If you’ve been diagnosed with non-small-cell lung cancer (NSCLC), you’ll work with a team of doctors and other specialists to get the right care.
Your NSCLC treatment team may include one or any of these health care pros:
- Oncologists, also called medical oncologists, are cancer specialists who prescribe drugs.
- Radiation oncologists perform radiation treatments.
- Interventional pulmonologists specialize in managing lung diseases like NSCLC.
- Thoracic surgeons specialize in lung cancer surgery.
- Palliative care specialists give supportive care to improve your quality of life, such as prescribing treatments for shortness of breath or to help you manage your emotions, appetite loss, nausea, or sleep problems.
- Dietitians and nutritionists help you figure out what to eat to get enough nutrients.
NSCLC Care by Stage
When your NSCLC is diagnosed, your doctors will stage your cancer. Staging tells you how large your tumor is and if it has spread to other parts of your body. Your NSCLC treatments will be based on your stage, your overall health, and the genetic makeup of the cancer.
Stage 0 cancer usually is treated with surgery only.
Stage I cancer is treated with surgery, sometimes followed by chemotherapy and/or radiation.
Stage II cancer is treated with surgery followed by chemo and/or radiation therapy, or targeted therapy if you have an EGFR gene mutation. An immunotherapy drug has now been approved by the FDA for stage II NSCLC. It can be used along with chemotherapy before surgery.
Stage III cancer is treated with a combination of chemotherapy, radiation, and surgery. In some cases, your doctor may prescribe either targeted therapy or immunotherapy with pembrolizumab as a first treatment instead.
Stage IV cancer is treated with a combination of chemotherapy, radiation, surgery, targeted therapy, and/or immunotherapy, depending on how far your cancer has spread and your overall health.
Your doctor may run tests that look at the genetic makeup of the cancer. The result of this testing can help determine your treatment plan.
NSCLC Treatment Types
Depending on your disease’s stage, genetic makeup, your age, or your overall health, your NSCLC treatment may include one or a combination of these therapies:
Surgery can remove the tumor and part or all of your lung, and sometimes, nearby lymph nodes to see if your cancer has spread. Some surgery for NSCLC is done with video cameras or robots as guides.
What you can expect: You’ll have surgery in the hospital under general anesthesia. You may need to stay in the hospital for 5-7 days. After that, you’ll recover at home. It may take weeks or months. If you have video- or robot-assisted lung surgery, your hospital stay and recovery may be shorter.
These are drugs used to shrink your tumor before surgery or kill cancer cells after surgery. Chemo may be prescribed alone or used along with other therapies. Some chemo drugs are pills, but often, it’s dripped or injected into your vein in a series of IV treatments.
What you can expect: Chemo may cause side effects like hair loss, nausea, weight loss, mouth sores, fatigue, skin bruising, or diarrhea. If you have fatigue, you may need to arrange rides to and from your treatments.
Radiation therapy for NSCLC uses high-energy X-rays or radioactive particles to shrink or kill your tumor or wipe out cancer cells after surgery. Radiation may be given alone or combined with other NSCLC therapies like drugs or surgery.
- External beam radiation therapy (EBRT) aims a burst of radiation to the spot of your cancer.
- Brachytherapy places tiny radioactive pellets near your tumor, often during surgery.
What you can expect: Beam radiation is usually given every weekday for 5-7 weeks. Treatments are painless and last a few minutes each. Brachytherapy is done once. Radiation side effects include fatigue, nausea, vomiting, and hair loss or skin redness or peeling at the treatment area.
Radiofrequency ablation (RFA)
RFA is a therapy that uses high-energy radio waves delivered through a small needle to heat and kill your tumor. You may have RFA if you have small tumors located near the outer edges of your lungs.
What you can expect: RFA is done as an outpatient treatment in the hospital with local anesthesia. For a few days after RFA, you may have some pain where the needle went in. RFA complications are rare but can include a collapsed lung or lung bleeding.
Targeted therapy drugs kill cancer cells, but unlike chemo, they leave healthy cells alone. They’re only used for tumors with a certain gene mutation. Your doctor will give you a genetic biomarker test to see if targeted therapy may work for you.
Targeted therapy drugs for NSCLC include:
Angiogenesis inhibitors that block the tumor’s blood supply so it shrinks. They include bevacizumab (Avastin) and ramucirumab (Cyramza).
Drugs that target tumors with certain gene mutations like EGFR, T790M, ALK, ROS1, BRAF, RET, MET, KRAS, or NTRK. These drugs are designed to seek out and block certain signals on the tumor cells.
What you can expect: Targeted therapies may cause some side effects during treatment, including fatigue, mouth sores, diarrhea, constipation, headaches, high blood pressure, increased infection risk, loss of appetite, skin problems, or vision changes.
These medications use your own immune system to seek out specific proteins and destroy your cancer cells. They’re also called checkpoint inhibitors.
Immunotherapy for NSCLC include drugs that block these proteins:
- PD-1: Nivolumab (Opdivo) and pembrolizumab (Keytruda)
- PD-L1: Atezolizumab (Tecentriq) and durvalumab (ImfinziImfinzi)
- CTLA-4: Ipilimumab (Yervoy)
What you can expect: You’ll get immunotherapy at a clinic in a series of weekly IV infusions for up to 6 weeks. Side effects may include fatigue, nausea, diarrhea, appetite loss, skin rash, itching, or joint pain.
Palliative care for NSCLC is used to make you feel better. It may include surgery to remove fluid built up around your lungs or to open airways so you breathe easier. Other palliative treatments are medicine to ease pain or nausea, supplemental oxygen, nutritional supplements to keep your weight up, or counseling to help you emotionally.
You may have palliative treatments at any point during your NSCLC treatment.
What you can expect: Palliative care may be done in the hospital, but some treatments can be done in your doctor’s office, long-term care clinics, or even at home.
Photo Credit: iStock / Getty Images
American Lung Association: “Lung Cancer Treatment,” “Targeted Therapies for Lung Cancer,” “Supportive (Palliative) Care for Lung Cancer.”
American Cancer Society: “Surgery for Non-Small Cell Lung Cancer,” “Chemotherapy for Non-Small Cell Lung Cancer,” “Radiation Therapy for Non-Small Cell Lung Cancer,” “Radiofrequency Ablation for Non-Small Cell Lung Cancer,” “Targeted Drug Therapy for Non-Small Cell Lung Cancer,” “Immunotherapy for Non-Small Cell Lung Cancer,” “Palliative Procedures for Non-Small Cell Lung Cancer,” “Treatment Choices for Non-Small Lung Cancer by Stage.”
National Cancer Institute: “Palliative Care in Cancer,” “Cancer Staging.”
CDC: “How Is Lung Cancer Diagnosed and Treated?”
Mayo Clinic: “Chemotherapy.”