non-small cell lung cancer treatment (pdq®) - national cancer institute

8/12/2019 Non-Small Cell Lung Cancer Treatment (PDQ) - National Cancer Institute

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National Cancer Institute at the National Institutes of Health

Table of Contents

General Information About Non-Small Cell Lung Cancer

Stages of Non-Small Cell Lung Cancer

Recurrent Non-Small Cell Lung Cancer

Treatment Option Overview

Treatment Options by Stage

Occult Non-Small Cell Lung Cancer

Stage 0 (Carcinoma in Situ)Stage I Non-Small Cell Lung Cancer

Stage II Non-Small Cell Lung Cancer

Stage IIIA Non-Small Cell Lung Cancer

Stage IIIB Non-Small Cell Lung Cancer

Stage IV Non-Small Cell Lung Cancer

Treatment Options for Recurrent Non-Small Cell Lung Cancer

To Learn More About Non-Small Cell Lung Cancer

Changes to This Summary (10/18/2013)

About This PDQ Summary

About PDQ

Purpose of This Summary

Reviewers and Updates

Clinical T rial Information

Permission to Use This Summary

Disclaimer

Contact Us

Last Modified: 10/18/2013

Non-Small Cell Lung Cancer Treatment (PDQ)

Patient Version
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Get More Information From NCI

General Information About Non-Small Cell Lung Cancer

Key Points for This Section

Non-small cell lung cancer is a disease in which malignant (cancer) cells form in the tissues of

the lung.

There are several ty pes of non-small cell lung cancer.

Smoking increases the risk of non-small cell lung cancer.

Possible signs of non-small cell lung cancer include a cough that doesn't go away and

shortness of breath.

Tests that examine the lungs are used to detect (find), diagnose, and stage non-small cell lung

cancer.

Certain factors affect prognosis (chance of recovery) and treatment options.

For most patients with non-small cell lung cancer, current treatments do not cure the cancer.

Non-small cell lung cancer is a disease in which malignant (cancer) cells

form in the tissues of the lung.

The lungs are a pair of cone-shaped breathing organs in the chest. The lungs bring oxygen into the

body as you breathe in. They release carbon dioxide, a waste product of the bodys cells, as you

breathe out. Each lung has sections called lobes. T he left lung has two lobes. The right lung is slightly

larger and has three lobes. T wo tubes called bronchi lead from the trachea (windpipe) to the right and

left lungs. The bronchi are sometimes also involved in lung cancer. T iny air sacs called alveoli and

small tubes called bronchioles make up the inside of the lungs.
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Ana tom y of th e respir ator y sy stem , sh owing t he trach ea and both lu ngs a nd their lobes a nd airway s.Lym ph nodes and the diaphra gm are also shown. Oxy gen is inhaled into the lungs and passes through th ethin m embr anes of the alv eoli and int o the bloodstrea m (see inset).

A thin membrane called the pleura covers the outside of each lung and lines the inside wall of the chest

cavity. T his creates a sac called the pleural cavity . The pleural cavity normally contains a small

amount of fluid that helps the lungs move smoothly in the chest when you breathe.

There are two main types of lung cancer: non-small cell lung cancer and small cell lung cancer.

See the following PDQ summaries for more information about lung cancer:
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another condition. Symptoms may be caused by lung cancer or by other conditions. Check with your

doctor if y ou have any of the following problems:

Chest discomfort or pain.

A cough that doesnt go away or gets worse over time.

Trouble breathing.

Wheezing.

Blood in sputum (mucus coughed up from the lungs).Hoarseness.

Loss of appetite.

Weight loss for no known reason.

Feeling very tired.

Trouble swallowing.

Swelling in the face and/or veins in the neck.

Tests that examine the lungs are used to detect (find), diagnose, and stage

non-small cell lung cancer.

Tests and procedures to detect, diagnose, and stage non-small cell lung cancer are often done at the

same time. Some of the following tests and procedures may be used:

Physical exam and history: An exam of the body to check general signs of health, including

checking for signs of disease, such as lumps or anything else that seems unusual. A history of the

patients health habits, including smoking, and past jobs, illnesses, and treatments will also be

taken.

Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or othersubstances in the body. These tests help to diagnose disease, plan and check treatment, or

monitor the disease over time.

Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy

beam that can go through the body and onto film, making a picture of areas inside the body.
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X-ra y of the chest. X-ray s are u sed to take pictu res of org ans an d bones ofthe ch est. X-ray s pass through the patient onto film.

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the

body, such as the chest, taken from different angles. The pictures are made by a computer

linked to an x-ray machine. A dye may be injected into a v ein or swallowed to help the organs or

tissues show up more clearly. This procedure is also called computed tomography,

computerized tomography, or computerized axial tomography.

Sputum cytology: A procedure in which a pathologist views a sample of sputum (mucus

coughed up from the lungs) under a microscope, to check for cancer cells.

Fine-needle aspiration (FNA) biopsy of the lung: The removal of tissue or fluid from thelung using a thin needle. A CT scan, ultrasound, or other imaging procedure is used to locate the

abnormal tissue or fluid in the lung. A small incision may be made in the skin where the biopsy

needle is inserted into the abnormal tissue or fluid. A sample is removed with the needle and sent
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to the laboratory. A pathologist then views the sample under a microscope to look for cancer

cells. A chest x-ray is done after the procedure to make sure no air is leaking from the lung into

the chest.

Fine-Needle Aspirat ion Biopsy of the Lung . The patient lies on a table t ha tslides through t he computed tomography (CT) mach ine, which takes x-raypictur es of the in side of the body . Th e x-ray pictur es help the doctor see

where the abnorm al tissue is in t he lu ng. A biopsy needle is insertedthr ough the chest wall an d into the ar ea of abnorm al lung tissue. A smallpiece of tissue is rem oved thr ough t he needle and checked un der themicroscope for signs of cancer.

Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for

abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and

lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may

also have a tool to remove tissue samples, which are checked under a microscope for signs of

cancer.
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Bronchoscopy. A bronchoscope is inserted through the mouth, trachea, andm ajor bronchi in to the lun g, t o look for a bnorma l ar eas. A bronchoscope is athin, tu be-like instrum ent with a ligh t and a lens for v iewing. It m ay alsohav e a cut ting tool. Tissue samples ma y be taken to be checked under am icr oscope for signs of disease.

Thoracoscopy: A surgical procedure to look at the organs inside the chest to check for

abnormal areas. An incision (cut) is made between two ribs, and a thoracoscope is inserted into

the chest. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. It

may also have a tool to remove tissue or lymph node samples, which are checked under a

microscope for signs of cancer. In some cases, this procedure is used to remove part of the

esophagus or lung. If certain tissues, organs, or lymph nodes cant be reached, a thoracotomy

may be done. In this procedure, a larger incision is made between the ribs and the chest is

opened.

Thoracentesis: The removal of fluid from the space between the lining of the chest and the

lung, using a needle. A pathologist views the fluid under a microscope to look for cancer cells.

Light and electron microscopy: A laboratory test in which cells in a sample of tissue are

viewed under regular and high-powered microscopes to look for certain changes in the cells.
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Immunohistochemistry study: A laboratory test in which a substance such as an antibody,

dye, or radioisotope is added to a sample of cancer tissue to test for certain antigens. This type

of study is used to tell the difference between different types of cancer.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

The stage of the cancer (the size of the tumor and whether it is in the lung only or has spread to

other places in the body).

The type of lung cancer.

Whether there are symptoms such as coughing or trouble breathing.

The patients general health.

For most patients with non-small cell lung cancer, current treatments do not

cure the cancer.

If lung cancer is found, taking part in one of the many clinical trials being done to improve treatmentshould be considered. Clinical trials are taking place in most parts of the country for patients with all

stages of non-small cell lung cancer. Information about ongoing clinical trials is available from the NCI

Web site.

Stages of Non-Small Cell Lung Cancer

Key Points for This Section

After lung cancer has been diagnosed, tests are done to find out if cancer cells have spread

within the lungs or to other parts of the body.

There are three ways that cancer spreads in the body.

Cancer may spread from where it began to other parts of the body.

The following stages are used for non-small cell lung cancer:

Occult (hidden) stage

Stage 0 (carcinoma in situ)

Stage IStage II

Stage IIIA

Stage IIIB

Stage IV

After lung cancer has been diagnosed, tests are done to find out if cancercells have spread within the lungs or to other parts of the body.

