Non-Small-Cell Lung Cancer Treatment by Stage

Reviewed by Brunilda Nazario, MD on December 07, 2020

After your lung cancer is diagnosed, the doctor will run tests to find out the size of the tumor and whether the cancer has spread to other parts of the body. This process is called staging. Knowing the stage of your disease is crucial because it will help you and your doctor choose the best course of treatment.

Here’s a look at the options for each stage. Keep in mind that no one can say for sure how your cancer will respond. Every person is different, and so is every cancer. Your doctor will make changes along the way to find what works best.


How It’s Defined

The cancer is only in the lining of your airways.


Surgery: If your health is good overall, surgery is probably all you need. Depending on where the tumor is, your surgeon will suggest one of these procedures:

  • Wedge resection: Cut out the tumor and a small amount of normal lung tissue.
  • Segmental resection (segmentectomy): Take out the part of the lung where the tumor is.
  • Sleeve resection: Remove a lobe of the lung and a part of the airway.
  • Lobectomy: Cut out an entire lobe of the lung. (The right lung is divided into three lobes; the left lung has two lobes.) Most surgeons prefer this option since it offers the best chance for a cure.
  • Pneumonectomy: Take out the entire lung. This might sound extreme, but you can live a normal life with only one lung.


Photodynamic therapy (PDT): This process uses a drug called a photosensitizer and a certain type of light to create a form of oxygen that kills nearby cells. It can help shrink tumors without the side effects of other drugs.

Brachytherapy:  This is a form of internal radiation where radioactive material is put into a tumor or into an airway next to a tumor.


How It’s Defined

In stage IA, the tumor is no larger than 3 centimeters (about 1 1/4 inches) across and hasn’t spread to any other tissues or lymph nodes. In stage IB, it’s no more than 4 centimeters and has spread to the main bronchus of the lung’s lining, or both.



Surgery: If you’re in good health, surgery may be all you need. Based on the tumor’s size and placement and how well your lungs work, your surgeon may suggest one of these procedures.

  • Sleeve resection
  • Segmentectomy or wedge resection (for tumors smaller than 2 centimeters across)
  • Lobectomy


Chemotherapy: With any of these surgeries, nearby lymph nodes are also removed to see if the cancer has spread. If your medical team feels your cancer could come back, they’ll probably suggest you get chemo after surgery to destroy any leftover cancer cells. You might hear this called adjuvant chemotherapy. You could take a chemo drug by mouth or get it in a vein.

Radiation: If you’re not healthy enough for surgery, your doctor may go with this therapy. It uses powerful X-rays to kill cancer cells. You may hear the doctor call it external radiation.

Radiofrequency ablation (RFA): This is a procedure where heat produced by radio waves kills cancer cells.


How It’s Defined

The tumor is between 3 and 7 centimeters across, or it has spread to your lymph nodes, or both.


Chemotherapy: Your doctor may want to do chemo (sometimes paired with radiation) before surgery to shrink the tumor. They might call this neoadjuvant chemotherapy. Even if your doctor doesn’t find cancer cells during surgery, they might suggest chemo afterward just in case cancer cells were left behind.


Surgery: If you’re healthy enough, the doctor will likely recommend one of the following:

  • Lobectomy
  • Sleeve resection
  • Pneumonectomy

After surgery, your doctor will check the tissue they removed to see if cancer cells are at the edges. If so, you may need another operation to remove more cancer cells.

Radiation: If you’re not healthy enough for surgery, you may get radiation instead.


How It’s Defined

Cancer is found in the lung and in the lymph nodes in the middle of the chest. Stage III has three subtypes:


How It’s Defined

If the cancer has spread only to lymph nodes on the same side of the chest where it began, it’s called stage IIIA.



Chemotherapy and radiation: If you can stand the side effects, treatment usually starts with chemo. It might be combined with radiation.

Surgery: If you’re healthy enough and your doctor thinks there’s a good chance they can remove any cancer that remains, they may suggest surgery. In some cases, it may be his first choice of treatment. It’s often followed by chemotherapy and sometimes radiation. The type of surgery depends on the size and location of the tumor, how far the cancer has spread into the lymph nodes, and whether you’ve had surgery before.

Immunotherapy: If you can't stand chemotherapy, radiation, or surgery, then your doctor may suggest this treatment to boost your immune system to kill cancer cells.


How It’s Defined

The cancer has spread to lymph nodes near the opposite lung or in your neck. These cancers can’t be completely removed by surgery.


Chemotherapy with radiation: Again, treatment depends on your overall health and how you can handle the treatments. If you’re in fairly good health, chemo and radiation might improve your condition.

Radiation or chemotherapy: If you can’t handle the combo treatment, you’ll probably get radiation therapy alone. Chemo by itself is less common.

Clinical trials: These cancers can be difficult to treat, so you may want to think about taking part in a clinical trial of newer treatments.

Immunotherapy: If you can't stand chemotherapy, radiation, or surgery, this treatment, a type of biologic therapy, may be an option.

