What Is Non-Small-Cell Lung Cancer (NSCLC)?
Most people who have lung cancer have NSCLC. Although it's serious, treatment can sometimes stop it from getting worse. There are things you can do to help you feel better, too.
People who smoke or who breathe a lot of smoke are most likely to get NSCLC. Many of them are over 65.
There are four kinds of NSCLC tumors:
- Adenocarcinoma starts in cells in your air sacs that make mucus and other substances, often in the outer parts of your lungs. It's the most common kind of lung cancer among both smokers and nonsmokers and people under 45. It often grows more slowly than other lung cancers.
- Squamous cell (epidermoid) carcinoma starts in cells that line the inner airways of the lungs. About a quarter of lung cancers are this kind.
- Large cell (undifferentiated) carcinoma grows and spreads more quickly. That can make it tougher to treat. It's about 10% of lung cancers.
- Adenosquamous carcinoma is relatively rare and generally develops in the outer part of the lungs. Smoking can increase the risk of its development.
The treatments your doctor suggests will depend on how far your lung cancer has spread.
Doctors aren't sure exactly what causes this disease. Many people who get it have smoked or been around smoke. Other things that make lung cancer more likely are:
- Radon, a radioactive gas found naturally in soil and rocks
- Mineral and metal dust
- Chronic obstructive pulmonary disease (COPD)
- Pulmonary fibrosis
- Air pollution
- Radiation treatment to your chest or breast
It can also run in families.
Like other types of lung cancer, symptoms can include:
- Coughing that lasts or gets worse
- Chest pain that often hurts more when you cough, laugh, or take deep breaths
- Hoarseness or voice changes
- Harsh, raspy sounds when you breathe
- Weight loss, little appetite
- Coughing up blood or mucus
- Shortness of breath
- Feeling weak or tired
- Lasting lung problems, like bronchitis or pneumonia
If the cancer spreads to other parts of the body, you may have:
Getting a Diagnosis
First, your doctor will talk with you and ask questions like:
- When did you first notice problems?
- How have you been feeling?
- Are you coughing or wheezing?
- Does anything make your symptoms better or worse?
- What do you do for a living?
- Do you, or did you, smoke?
- Has anyone in your family had lung cancer?
They'll also give you a physical exam. You will need tests, too.
Imaging tests help your doctor find tumors inside your lungs. They can also show whether the cancer has spread.
- X-rays use low doses of radiation to make images of structures inside your body.
- MRI, or magnetic resonance imaging, shows blood flow, organs, and structures.
- Ultrasound creates a picture by bouncing sound waves off tissues inside you.
- PET scans use a radioactive compound or tracer that collects where your cells are very active.
- CT scans are powerful X-rays that make detailed pictures of the tissue and the blood vessels in the lung.
Fine-needle aspiration biopsy takes cells from an abnormal growth or the fluid in your lungs.
Your doctor may want to look inside your lungs and chest using a thin, flexible tube with a light and tiny camera. They may also take samples of tissue, including from nearby lymph nodes, to check for cancer cells. They can do this a few different ways:
Endobronchial ultrasound uses bronchoscopy with an ultrasound placed at the tip of the tube to look at lymph nodes and other structures.
Thoracoscopy uses a few small cuts along your side to look at the outside of your lung and the tissue around it.
Mediastinoscopy makes a small cut just above your breastbone, in the space between your lungs.
Based on what your doctor finds, they'll assign a stage, describing where the cancer is. That will help your medical team figure out the best treatment for you. You’ll want to know what each stage means:
- Occult stage: "Occult" means "hidden." Cancer cells are in lung fluid or sputum, but the doctor can't find where the cancer is in your lungs.
- Stage 0: Cancer cells are in the lining of your airways.
- Stage I: A small tumor is in only one lung. The cancer hasn't spread to lymph nodes.
- Stage II: A larger tumor is in one lung, or the cancer has spread to nearby lymph nodes.
- Stage III: Cancer in one lung has spread to farther lymph nodes or into nearby structures.
- Stage IV: Cancer has spread to both lungs, to fluid around the lungs, or to other parts of the body, such as the brain and liver.
Questions for Your Doctor
Finding out that you have cancer is overwhelming. You may want to start by asking your doctor:
- How serious is my lung cancer?
- Has it spread, where to, and what does that mean?
- What are my cancer treatment options? How well do they work?
- What are the side effects?
- What other treatments might I need to feel OK?
- Will I have to stop working while having treatment?
- What happens if the cancer continues to spread?
- Have you treated anyone else with this type of lung cancer?
- Can I take part in clinical trials? How can I find out about that?
- Is there a medical center that takes care of my kind of cancer regularly that I could go to?
Ask a friend or family member to go with you to your appointments for emotional support and to help you understand what the doctor tells you.
You may feel more comfortable getting a second opinion before deciding on your treatment plan.
Doctors treat this kind of lung cancer in two ways: They target the cancer itself, and they try to make you feel better. Their goal is to stay ahead of the symptoms and make you as comfortable as possible.
Your doctor may suggest a combination of treatments, depending on what kind of cancer you have and where it is.
Surgery. If you’re in an early stage, your doctor will probably recommend surgery to take out the cancer. You could have a part or all of your lung removed. Other types of surgery destroy cancer cells by freezing them or using a heated probe or needle.
Radiation. It can kill cancer cells that remain after surgery. It also treats certain cancers that your doctor can't get rid of with surgery. The radiation comes either from a high-energy beam aimed at the cancer from outside of your body using a special machine, or from a radioactive substance put inside your body in or near the cancer.
Chemotherapy. Whether you get it as pills or with a needle in a vein or muscle, the drugs travel throughout your body to kill the cancer. Your doctor might put it in your spinal fluid, a specific organ, or a space inside your body to target cancer cells in that area. You could get chemo before surgery to make a tumor smaller, after surgery, or both, or even if you don't have surgery.
Targeted therapy. These drugs and antibodies stop cancer cells from growing and spreading in very specific ways. Because of how they work, they usually harm normal cells less than radiation and chemo.
Laser and photodynamic therapy (PDT). This technique uses a special laser light to "turn on" special drugs that cancer cells have absorbed. This kills them and helps avoid damage to healthy tissue.
Clinical trials. Scientists are studying new ways to treat cancer. Check the National Cancer Institute's web site and ask your doctor if a clinical trial would be a good fit for you, what you should consider, and how to sign up.
Let your doctor know if you have any pain or shortness of breath. There are treatments for that so you can feel better.
Taking Care of Yourself
As you follow your treatment plan, pay attention to any changes you feel. Tell your doctor how you’re doing, both physically and emotionally.
Some days, your appetite may not be great. But you'll need to eat well to keep your strength and energy up. Try to eat several small meals throughout the day instead of a few large ones.
If you have trouble breathing, oxygen from a tank may help. So can practicing relaxation techniques, like meditation, listening to music, or picturing yourself in a peaceful place. Complementary treatments, including gentle massage and aromatherapy, may put you more at ease. Talk to your doctor about what you can do when you're tired, in pain, or breathless.
Finding out that you have cancer is very hard to deal with. You may be afraid, angry, or sad. Strong emotions are normal. A support group or a counselor who works with people who have cancer could help you work through your feelings. Look online or in your community, or ask your doctor for suggestions and about other professionals who can help support you -- perhaps social workers, nurses, clergy, or other doctors.
What to Expect
If it's caught early enough, your cancer may be curable. Even if it's not, your treatment should help you live longer and feel better. Throughout your treatment, you can make choices about what's best for you.
The Lung Cancer Alliance can help you find other people and families near you who have also faced this disease. Their support can make it easier to live with NSCLC.