The process used to find out if cancer has spread within the lungs or to other parts of the body is called
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staging. The information gathered from the staging process determines the stage of the disease. It is

important to know the stage in order to plan treatment. Some of the tests used to diagnose non-small

cell lung cancer are also used to stage the disease. (See the General Information section.) Other tests

and procedures that may be used in the staging process include the following:

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a

computer to make a series of detailed pictures of areas inside the body, such as the brain. This

procedure is also called nuclear magnetic resonance imaging (NMRI).

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the

body, such as the brain and abdomen, taken from different angles. The pictures are made by a

computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the

organs or tissues show up more clearly. T his procedure is also called computed tomography,

computerized tomography, or computerized axial tomography.

PET scan (positron emission tomography scan): A procedure to find malignant tumor

cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET

scanner rotates around the body and makes a picture of where glucose is being used in the body.

Malignant tumor cells show up brighter in the picture because they are more active and take up

more glucose than normal cells do.

PET (positron emission tomogra phy ) scan. The patien t lies on a t able tha tslides through t he PET m achine. Th e head rest an d white strap help thepatient lie still. A small a m oun t of ra dioactiv e glucose (sug ar ) is injectedinto the patient's v ein, and a scanner ma kes a picture of where the glu coseis being u sed in the body . Cancer cells show up brigh ter in th e pictu re

because they ta ke u p m ore glucose than n orm al cells do.

Radionuclide bone scan: A procedure to check if there are rapidly dividing cells, such as

cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and

travels through the bloodstream. The radioactive material collects in the bones and is detected

by a scanner.
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Pulmonary function test (PFT): A test to see how well the lungs are working. It measures

how much air the lungs can hold and how quickly air moves into and out of the lungs. It also

measures how much oxygen is used and how much carbon dioxide is given off during breathing.

This is also called lung function test.

Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the

body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at

the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internaltissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.

This procedure is also called endosonography. EUS may be used to guide fine needle aspiration

(FNA) biopsy of the lung, lymph nodes, or other areas.

Endoscopic ultr asound-guided fine-needle aspirat ion biopsy. An endoscopethat has an ult ra soun d probe and a biopsy needle is inserted thr ough th em out h and in to the esophag us. Th e probe boun ces soun d wa v es off bodytissues to make echoes that form a sonogr am (computer pictu re) of thely m ph nodes near the esophag us. The sonogram helps the doctor see wh ereto place the biopsy needle to remov e tissue from th e ly m ph nodes. Thistissue is checked under a m icroscope for sign s of cancer .

Mediastinoscopy: A surgical procedure to look at the organs, tissues, and lymph nodes

between the lungs for abnormal areas. An incision (cut) is made at the top of the breastbone and

a mediastinoscope is inserted into the chest. A mediastinoscope is a thin, tube-like instrument

with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node

samples, which are checked under a microscope for signs of cancer.
http://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=750109&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=638184&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=514453&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=549425&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46353&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=44636&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45570&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46287&version=Patient&language=Englishhttp://www.cancer.gov/PublishedContent/MediaLinks/713154.htmlhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45762&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45691&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46587&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46157&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=572035&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46428&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46602&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=538147&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=538149&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=658018&version=Patient&language=English


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Mediastinoscopy . A m ediastinoscope is inserted int o the chest th rough anincision a bov e the breastbone to look for abnorma l ar eas betw een the lu ngs.

A m edia stinoscope is a t hin , t ube-like inst rument wit h a ligh t an d a len s forv iew in g. It m ay al so hav e a cu tt ing tool. Tissue sam ples m ay be tak en fromly m ph nodes on th e righ t side of the chest an d checked under a m icroscopefor signs of cancer. In an anterior m ediastinotomy (Chamberlainprocedure), t he in cision is m ade beside the breastbone to remov e tissuesamples from the ly m ph nodes on t he left side of the ch est.

