Non-Small-Cell Lung Cancer Treatments by Stage

There are many different ways to treat non-small-cell lung cancer, or NSCLC. The treatments you get depend on many things, such as:

  • The type of lung cancer
  • Your stage (how big the tumor is and if the cancer has spread)
  • Where the tumor is in your lung
  • The gene changes found in your NSCLC cells
  • Your general health
  • Your preferences

As with any condition, your treatment is an ongoing discussion with your medical team. Your doctors can make recommendations, but it’s up to you to decide how much or what kind of treatment you want. As your treatments go along, be sure you tell your doctor about any side effects you’re having, any pain you have, and how you’re doing emotionally. Always feel free to ask questions, whether it’s about changes you’ve noticed, nutrition or other lifestyle topics, or anything else that’s on your mind. Your medical team cares about your whole self, not just your cancer.

Treatment Glossary

Most people with non-small-cell lung cancer get more than one type of treatment. For instance, you might have surgery and then get chemotherapy and radiation. And if one type of treatment stops working, there’s often another kind that you can get.

These are the treatments most commonly used to treat NSCLC:

Chemotherapy (chemo) meds kill cancer cells or slow their growth. The drugs kill any cells that grow quickly, like cancer cells. Many times chemo drugs are used in combinations.

Clinical trials. NSCLC is often hard to treat. In a clinical trial, you get the best treatment available now and may also get new treatments. Talk to your doctor if you’d like to learn more about clinical trials that you might qualify for and what’s involved.

Immunotherapy. These drugs can help your immune system better recognize and attack cancer cells.

Radiation. Radiation uses high-energy rays (like X-rays) to kill cancer cells. If you get external beam radiation, the rays come from a large machine that aims the beams at the tumor through your skin. Internal radiation may be another option. To do this, doctors put tiny radioactive pellets into the tumor to kill it.

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Surgery. Surgery to take out the cancer gives the best chance of curing NSCLC. This may be an option if you have a small tumor that’s only in your lung (early-stage NSCLC). The type of operation you get depends on how much cancer there is and where it is in your lung. A surgeon might remove the tumor, the part of your lung with the tumor in it, or your entire lung. If the cancer has spread to nearby lymph nodes, your surgeon may take them out, too.

Targeted therapy. These drugs are made to target specific proteins and gene changes in cancer cells to keep them from growing.

Stage I NSCLC Treatments

You’ll get surgery if the tumor can be removed and it hasn’t spread to your lymph nodes. The surgeon will remove the part of your lung with the tumor and also take out nearby lymph nodes to check them for cancer.

If tumor testing shows that all the cancer was taken out, this may be the only treatment you need. If there may be cancer left behind, you might need more surgery, maybe with chemo afterward. Or instead of surgery, you might be able to get radiation to the tumor site.

If you’re too sick to have surgery and the cancer hasn’t spread to your lymph nodes, you’ll get radiation. You can get chemo along with it if you have certain high-risk factors that make the cancer more likely to come back.

If the cancer has spread to your lymph nodes, your doctors will treat it like a stage III cancer.

Stage II NSCLC Treatments

You’ll get surgery if the tumor can be removed and it hasn’t spread to your lymph nodes. The surgeon will take out the part of your lung with the tumor. Sometimes, you may have to have the whole lung removed. Your surgeon will also take out nearby lymph nodes to check them for cancer.

If tumor testing shows that all the cancer was taken out, this may be the only treatment you need. If you have certain high-risk factors that make the cancer more likely to come back, you may need chemo.

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If there may be cancer left behind, you might need more surgery with chemo afterward. Or you can get radiation to the tumor site, maybe along with chemo.

The location of the NSCLC also matters. If it’s in the very top of your lungs (called the superior sulcus), you’ll get chemo and radiation together before surgery to remove the tumor. You’ll get more chemo after surgery.

If you’re too sick to have surgery and the tumor hasn’t spread to your lymph nodes, you’ll get radiation, maybe along with chemo if you have certain high-risk factors that make the cancer more likely to come back.

If the cancer has spread to your lymph nodes, your doctor will treat it like a stage III cancer.

Stage III NSCLC Treatments

You’ll get surgery if the tumor can be removed and cancer has spread to your lymph nodes on the same side as the tumor.

If tumor testing shows that the surgery took out all the cancer in your lung, you’ll get chemo after surgery. Depending on the number of your nodes with cancer in them, you may then get radiation to those nodes after chemo.

If there may be cancer left behind after surgery, you might get chemo and radiation. You may get them at the same time, or you might get the chemo first and the radiation later.

If the tumor is more than 7 centimeters (cm) across and hasn’t spread to your lymph nodes, you’ll get surgery to take out the tumor and nearby lymph nodes so a lab can test them for cancer. After surgery, you’ll get chemo and radiation, either at the same time or chemo and then radiation.

If the tumor is in any part of your lung except the top of your lungs (the superior sulcus) and is large (more than 5 centimeters across), or has grown into the space between your lungs, or you have tumors in both lungs, your treatment will be one of these options:

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Surgery, if possible. If tumor testing shows that the operation took out all of the cancer, you’ll get chemo after surgery. But if those tests show that there may be some cancer left behind, you may need another operation followed by chemo, or you can get chemo and radiation, either at the same time or chemo first and then radiation.

Chemo and radiation before surgery. You can get them either at the same time or the radiation after you’re done with chemo. Then you get surgery to remove the tumor. This may be the only treatment you get, if tumor testing shows that the operation removed all the cancer. If testing shows that some cancer was left behind, you may need more surgery.

