There are several different ways to treat your non-small-cell lung cancer (NSCLC). You and your care team will work together to find the options that will help you live longer and feel as good as possible every day.

The right treatment for you depends on:

  • Your overall health
  • How well your lungs work
  • The characteristics of your cancer
  • Where your cancer is or has spread
  • Which treatments you’ve already tried

SURGERY

Stages 0, I, II or III

During surgery, all or part of your lung is removed.

Depending on where your cancer is or how advanced it is, you and your medical team will have different options.

Lobectomy: An entire lobe is removed. If possible, this is the preferred surgery for NSCLC.

Segmentectomy: A portion of a lung lobe -- a part of your lung that moves oxygen to your blood -- is removed. You may get this if your cancer is in an early stage, or if your tumor is on the side of your lung.

Wedge resection: A triangle-shaped slice of tissue is taken out. It could be done to get rid of a tumor and some healthy tissue around it.

Pneumonectomy: An entire lung is removed. This could be done if your cancer is near the center of your chest.

Sleeve resection: This gets its name because it’s like cutting out a stained part of a shirt sleeve, then reattaching the cuff. If your cancer is in a large airway, you may have this instead of a pneumonectomy. 

After your surgery, the tissue that was taken out gets checked for cancer cells around the edges. If some are found, you may have another procedure.

How will surgery make you feel? 

All surgeries carry some risks and have side effects. Which ones you’ll have will depend on the type of surgery you have and how you were feeling before the operation.

You could have:

  • Reactions to the anesthesia
  • A lot of bleeding
  • Blood clots
  • Infections
  • Pneumonia

Questions to Ask Your Doctor

These questions can help you learn more about your surgery options. Take them with you to your next visit. 

  1. How will surgery help me?
  2. Is there anything I should do to prepare for my operation?
  3. What are the risks?
  4. Will I need other treatments besides surgery?
  5. How long will I be in the hospital?
  6. What does recovery entail?
  7. When will I be able to get back to normal activities?

RADIATION

Stages I, IIIA, IIIB, IV 

With this treatment, high-energy rays like X-rays kill cancer cells. It also kills healthy cells in its path. You may have this as your main treatment or with another treatment, such as surgery or chemotherapy.

If your tumor can’t be removed because of its size or location, or if surgery isn’t right for you, this may be your main treatment.

You may have it before surgery to shrink your tumors so they can be removed, or you could have it after surgery to get rid of any cancer cells left behind.

It could also be used to ease symptoms if your cancer is advanced.

How will radiation make you feel? 

Depending on where you get the treatment, you may have:

  • Fatigue
  • Nausea
  • Loss of appetite
  • Weight loss
  • Skin changes like redness, peeling, or blistering
  • Hair loss
  • Cough
  • Trouble breathing
  • Sore throat
  • Trouble swallowing
  • Memory loss
  • Headache
  • Trouble thinking
  • Less of a sex drive

Usually, these will go away when your treatment is over.

Questions to Ask Your Doctor

These questions can help you learn more about your radiation options. Take them with you to your next visit.

  1. How will radiation help me?
  2. Is there a type I can try with fewer doses?
  3. What are the risks?
  4. Will I need other treatments besides radiation?
  5. How often will I need treatment?

LASER THERAPY

Stage IV

With laser treatment, a focused beam of light is used to destroy cancer cells. Your doctor may suggest this treatment if your cancer is blocking an airway and making it tough for you to breathe, or if your cancer is very small or in a very early stage.

You’re given medicine to make you sleepy. While you’re asleep, a doctor puts a tube called a bronchoscope into your airways, then passes the laser through the tube and burns away as much of the tumor as they can. It takes about 30 minutes.

How will laser therapy make you feel?  

You could have:

  • A sore throat
  • Some blood in your mucus
  • A metallic taste in your mouth

These will usually last a few days. If you cough up blood, reach out to your doctor right away.

Questions to Ask Your Doctor

These questions can help you learn more about laser therapy. Take them with you to your next visit.

  1. How will this help me?
  2. What are the risks?
  3. What side effects should I expect?
  4. Will I need other treatments besides laser therapy?
  5. How often will I need treatment?
  6. What is the long-term outlook?
  7. What can I expect after my treatment?
  8. When will I be able to resume normal activities?

PHOTODYNAMIC THERAPY

Stages 0, IV

In this treatment, your doctor uses a drug called a photosensitizer that, when it’s exposed to a certain type of light, makes a form of oxygen that kills nearby cells. You might get it:

  • If surgery is not a safe option for you
  • If your cancer is stage 0, or your tumors are very small
  • To relieve symptoms that make it tough to breathe
  • When other treatments haven’t worked
  • If your cancer is advanced (In that case, it would be used only to ease symptoms.)

It may also be used along with other treatments like surgery, radiation, or chemotherapy.

The photosensitizer is injected into your bloodstream. It stays in cancer cells longer than regular cells. Between 24 and 72 hours later, the cancer cells are exposed to light, then the photosensitizer in the cancer cells absorbs the light and creates the oxygen to kill them.

How will photodynamic therapy make you feel?

You could temporarily have:

  • A burning sensation
  • Swelling
  • Coughing
  • Trouble swallowing
  • Trouble breathing
  • Stomach pain
  • Sensitive skin
  • Sensitive eyes

Questions to Ask Your Doctor

These questions can help you learn more about photodynamic therapy. Take them with you to your next visit.