Anterior mediastinotomy: A surgical procedure to look at the organs and tissues between

the lungs and between the breastbone and heart for abnormal areas. An incision (cut) is made

next to the breastbone and a mediastinoscope is inserted into the chest. A mediastinoscope is a

thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove

tissue or lymph node samples, which are checked under a microscope for signs of cancer. T his is

also called the Chamberlain procedure.

Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the

tissue under a microscope to look for cancer cells.

Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small

piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views

the bone marrow, blood, and bone under a microscope to look for signs of cancer.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

Tissue. T he cancer spreads from where it began by growing into nearby areas.

Lymph system. The cancer spreads from where it began by getting into the lymph system. The

cancer travels through the lymph vessels to other parts of the body.

Blood. The cancer spreads from where it began by getting into the blood. The cancer travelsthrough the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.
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When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from

where they began (the primary tumor) and travel through the lymph system or blood.

Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and

forms a tumor (metastatic tumor) in another part of the body.

Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor

(metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if non-small cell

lung cancer spreads to the brain, the cancer cells in the brain are actually lung cancer cells. The disease

is metastatic lung cancer, not brain cancer.

The following stages are used for non-small cell lung cancer:

Occult (hidden) stage

In the occult (hidden) stage, cancer cannot be seen by imaging or bronchoscopy. Cancer cells are

found in sputum (mucus coughed up from the lungs) or bronchial washing (a sample of cells taken frominside the airways that lead to the lung). Cancer may have spread to other parts of the body.

Stage 0 (carcinoma in situ)

In stage 0, abnormal cells are found in the lining of the airways. These abnormal cells may become

cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I
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Stag e I non-small cell lu ng ca ncer. In stage IA, ca ncer is in th e lung only and is 3 cm or sma ller. In stag e IB,the cancer is (a) larger th an 3 cm but not larger tha n 5 cm , (b) has spread to the m ain bronchus, and/or (c)has spread to the innerm ost lay er of the lun g lining. Part of the lung ma y hav e collapsed or becomeinflamed (not shown).

In stage I, cancer has formed. Stage I is divided into stages IA and IB:

Stage IA: The tumor is in the lung only and is 3 centimeters or smaller.

Stage IB: Cancer has not spread to the ly mph nodes and one or more of the following is true:

The tumor is larger than 3 centimeters but not larger than 5 centimeters.

Cancer has spread to the main bronchus and is at least 2 centimeters below where the

trachea joins the bronchus.

Cancer has spread to the innermost layer of the membrane that cov ers the lung.

Part of the lung has collapsed or developed pneumonitis (inflammation of the lung) in the

area where the trachea joins the bronchus.

Stage II

Stage II is divided into stages IIA and IIB. Stage IIA and IIB are each divided into two sections

depending on the size of the tumor, where the tumor is found, and whether there is cancer in the lymph

nodes.

Stage IIA:

Stage IIA n on-sm all cell lu ng ca ncer. Cancer has spread to certa in ly mph nodes on th e same side of

the chest as the primar y tum or; the cancer is (a) 5 cm or smaller, (b) ha s spread to the m ainbronchus, a nd/or (c) h as spr ead to the in nerm ost la y er of th e lu ng l in in g. OR, can cer has not spreadto ly mph n odes; the cancer is (d) larger th an 5 cm but not larger tha n 7 cm, (e) has spread to thema in bronchus, and/or (f) has spread to the innerm ost lay er of the lun g lining. Part of the lung ma yha v e collapsed or become inflam ed (not shown).
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(1) Cancer has spread to lymph nodes on the same side of the chest as the tumor. The lymph

nodes with cancer are within the lung or near the bronchus. Also, one or more of the following is

true:

The tumor is not larger than 5 centimeters.



Cancer has spread to the innermost layer of the membrane that cov ers the lung.Part of the lung has collapsed or developed pneumonitis (inflammation of the lung) in the


or

(2) Cancer has not spread to lymph nodes and one or more of the following is true:







Stage IIB:

Stage IIB non-small cell lu ng ca ncer. Cancer h as spread to certain ly mph nodes on th e same side of

the chest as the primar y tumor; the cancer is (a) larger tha n 5 cm but not larger tha n 7 cm, (b) hasspread to the m ain bronchu s, and/or (c) has spread to the inn ermost la y er of the lung lining. Part ofthe lun g m ay hav e collapsed or become inflam ed (not shown). OR, (d) the cancer is larger th an 7cm; (e) has spread to the ma in bronchus, (f) the diaphra gm , (g) t he chest wall or th e lining of thechest wa ll; and/or (h) has spread to the m embrane ar ound the h eart. Th ere may be one or m oreseparate tum ors in the same lobe of the lung; cancer m ay hav e spread to the nerv e that controls the
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diaphra gm ; the wh ole lung ma y hav e collapsed or become inflam ed (not shown).