If the tumor cannot be removed, you’ll get radiation along with chemo followed by immunotherapy with durvalumab for up to 1 year.

If you have more than one tumor in the same lung, and at least one of the tumors is more than 5 centimeters across, you’ll get surgery. Then your treatment depends on how many lymph nodes contain cancer.

If the cancer isn’t in your lymph nodes or is only in nodes inside the same lung as the tumor, you’ll get chemo.

If it’s in lymph nodes around your windpipe or the space between your lungs on the same side as the tumor, and testing shows that all the cancer was removed, you’ll get chemo and maybe radiation after the chemo is done.

If it’s in lymph nodes around your windpipe or the space between your lungs on the same side as the tumor, and testing shows that some cancer may be left behind, you may get radiation and chemo at the same time, or the radiation may be given after the chemo is done.

If the Cancer Is in Your Mediastinal Nodes

These are the lymph nodes in the space between your lungs. If the cancer has spread to them, and there’s more than one tumor inside the same lung or the tumor is less than 7 centimeters across, your treatment options depend on whether the tumor can be removed.

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If possible, you’ll get surgery to remove the tumor and nearby lymph nodes. If tumor testing shows all the cancer was removed, you’ll get chemo after surgery.

If testing shows that some cancer was left behind after the operation, you may get chemo and radiation, either at the same time or the radiation can be given after the chemo is done.

If your NSCLC cannot be removed, your treatment depends on how many lymph nodes contain cancer cells.

If the cancer is only in nodes inside the same lung as the tumor, you’ll get chemo.

If it’s in lymph nodes around your windpipe or the space between your lungs on the same side as the tumor, options include:

Radiation and chemo at the same time, then the immunotherapy drug durvalumab for up to 1 year.

Chemo, possibly with radiation, and then tests to see if the tumor is growing or spreading. If it’s not, surgery may be an option, likely followed by more chemo and maybe radiation. If it’s growing or spreading in the same area, you’ll get radiation, maybe with chemo. If it has spread beyond the place where it first started, doctors will treat it like a stage IV cancer.

If You Have a Superior Sulcus Tumor

Superior sulcus tumors are in the very top of your lungs. Doctors treat them based on their size.

If the tumor is less than 7 centimeters across, you’ll get chemo and radiation together before surgery to remove the tumor. You’ll also get more chemo after surgery.

If the tumor is more than 7 centimeters across, treatment options depend on whether it can be removed with surgery.

If it might be able to be removed, you’ll get chemo and radiation together before surgery to shrink the tumor. You’ll then get a chest CT scan to see if the tumor shrank enough to take it out. If it can be taken out, you’ll get surgery and then more chemo. If it cannot be taken out, you’ll get radiation and chemo at the same time.

If the tumor cannot be removed, you’ll get radiation and chemo at the same time, then the immunotherapy drug durvalumab for up to 1 year.

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Stage IV NSCLC Treatment

In this stage, the cancer has spread to both your lungs, the fluid around your lung, the fluid around your heart, or to a distant lymph node or an organ in another part of your body, like your brain, liver, or bones. Stage IV cancer is rarely cured, but treatment can help keep it under control.

Whole-body (systemic) treatments: In most cases, targeted therapy, chemotherapy, and immunotherapy are the main treatments. A lab will test your cancer cells for certain markers and gene changes so your doctor knows which targeted therapy drugs will work best for you. Tests will also be used to find out the exact type of NSCLC you have.

Over time, the targeted therapy drug may stop working. When this happens, a new targeted drug is often used. (Your doctor may call this subsequent therapy.) Doctors can use many different chemo drugs, too, sometimes along with the targeted drugs. And they consider using immunotherapy to treat certain types of NSCLC.

Local treatments: Depending on where the cancer is, you may first get treatment to the part of your body with the cancer. Your doctor may call this “local” treatment. You can often get chemo, targeted therapy, and immunotherapy with any of these treatments.

If you have cancer cells in the fluid around your lung, your doctor will remove the fluid with a needle or a soft thin tube (catheter) that goes through your skin and into that space.

If you have cancer cells in the fluid around your heart, you may get surgery to create a pericardial window. This a small hole that’s made in the sac around your heart so the excess fluid can drain into your chest. This way it doesn’t affect how your heart works. Surgeons can do this using special scopes that are put in through tiny cuts in your skin. Or they can do it through one bigger cut in your skin.

If the cancer has spread to only a few areas, your medical team may be able to use radiation or surgery to treat the tumors. For instance, they might treat a small tumor in your brain with a special type of radiation that sends a high dose only to the tumor (called stereotactic radiation) or with surgery. Afterward, you may get radiation treatment for your whole brain.

Doctors may also use surgery and radiation to treat any problems the cancer is causing, like pain, bleeding, or a blocked airway.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on April 17, 2018

Sources

SOURCES:

American Cancer Society: “Treating Non-Small Cell Lung Cancer,” “Treatment Choices for Non-Small Cell Lung Cancer, by Stage,” “Non-Small Cell Lung Cancer Stages.”

National Cancer Institute: Non-Small Cell Lung Cancer Treatment (PDQ®)–Patient Version: “Treatment Option Overview,” “Treatment Options by Stage.”

National Comprehensive Cancer Network: “Clinical Practice Guidelines in Oncology (NCCN Guidelines®), Non-Small Cell Lung Cancer, Version 3.2018 – February 21, 2018.”  

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