  1. How will this help me?
  2. What are the risks?
  3. How often will I need treatment?
  4. Will I need other treatments besides photodynamic therapy?
  5. What is the long-term outlook?
  6. What can I expect after my treatment?
  7. When will I be able to resume normal activities?

CHEMOTHERAPY

Stages I, II, IIIA, IIIB, IV

In this treatment, cancer drugs travel through your bloodstream to kill cancer cells.

You may get chemotherapy:

  • To make a tumor small enough so that it can be removed by surgery
  • After surgery to get rid of any lingering cancer cells
  • Along with radiation therapy if surgery isn’t possible
  • As your main treatment if your cancer is advanced, or if surgery is too dangerous

The drugs are either injected into one of your veins, or you’ll be given medicine to take by mouth. In most cases, you’ll take a combination of two drugs. You’ll probably get the drugs in cycles, with 1 to 3 days of treatment, followed by some time for your body to recover. But depending on the drugs your team chooses, you may get them daily. Cycles usually last for 3 to 4 weeks but can be longer if your cancer is advanced.

How will chemotherapy make you feel?

Side effects will depend on the drugs that you and your team decide on and how long you take them. You may have:

  • Diarrhea
  • Constipation
  • Hair loss
  • Fatigue
  • Nausea and vomiting

You may also get infections more easily.

Questions to Ask Your Doctor

These questions can help you learn more about chemotherapy. Take them with you to your next visit.

  1. Which chemotherapy drug do you recommend and why?
  2. How long will I need treatment? How often will I need it?
  3. What side effects can I expect?
  4. What other treatments will I need?
  5. What if my chemo treatments stop working?
  6. Is this a cure? What is the long-term prognosis?
  7. What can I expect after my treatment?
  8. When will I be able to resume normal activities?

TARGETED THERAPY

Stage IV

While chemotherapy hits all the cells in your body, targeted therapies home in on things that are unique to cancer cells in an effort to keep the cancer from growing and spreading. Because it focuses just on cancer cells, targeted therapy may cause less damage to your healthy cells than chemotherapy.

For now, you’ll probably get a targeted therapy if your cancer is advanced. You may get chemotherapy along with this, or you may get only targeted therapy.

Depending on the type of drug, you would either get them as pills or capsules, or through an IV.

Different types of these drugs target different things:

  • Angiogenesis inhibitors block the growth of new blood vessels that tumors need to grow.
  • EGFR inhibitors block a protein on the surface of cancer cells that helps them grow and divide.
  • Other drugs focus on a change in a specific gene (ALK, ROS1, BRAF, or NTRK) that can cause cancer cells to grow and spread.

Your team will let you know which drugs will work best on your cancer.

How will targeted therapy make you feel?

Since these drugs work only on cancer cells, side effects are often not as severe. Which ones you may have will depend on which drugs you take, but common ones can include:

  • Constipation
  • Diarrhea
  • Hair loss
  • Headaches
  • High blood pressure
  • Itching
  • Loss of appetite
  • Joint pain
  • Mouth sores
  • Nausea
  • Rashes on the face and chest
  • Swelling
  • Tiredness
  • Vision changes
  • Vomiting

Questions to Ask Your Doctor

These questions can help you learn more about targeted therapy. Take them with you to your next visit. 

  1. Which targeted therapy drugs are most likely to help me?
  2. How often do I get treatment?
  3. Will I need other treatments?
  4. What if it stops working?
  5. Is this a cure?
  6. What is the long-term outlook?
  7. What can I expect after my treatment?
  8. When will I be able to resume normal activities?

IMMUNOTHERAPY

Stages III and IV

These medicines power your immune system to find and destroy cancer cells better. They do this by adjusting things called checkpoints. They’re molecules that usually keep your immune system from attacking the normal cells in your body. Cancer cells sometime manipulate these checkpoints to keep from being destroyed. Immunotherapy drugs block these checkpoints:

PD-1: A protein found on some of the cells in your immune system. It keeps those cells from attacking certain other cells in your body. When it’s blocked, your immune system has more power against cancer cells.

PD-L1: A protein similar to PD-1 that’s on some tumor cells and some immune system cells. When it’s blocked, your immune system can work harder against cancer cells.

Depending on which drug you take, you’ll get them as a first treatment, or if your cancer grows again after another drug treatment like chemotherapy, or as a way of keeping your advanced cancer from getting worse.

There are many different types of immunotherapy drugs, but only immune checkpoint inhibitors are approved to treat NSCLC.

You’d get these drugs by IV every 2 or 3 weeks.

How will immunotherapy make you feel? 

Common side effects include:

  • Fatigue
  • Cough
  • Nausea
  • Itching
  • Skin rash
  • Loss of appetite
  • Constipation
  • Joint pain
  • Diarrhea

Other, more serious side effects are much rarer. Make sure to let your medical team know about any side effects you have. They may want to change your dose or stop your treatment.

Questions to Ask Your Doctor

These questions can help you learn more about immunotherapy. Take them with you to your next visit.

  1. Which immunotherapy drugs are most likely to help me?
  2. How often do I get treatment?
  3. What side effects can I expect?
  4. Which side effects should I call you about?
  5. Will I need other treatments?
  6. Is a clinical trial right for me?
  7. What if it stops working?
  8. Is this a cure? What is the long-term outlook?
  9. What can I expect after my treatment?
  10. When will I be able to resume normal activities?