(1) Cancer has spread to nearby lymph nodes on the same side of the chest as the tumor. T he

lymph nodes with cancer are within the lung or near the bronchus. Also, one or more of the

following is true:


Cancer has spread to the main bronchus and is at least 2 centimeters below where thetrachea joins the bronchus.




or

(2) Cancer has not spread to lymph nodes and one or more of the following is true:

The tumor is larger than 7 centimeters.Cancer has spread to the main bronchus (and is less than 2 centimeters below where the

trachea joins the bronchus), the chest wall, the diaphragm, or the nerve that controls the

diaphragm.

Cancer has spread to the membrane around the heart or lining the chest wall.

The whole lung has collapsed or developed pneumonitis (inflammation of the lung).

There are one or more separate tumors in the same lobe of the lung.

Stage IIIA

Stage IIIA is divided into three sections depending on the size of the tumor, where the tumor is found,

and which lymph nodes have cancer (if any).
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Stag e IIIA non-small cell lun g can cer (1 ). Cancer h as spread to certa in ly m phnodes on the same side of the chest as the primar y tum or. The cancer m ay hav espread to (a) the m ain bronchus; (b) lung lining, ch est w all lining, or ch est w all;(c) diaphragm ; and/or (d) membran e around the heart; and/or (e) there ma y beone or m ore separate tum ors in the same lobe of the lung. Cancer m ay hav espread to the nerv e that contr ols the diaphragm , and part or all of the lun g m ayha v e collapsed or becom e inflam ed (not shown).

(1) Cancer has spread to lymph nodes on the same side of the chest as the tumor. The lymph nodes with

cancer are near the sternum (chest bone) or where the bronchus enters the lung. Also:

The tumor may be any size.

Part of the lung (where the trachea joins the bronchus) or the whole lung may have collapsed or

developed pneumonitis (inflammation of the lung).

There may be one or more separate tumors in the same lobe of the lung.

Cancer may have spread to any of the following:

Main bronchus, but not the area where the trachea joins the bronchus.

Chest wall.

Diaphragm and the nerve that controls it.Membrane around the lung or lining the chest wall.

Membrane around the heart.

or
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Stag e IIIA lun g can cer (2). Can cer ha s spread to certa in ly m ph nodes on the sam eside of the chest as the primar y tum or. The cancer m ay hav e spread to (a) thema in bronchus; (b) the lung lining, ch est wa ll lining, or chest w all; (c)diaphra gm ; (d) heart and/or m embrane a round the it; (e) m ajor blood v esselsthat lead to or from t he h eart; (f) tra chea; (g) esophagus; (h) sternum ; and/or (i)carina; a nd/or (j) t here m ay be one or m ore separate tu mors in any lobe of thesame lung. Cancer m ay hav e spread to the nerv es that control the diaphragmand lary nx, a nd the wh ole lung m ay hav e collapsed or become inflamed (notshown).

(2) Cancer has spread to ly mph nodes on the same side of the chest as the tumor. The lymph nodes with

cancer are within the lung or near the bronchus. Also:


The whole lung may have collapsed or developed pneumonitis (inflammation of the lung).

There may be one or more separate tumors in any of the lobes of the lung with cancer.


Main bronchus, but not the area where the trachea joins the bronchus.

Chest wall.Diaphragm and the nerve that controls it.

Membrane around the lung or lining the chest wall.

Heart or the membrane around it.
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Major blood vessels that lead to or from the heart.

Trachea.

Esophagus.

Nerve that controls the larynx (voice box).

Sternum (chest bone) or backbone.

