Advanced non-small cell lung cancer (NSCLC) is when cancer cells from the original tumor spread to other organs or lymph nodes in a person’s body. Doctors also call it stage 4 cancer.

The American Cancer Society (ACS) explains that doctors usually use the American Joint Committee on Cancer’s TNM system to work out at what stage a person’s cancer is.

The TNM system looks at three key features — the size of the original tumor (T), whether it has spread into the person’s lymph nodes (N), and whether it has metastasized (M), or spread, into other organs.

With non-small cell lung cancer, advanced cancer can also mean it has spread into the other lung.

This article explains what advanced non-small cell lung cancer is and looks into its treatment options. It also explores the symptoms to look out for and discusses a person’s outlook.

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According to the Centers for Disease Control and Prevention (CDC), NSCLC is the more common type of lung cancer.

The ACS explains that there are three main types:

The ACS adds that it groups them together as they share similar treatments and outlooks. However, there are some differences.

Adenocarcinomas tend to grow in the outer edges of a person’s lungs, and doctors are more likely to find them before they spread to other organs.

Large cell carcinomas, on the other hand, grow and spread quickly, which can make them difficult to treat.

Advanced cancers are harder to treat, as they are more likely to have spread before a doctor can diagnose a person. The ACS notes that the 5-year survival rate for people with advanced NSCLC is just 9%.

This means a person has a 9% chance of living for 5 years compared to those without NSCLC. However, it is important to remember that these figures are estimates. A person can consult a healthcare professional about how their condition is going to affect them.

Is it curable?

The ACS admits that advanced NSCLC is very hard to cure. Treatments aim to improve a person’s quality of life and may help them live longer.

Doctors tailor treatment plans for each individual, considering the person’s overall health, where the cancer has spread, and what symptoms they are experiencing.

Many people with NSCLC do not experience symptoms until their cancer advances. According to the CDC, symptoms include:

  • a persistent cough that does not get better
  • coughing up blood
  • chest pain
  • shortness of breath
  • general fatigue
  • wheezing
  • hoarseness
  • unexplained weight loss
  • recurring infections, such as pneumonia or bronchitis

Other symptoms depend on where the person’s cancer has spread. Approximately 20% of people with NSCLC have metastatic bone cancer by the time a doctor diagnoses them, when they may be experiencing bone pain.

A person may have headaches or experience changes in their personality if the cancer has spread to their brain.

Doctors take many factors into account before deciding on the best treatment options.

The National Cancer Institute (NCI) explains that doctors may recommend different combinations of chemotherapy medications for the different types of NSCLC and where it has spread.

Some people may be able to have surgery to remove some, or all, of the tumors that have spread, or to reduce the size of the original tumor.

Doctors may also recommend targeted therapy, which is a treatment that interferes with cancer proteins and changes how the cells divide and spread, or immunotherapy. Immunotherapy treatments boost a person’s own immune response.

If the person’s airways are blocked, doctors may recommend laser therapy to remove the obstruction or internal radiation therapy.

If a person’s NSCLC has spread to their brain, doctors may suggest surgery, followed by radiation therapy. They may suggest precision radiation therapy, called stereotactic radiation, or target the whole brain.

Doctors may also recommend radiation therapy to reduce other symptoms that are limiting the person’s quality of life.

Doctors use different tests to see if a person has cancer, but they can only diagnose NSCLC by looking at the cells under a microscope.

The ACS explains that if a doctor suspects a person has lung cancer during a physical exam, they usually recommend additional imaging tests to show the location of any tumors. These include:

If doctors find a suspicious mass, they may perform a biopsy, during which they collect a small sample of the tissue and send it to a laboratory for microscopic review.

They may also collect samples of any mucus the person coughs up. These sputum samples help them identify cancers that start in a person’s airways, such as squamous cell carcinomas, but may not reveal other types of NSCLC.

The ACS adds that doctors often recommend molecular tests that look for specific gene changes in a person’s NSCLC. The genetic changes help them select the best, targeted therapy to treat that particular cancer.

Doctors can also direct people to support networks that may be able to help both financially and emotionally.

National organizations, such as the American Lung Association and the ACS, host online support communities, where people can share experiences and find practical help.

The ACS also highlights organizations that can help with financial matters, such as covering transportation costs to appointments or to short-term housing for longer cancer treatments.

Many local branches of national charities run local support groups and have in-person meetings.

Advanced non-small cell lung cancer is when the original cancer spreads from the lungs to other parts of a person’s body. Many people do not know they have lung cancer until they are at this stage.

Although doctors may not be able to cure these cancers, they can help relieve a person’s symptoms, prolong their life, and improve their quality of life.