There are many types of treatment for non-small cell lung cancer. The choice usually depends on how advanced the cancer is. Some people have only one treatment, but most people receive a combination.
This article outlines the standard types of treatment for NSCLC, how they work, and what to expect. It also lists treatments according to stages of the disease.
Surgery is usually only an option for people who have NSCLC at stages 1, 2, and occasionally 3. People must also be healthy enough to undergo surgery and have a good chance of recovering well.
There are four types of surgery that can help treat NSCLC:
- Wedge resection: Surgeons remove the tumor and some of the tissue surrounding it.
- Lobectomy: Surgeons remove a whole lobe of the lung.
- Pneumonectomy: Surgeons remove one lung.
- Sleeve resection: Surgeons move part of the bronchus, the airway that connects the windpipe to the lungs.
Doctors may recommend more extensive surgery for people with healthier lungs. This is because there is a better chance of fully recovering and curing the cancer completely.
Sometimes, doctors use robotic systems to assist them during surgery.
What to expect
Before surgery, a person has an appointment to check that they are well enough. This might involve:
When a person wakes up from surgery, they may have one or more tubes coming from their chest and linking to a container. This is so that excess fluid and air can exit the body.
A person can expect to stay in the hospital for 5–7 days after surgery. The timing depends on the surgery and how recovery goes.
Afterward, a person may receive radiation therapy or chemotherapy to kill off any remaining cancer cells. This extra, preventive treatment is called adjuvant therapy.
Radiation therapy, or radiotherapy, involves using high-energy radiation beams to kill cancer cells or shrink tumors.
It destroys cancer cells and healthy cells directly in the path of the radiation beam. Because of the damage to healthy cells, radiation therapy cannot be used to treat widespread cancer.
If a person does not want or cannot have surgery, doctors may recommend radiation therapy.
This approach can be especially effective in the earlier stages of the disease, and it can lead to a 3-year survival rate of
What to expect
The duration of radiation therapy depends on a person’s physical fitness. A person can usually expect to have several sessions of radiation therapy over
During these sessions, a doctor uses an immobilization device to help the person stay still and more precisely locate and target the cancer.
Radiation therapy for lung cancer can cause side effects, including:
- loss of appetite
- a sore throat
- difficulty swallowing
- skin irritation
- a cough
- a fever
- shortness of breath
Chemotherapy involves treatment with cancer-killing medicine. People receive this intravenously, as a drip or injection, or orally, as capsules or tablets.
Not everyone with NSCLC needs chemotherapy. People who do may receive it in the following situations:
- before surgery, to shrink a tumor and improve the likelihood of a successful procedure
- after surgery, to prevent cancer from returning
- when surgery is not possible, to relieve symptoms and slow the spread of cancer
- in combination with radiation therapy, to improve its effectiveness
What to expect
A person may receive chemotherapy as an injection, which lasts a few minutes, or as an infusion, which takes longer.
Common side effects of chemotherapy include:
These side effects gradually pass after the treatment. In the meantime, doctors can prescribe other medicines to reduce them.
Targeted therapy is a type of biological therapy. It involves using specific drugs to target specific cancer cells or tissue that helps cancer grow.
To find the right targeted therapy, a doctor orders tests that reveal the genes, proteins, and other factors involved in a person’s cancer. This is called biomarker testing.
Once the doctor has the results, they can select the drug combinations that are most likely to destroy the cancerous cells.
What to expect
Not everyone is eligible for targeted therapies. The Food and Drug Administration (FDA) has only approved the treatment for people with certain gene abnormalities.
An eligible person will receive these therapies intravenously or orally.
Targeted therapies can have different side effects depending on the type of drugs involved. Some common side effects include:
- liver conditions, such as hepatitis
- skin, nail, and hair changes
- problems with blood clotting
- high blood pressure
Immunotherapy is another type of biological therapy. It uses the body’s immune system to fight cancer. Substances made in the body or in a laboratory from living organisms can help boost the body’s natural defenses and kill cancer cells.