Carina (where the trachea joins the bronchi).

or

Stag e IIIA non-sma ll cell lung cancer (3 ). Cancer h as spread to (a) th e heart ; (b)m ajor blood v essels that lead to or from t he heart ; (c) tra chea; (d) esophag us; (e)sternu m; and/or (f) carina. Cancer m ay hav e spread to the nerv e that controlsthe lary nx (not shown).

(3) Cancer has not spread to the lymph nodes and the tumor may be any size. Cancer has spread to any

of the following:

Heart.Major blood vessels that lead to or from the heart.

Trachea.

Esophagus.
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Stage IIIB

Stage IIIB is divided into two sections depending on the size of the tumor, where the tumor is found,

and which lymph nodes have cancer.

Stag e IIIB non-sma ll cell lung cancer (1 ). Cancer h as spread to ly mph n odesabove t he collarbone or on the opposite side of the chest as th e prima ry tu mor.The cancer m ay hav e spread to (a) the main bronchus; (b) lung lining , chest

wal l l in in g, or chest wal l; (c) dia phrag m; (d) heart or th e m em bran e aroun d it ;(e) ma jor blood v essels that lead to or from t he heart ; (f) trach ea; (g) esophag us;(h) sternum ; and/or (i) car ina; and/or (j) t here m ay be one or m ore separat etum ors in an y of the lobes of the lung . Part or all of the lung ma y hav e collapsedor become inflam ed and cancer m ay hav e spread to the backbone and/or t henerv es that control the diaphragm and lary nx (not shown).

(1) Cancer has spread to lymph nodes above the collarbone or to lymph nodes on the opposite side of

the chest as the tumor. Also:

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Part of the lung (where the trachea joins the bronchus) or the whole lung may have collapsed or

developed pneumonitis (inflammation of the lung).

There may be one or more separate tumors in any of the lobes of the lung with cancer.


Main bronchus.

Chest wall.

Diaphragm and the nerve that controls it.Membrane around the lung or lining the chest wall.

Heart or the membrane around it.


Trachea.

Esophagus.




or

Stag e IIIB non-sma ll cell lung can cer (2). Can cer ha s spread to certa in ly m phnodes on the same side of the chest as the prim ar y tum or and to (a) th e hear t; (b)m ajor blood v essels that lead to or from t he heart ; (c) tra chea; (d) esophag us; (e)
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sternu m; a nd/or (f) carina ; and/or (g) there m ay be separat e tum ors in differentlobes of the sam e lung. Cancer m ay hav e spread to the backbone and/or t henerv e that controls the lary nx (not shown).

(2) Cancer has spread to ly mph nodes on the same side of the chest as the tumor. The lymph nodes with

cancer are near the sternum (chest bone) or where the bronchus enters the lung. Also:


There may be separate tumors in different lobes of the same lung.

Cancer has spread to any of the following:

Heart.


Trachea.

Esophagus.




Stage IV

Stage IV n on-sma ll cell lung cancer. Th e cancer h as spread to the other lun g,and/or to lym ph nodes, fluid ar oun d the lun gs or heart , an d/or other places inthe body, such as the brain , liv er, adrenal gla nds, kidneys, or bones.

In stage IV, the tumor may be any size and cancer may have spread to lymph nodes. One or more of the
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information on new treatments for patients with cancer. When clinical trials show that a new treatment

is better than the standard treatment, the new treatment may become the standard treatment. Patients

may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who

have not started treatment.

Nine types of standard treatment are used:

Surgery

Four types of surgery are used to treat lung cancer:

Wedge resection: Surgery to remove a tumor and some of the normal tissue around it. When a

slightly larger amount of tissue is taken, it is called a segmental resection.

Wedg e resect ion of th e lu ng . Part of the lu ng lobe containing t he ca ncer anda small am ount of healthy tissue around it is removed.

Lobectomy: Surgery to remove a whole lobe (section) of the lung.
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Lobectom y . A lobe of the lu ng is rem ov ed.

Pneumonectomy: Surgery to remove one whole lung.

Pneum onectomy . The wh ole lung is remov ed.

Sleeve resection: Surgery to remove part of the bronchus.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may

be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left.

Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant

therapy.

Radiation therapy
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Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill

cancer cells or keep them from growing. There are two types of radiation therapy. External radiation

therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation

therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed

directly into or near the cancer.

