle breathing. Try not to think about filling your lungs with air. Instead, work on moving the muscles around your lungs, like your diaphragm. Your doctor can prescribe supplemental oxygen to help you with shortness of breath, too.

Supportive or palliative care can also help you manage symptoms of early non-small-cell lung cancer or treatment side effects. Your doctor can prescribe treatment to ease pain, open your airways so you breathe easier, reduce nausea or fatigue, ease constipation, help you sleep better or improve your appetite, or ease anxiety or depression.

If you can get a diagnosis of non-small-cell lung cancer and start treatment early on, you have a better chance of success. People with early NSCLC have a 63% relative 5-year survival rate. That means you’re 63% as likely to live 5 years as someone with no cancer.

Because treatments for NSCLC are improving all the time, you may expect an even better outcome if you’re diagnosed now than you would have had in the past.

While you manage your early non-small-cell lung cancer and treatment, you’ll need support from family and friends:

  • Ask for help with tasks around the house when you need to.
  • Turn to your loved ones for emotional support or just to listen as you talk about dealing with lung cancer.
  • Talk to a counselor, pastor, social worker, or lung cancer support group if you need help dealing with emotions, how cancer affects your life, or fears about cancer.