Immunotherapy is a relatively new treatment, and many clinical trials are underway in an effort to find the best way to use it. According to one 2020 report, there are increasingly promising results from numerous studies using immunotherapy to treat NSCLC.
What to expect
A person may have immunotherapy in combination with chemotherapy or other targeted drugs. The treatment can be intravenous or oral, and it can take place over days, weeks, or months, depending on the unique properties of the person’s cancer.
A person may experience the following side effects:
There are also other, less common treatment options for people with NSCLC. They include:
- Cryotherapy: Doctors freeze abnormal tissue using an endoscope.
- Laser therapy: Doctors use lasers to destroy cancer cells.
- Photodynamic therapy: A person receives a drug via an injection that helps doctors locate cancerous cells more easily. The doctors then use a laser to destroy these cells.
- Electrocautery: A doctor uses a heated needle or probe to destroy cancer cells.
The following table shows the treatment options available for people with NSCLC at different stages.
|0||The cancer only affects the lining layer of the airways, not the lung tissue or other areas.||The cancer is curable with surgery. Usually, people do not require chemotherapy or radiotherapy.|
|1||The tumor is smaller than 4 centimeters (cm) and has not spread to the lymph nodes.||People usually only require surgery. Surgeons may remove lung tissue to check for spreading during the operation.|
|2||The tumor is smaller than 5 cm. It may have spread to the lymph nodes or may affect other tissue, such as the chest wall, outer heart tissue, or the main bronchus.||Those eligible can have surgery. This may involve removing a whole lung. Surgeons remove any cancerous lymph nodes or other tissue then or in a further operation. |
Doctors may recommend chemotherapy or radiation therapy to destroy any remaining cancer cells.
|3A||The tumor is smaller than 7 cm. The cancer may have spread to the bronchus, innermost lung membrane, chest wall, heart tissue, diaphragm nerves, carina, trachea, esophagus, breastbone, backbone, larynx, or the vena cava or aorta.||Treatment may include a combination of radiation therapy, chemotherapy, and surgery. It usually begins with chemotherapy, sometimes alongside radiation therapy.|
The doctor may then recommend surgery, then more chemotherapy or radiation therapy.
|3B||The tumor can be any size. The cancer may have spread to the lymph nodes near the neck or lungs. It may also have spread to the same places as in stage 3A.||Surgery cannot completely remove the cancer at this stage. People may require chemotherapy or radiation therapy, and they may need to take an immunotherapy drug for up to 1 year.|
People not eligible for this treatment method may have chemotherapy, radiation therapy, or immunotherapy alone.
|4A||The tumor has already spread to one other area before the diagnosis. It may now affect the other lung, the heart or lung linings or fluid, another organ, such as the brain, the liver, an adrenal gland or lymph node, a kidney, or a bone.||Surgery or radiation therapy in the area of spread may cure the disease. Treatment of the lung tumor may then include a combination of surgery, chemotherapy, and radiation therapy.|
|4B||The cancer has spread to one or more organs that are farther from the lung, such as the brain, an adrenal gland, a kidney, the liver, a far away lymph node, or a bone.||A person may undergo biomarker testing and receive targeted therapy or immunotherapy. If the person is healthy enough, they may receive chemotherapy.|
Further treatment may involve reducing symptoms, for example with laser therapy, photodynamic therapy, or stent placement.
|Progressing or |
|The cancer continues to grow, or progress, during treatment. It may also come back, or recur.||Treatment varies according to the size and location of the tumor. It also depends on previous treatments and the person’s health. |
If cancer progresses during the first treatment, the person may receive radiation therapy or chemotherapy.
Targeted therapy may help if chemotherapy does not work, and immunotherapy may help treat certain types of NSCLC.
The treatment plan for recurring cancer may include a combination of any of the above treatments, depending on the location and size of the tumor.
There is a growing number of treatments for NSCLC, including surgery, chemotherapy, radiation therapy, immunotherapy, and targeted therapies.
The best approach depends on the nature of a person’s cancer, its stage, the size of the tumor, and the person’s general health. Specialists called oncologists take into account these factors and the desires and goals of the person before recommending a course of treatment.