Radiosurgery is a method of delivering radiation directly to the tumor with little damage to healthy

tissue. It does not involve surgery and may be used to treat certain tumors in patients who cannot havesurgery.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. It

also depends on where the cancer is found. For tumors in the airways, radiation is given directly to the

tumor through an endoscope.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing

the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a

vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body

(systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an

organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas

(regional chemotherapy). T he way the chemotherapy is given depends on the type and stage of the

cancer being treated.

See Drugs Approved for Non-Small Cell Lung Cancer for more information.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack

specific cancer cells without harming normal cells. Monoclonal antibodies and tyrosine kinase

inhibitors are two types of targeted therapy being used in the treatment of non-small cell lung cancer.

Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory from a

single type of immune system cell. T hese antibodies can identify substances on cancer cells or normal

substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer

cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion.

They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

Monoclonal antibodies used to treat non-small cell lung cancer include bevacizumab and cetuximab.

Bevacizumab binds to vascular endothelial growth factor (VEGF) and may prevent the growth of new

blood vessels that tumors need to grow. Cetuximab binds to epidermal growth factor receptor (EGFR)

and works to stop cancer cells from growing and dividing.

Tyrosine kinase inhibitors are targeted therapy drugs that block signals needed for tumors to grow.

Tyrosine kinase inhibitors may be used with other anticancer drugs as adjuvant therapy.

Tyrosine kinase inhibitors used to treat non-small cell lung cancer include erlotinib and gefitinib. They

are types of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors. Crizotinib is a type of

tyrosine kinase inhibitor that is used to treat non-small cell lung cancer with certain gene changes.
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See Drugs Approved for Non-Small Cell Lung Cancer for more information.

Laser therapy

Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill

cancer cells.

Photodynamic therapy (PDT)

Photodynamic therapy (PDT) is a cancer treatment that uses a drug and a certain type of laser light to

kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug

collects more in cancer cells than in normal cells. Fiberoptic tubes are then used to carry the laser light

to the cancer cells, where the drug becomes active and kills the cells. Photodynamic therapy causes

little damage to healthy tissue. It is used mainly to treat tumors on or just under the skin or in the lining

of internal organs. When the tumor is in the airways, PDT is given directly to the tumor through an

endoscope.

Cryosurgery

Cryosurgery is a treatment that uses an instrument to freeze and destroy abnormal tissue, such as

carcinoma in situ. This type of treatment is also called cry otherapy. For tumors in the airways,

cryosurgery is done through an endoscope.

Electrocautery

Electrocautery is a treatment that uses a probe or needle heated by an electric current to destroy

abnormal tissue. For tumors in the airways, electrocautery is done through an endoscope.

Watchful waiting

Watchful waiting is closely monitoring a patients condition without giving any treatment until

symptoms appear or change. T his may be done in certain rare cases of non-small cell lung cancer.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention

every new treatment being studied. Information about clinical trials is available from the NCI Web

site.

Chemoprevention

Chemoprevention is the use of drugs, vitamins, or other substances to reduce the risk of cancer or to

reduce the risk cancer will recur (come back).

New combinations

New combinations of treatments are being studied in clinical trials.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part

of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and
http://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45961&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45961&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46556&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=44744&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45487&version=Patient&language=Englishhttp://cancer.gov/clinicaltrialshttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45022&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=651193&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=454803&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45942&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46488&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46683&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=44636&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45985&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=476949&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45238&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45748&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45154&version=Patient&language=Englishhttp://www.cancer.gov/cancertopics/druginfo/lungcancer#dal1


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effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take

part in a clinical trial may receive the standard treatment or be among the first to receive a new

treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future.

Even when clinical trials do not lead to effective new treatments, they often answer importantquestions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer

treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test

treatments for patients whose cancer has not gotten better. T here are also clinical trials that test new

ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section thatfollows for links to current treatment clinical trials. These have been retrieved from NCI's listing of

clinical trials.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be

repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions

about whether to continue, change, or stop treatment may be based on the results of these tests. T his is

sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. T he results of

these tests can show if your condition has changed or if the cancer has recurred (come back). T hese

tests are sometimes called follow-up tests or check-ups.