Breathing Exercises During and After Treatment Two easy breathing exercises that can help you breathe easier during and after treatment for lung cancer.70

SPEAKER: Two simple exercises

can help you breathe easier

during and after treatment

for non-small cell lung cancer.

They're especially useful if you

get short of breath.

Practice both techniques three

to four times a day.

Do them each for about five

minutes and gradually increase

the amount of time when you feel


Start with pursed lip breathing.

You can do this anywhere, even

while you're walking around.

Slowly inhale through your nose

for about three seconds.

Then, purse your lips together

and exhale through your mouth

for about six seconds.

Next, try

diaphragmatic breathing.

Lean back in a chair or lie down

comfortable furniture.

Either way, make sure your back

and the head or supported.

Put one hand on your stomach

and the other on your chest.

Now, breathe in

through your nose

and into your belly for about

two seconds.

You should feel your belly move,

and your chest should stay


Then, exhale with your lips

pursed together for about four


Want to make these exercises

more effective?

Stay active.

The more you move, the better.

Kim Wilson, pulmonary rehabilitation coordinator, St. Joseph's Hospital, Atlanta./delivery/4b/72/4b720b75-9719-426a-ae06-64307525ea2d/funded-vo-feature-breathing-exercises-lung-cancer_,400k,2500k,1000k,4500k,750k,.mp402/14/2019 12:00:00650350breathing exercises during and after treatment/webmd/consumer_assets/site_images/article_thumbnails/video/breathing_exercises_during_and_after_treatment_video/650x350_breathing_exercises_during_and_after_treatment_video.jpg091e9c5e81bc54be


How It’s Defined

The cancer has spread to both lungs, to fluid in the area surrounding the lungs, or to other organs.


Chemotherapy and radiation: A cancer that’s spread to distant sites in your body can be hard to cure. As long as you’re in fairly good health and can handle the side effects, treatments like chemotherapy and radiation can ease your symptoms and help you live longer.


Immunotherapy:  This involves drugs that help your body’s own immune system find and destroy cancer cells. 

Targeted therapy: These drugs target certain parts of cancer cells. A test can tell if you'll respond to this treatment.

Photodynamic therapy: Doctors use light to kill cancer cells and shrink tumors.

Stent: Lung tumors that have grown into an airway can cause trouble breathing or other problems. Your doctor puts a hard silicone or metal tube called a stent into the airway to hold it open.

Targeted Therapy: How Does It Work?Targeted treatments work to block cancerous cells from multiplying. What are the different types?54

SPEAKER: Targeted therapy are

special anticancer drugs that

can tell the difference

between a normal

and a cancerous cell.

These drugs work by attaching

themselves to different parts

of cancer cells,

basically changing the way they


Some drugs block the creation

of new blood vessels

that bring oxygen and nutrients

to the cancer cell,

eventually starving it to death.

Other types

of targeted therapies

block the cells communications

center that commands it to grow

and reproduce.

There are also targeted

therapies that deliver

radioactive material that

directly kills cancer cells,

and others that stimulate

your immune system to destroy

the cell.

Your cancer care team will

advise you on the type of drug

therapy you need,

how you will get it,

and the benefits and side


American Cancer Society: "Targeted Therapy Drugs for Non-Small Cell Lung Cancer," "Treatment Choices for Non-Small Cell Lung Cancer by Stage."<br>Translational Lung Cancer Research: "Targeted Therapy for non-small cell lung cancer: current standards and the promise of the future."<br>National Cancer Institute: "What types of targeted therapies are available?"/delivery/aws/08/76/0876138b-ddb9-385f-981b-9b87c9911e79/091e9c5e81e33cb8_funded-medical-animation-how-targeted-therapy-works-nsclc_,4500k,2500k,1000k,750k,400k,.mp402/04/2020 12:00:0018001200photo of lung cancer targeted therapy/webmd/consumer_assets/site_images/article_thumbnails/video/targeted_therapy_how_it_works_lung_cancer_video/1800x1200_targeted_therapy_how_it_works_lung_cancer_video.jpg091e9c5e81e33cb8
WebMD Medical Reference



American Cancer Society: “How is non-small cell lung cancer staged?” “Surgery for non-small cell lung cancer,” “Treatment choices by stage for non-small cell lung cancer,” “Radiation therapy for non-small cell lung cancer,” “Targeted Therapies for non-small cell lung cancer,” “Non-Small Cell Lung Cancer Stages.” "Immunotherapy for Non-Small Cell Lung Cancer."

The Society of Thoracic Surgeons: “Lung/Thoracic Surgery.”

Penn Medicine: “Photodynamic Therapy (PDT).”

Journal of Thoracic Disease: “Adjuvant or neoadjuvant chemotherapy for NSCLC.”

UpToDate: “Patient Information: Non-small cell lung cancer treatment; Stage I to III cancer (Beyond the Basics)."

National Cancer Institute: “General Information About Non-Small Cell Lung Cancer (NSCLC),” "Biologic Therapies for Cancer."

Annals of Thoracic Medicine: “Bronchial Stents.”

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