Treatment Options by Stage

Occult Non-Small Cell Lung Cancer

Treatment of occult non-small cell lung cancer depends on the stage of the disease. Occult tumors are

often found at an early stage (the tumor is in the lung only) and sometimes can be cured by surgery.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with

occult non-small cell lung cancer. For more specific results, refine the search by using other search

features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your

doctor about clinical trials that may be right for you. General information about clinical trials isavailable from the NCI Web site.

Stage 0 (Carcinoma in Situ)
http://www.cancer.gov/clinicaltrialshttp://www.cancer.gov/Search/ClinicalTrialsLink.aspx?Diagnosis=41125&tt=1&format=1&cn=1http://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45570&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=318813&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=270740&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46634&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45885&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=363610&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=44671&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46556&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=651193&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45885&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46450&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=44267&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46580&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46556&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=44930&version=Patient&language=English


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Treatment of stage 0 may include the following:

Surgery (wedge resection or segmental resection).

Photodynamic therapy using an endoscope.

Electrocautery, cryosurgery, or laser surgery using an endoscope.


stage 0 non-small cell lung cancer. For more specific results, refine the search by using other searchfeatures, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your

doctor about clinical trials that may be right for you. General information about clinical trials is

available from the NCI Web site.

Stage I Non-Small Cell Lung Cancer

Treatment of stage I non-small cell lung cancer may include the following:

Surgery (wedge resection, segmental resection, sleeve resection, or lobectomy).

External radiation therapy (for patients who cannot have surgery or choose not to havesurgery).

A clinical trial of chemotherapy or radiation therapy following surgery .

A clinical trial of surgery followed by chemoprev ention.

A clinical trial of treatment given through an endoscope, such as photodynamic therapy (PDT).


stage I non-small cell lung cancer. For more specific results, refine the search by using other search


doctor about clinical trials that may be right for you. General information about clinical trials isavailable from the NCI Web site.

Stage II Non-Small Cell Lung Cancer

Treatment of stage II non-small cell lung cancer may include the following:

Surgery (wedge resection, segmental resection, sleeve resection, lobectomy, or

pneumonectomy).

Chemotherapy followed by surgery.

Surgery followed by chemotherapy.External radiation therapy (for patients who cannot have surgery or choose not to have

surgery).

A clinical trial of radiation therapy following surgery.


stage II non-small cell lung cancer. For more specific results, refine the search by using other search




Stage IIIA Non-Small Cell Lung Cancer

Treatment of stage IIIA non-small cell lung cancer that can be removed with surgery may include the
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Chemotherapy followed by external radiation therapy.

Chemotherapy and radiation therapy given as separate treatments over the same period of time.

Chemotherapy followed by surgery.

External radiation therapy alone for patients who cannot be treated with chemotherapy.

External or internal radiation therapy as palliative therapy, to relieve pain and other symptoms

and improve the quality of life.

Clinical trials of new radiation therapy schedules and new combinations of treatments.

For more information about supportive care for symptoms such as cough, shortness of breath, and

chest pain, see the following PDQ summaries:

Cardiopulmonary Syndromes

Pain


stage III non-small cell lung cancer. For more specific results, refine the search by using other search




Stage IV Non-Small Cell Lung Cancer

Treatment of stage IV non-small cell lung cancer may include the following:

Combination chemotherapy.

Maintenance therapy with an anticancer drug to help keep cancer from progressing, after

combination chemotherapy.Combination chemotherapy and targeted therapy with a monoclonal antibody.

Targeted therapy with a tyrosine kinase inhibitor.

External radiation therapy as palliative therapy, to relieve pain and other symptoms and

improve the quality of life.

Laser therapy and/or internal radiation therapy.

A clinical trial of new drugs and combinations of treatments.

For more information about supportive care for symptoms including cough, shortness of breath, and

chest pain, see the following PDQ summaries:

Cardiopulmonary Syndromes

Pain


stage IV non-small cell lung cancer. For more specific results, refine the search by using other search




Treatment Options for Recurrent Non-Small Cell Lung Cancer

Treatment of recurrent non-small cell lung cancer may include the following:
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non-small cell lung cancer treatment (pdq®) - national cancer institute

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