What is Non-Small Cell Lung Cancer (NSCLC)?

 

What is Non-Small Cell Lung Cancer

When cancer originates in the lungs, it’s called lung cancer. There are two main kinds of lung cancer: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC).

NSCLC is the most common kind of lung cancer, comprising 80 to 85 percentTrusted Source of lung cancer diagnoses. It doesn’t grow as quickly as small cell lung cancer.

There are three main kinds of NSCLCs:

  • adenocarcinomas
  • squamous cell carcinomas
  • large cell carcinoma

In its early stages, NSCLC usually doesn’t cause any symptoms. When symptoms start to develop, they can include:

  • persistent cough
  • fatigue
  • chest pain
  • unintentional and unexplained weight loss
  • breathing problems
  • joint or bone pains
  • weakness
  • coughing up blood

If the cancer spreads to other areas of the body, it can cause additional or worsened symptoms, such as:

  • difficulty breathing
  • problems with speech
  • pain in areas where cancer cells have spread, such as in bones, head, back, or abdomen
  • increased weakness or fatigue
  • seizures

Sometimes there are no discernible symptoms, at least initially. An imaging test used for other purposes may reveal the diagnosis.

Speak with your doctor about any unusual symptoms so they can help guide you and, if necessary, find the right diagnosis and treatment.

A number of factors can increase your risk for developing lung cancer. Smoking cigarettes or being exposed to secondhand smoke is a primary risk factor for the disease. Exposure to asbestos and certain paints or chemicals may also increase your risk.

While you may not be able to completely prevent NSCLC, there are steps you can take to reduce your risk of developing the disease. If you smoke cigarettes, you should develop a plan to quit.

Talk with your doctor about tools that can help you quit smoking and about any support groups that exist. Avoid or limit your exposure to the chemical radon, as it increases your risk of the disease. Have your house tested for radon and treated, if necessary.

Along with a physical exam and medical history, a variety of tests can help your doctor diagnose lung cancer. Tests your doctor may order include:

  • bone scan
  • imaging tests like MRI, CT scan, and PET scan of the chest
  • microscopic examination of sputum (phlegm) to check for cancer cells
  • biopsy of the lung (a piece of lung tissue is removed for testing)

Once the diagnosis of cancer has been confirmed, the cancer will be staged. Staging is the way doctors classify the cancer according to its spread in the body. NSCLC has five stages, from stage 0 to stage 4, from weakest to strongest severity.

Outlook and treatment is based on the stage. Stage 4 cancer is typically not curable, so treatment is usually aimed at relieving symptoms.

Staging of NSCLC is based on the AJCC Cancer Staging Manual and is determined by these factors:

  • size and location of the tumor or cells
  • whether it’s spread to the lymph nodes or to other parts of the body
StageDiagnostic factors
Stage 0Also known as “situ disease,” the cancer cells haven’t spread into nearby tissues.
Stage 1AThe small tumor is less than 3 centimeters (cm) in diameter and hasn’t spread to any nearby lymph nodes. It can likely be removed with surgery.
Stage 1BThe small tumor is between 3 and 4 cm in diameter and hasn’t spread to any nearby lymph nodes. It can likely be removed with surgery.
Stage 2AThe tumor is between 4 and 5 cm in diameter and hasn’t spread to any nearby lymph nodes.
Stage 2BThe tumor is 5 cm or less in size and has spread to nearby lymph nodes.
Stage 3Stage 3 is categorized into three substages with varying tumor sizes and spread to lymph nodes. Stage 3 cells haven’t spread to distant parts of the body. Stages 3A and 3B can sometimes involve surgery, but stage 3C will require other therapies.
Stage 4AThe cancer cells have spread within the chest and potentially to one area outside of the chest.
Stage 4BThe cancer cells have spread outside of the chest into more than one distant area or organ. Generally, surgery isn’t an option.
Recurrent NSCLCA recurrence means that cancer cells have returned after treatment. This can vary by location and severity.

Treatment for NSCLC can vary, based on the stage of disease, your health, and other factors. Talk with your doctor about the best treatment option for you and the possible side effects. Different modes of treatment may be combined to yield the best results.

There are five main ways to treat non-small cell lung cancer, including:

Surgery

Surgery can be used in the early stages of NSCLC. Depending on the location of the cancer, one of the following procedures may be necessary:

  • lobectomy (removal of a lobe)
  • wedge resection (removal of the tumor and some surrounding tissue)
  • segmentectomy (removal of a portion of the lung)
  • pneumonectomy (removal of the entire lung)

Treatments before or after may also accompany the surgery. These could include:

  • chemotherapy
  • targeted therapy
  • immunotherapy

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells and prevent new ones from growing. A regimen would be created consisting of a number of treatments over the course of a few days to a few weeks.

Radiation wouldn’t be used to treat cancer that has spread throughout the body, but it can be useful in targeting specific areas and small tumors. It may also be an option when surgery isn’t.

Chemotherapy

Chemotherapy is a type of systemic therapy that uses anticancer drugs to kill cancer cells. They can be given intravenously or in pill form. Like with radiation, a regimen would be created with a number of cycles over a period of time.

Chemotherapy drugs would be chosen based on the type of cancer and may be combined with other chemotherapy drugs. Chemotherapy can improve the outlook for all stages of lung cancer.

Targeted therapy

Targeted therapies address specific proteins, genes, or the environment that enables cancer growth. They can address issues such as cells with generic mutations or stopping angiogenesis (the process of making new blood vessels).

New targeted therapies are being developed every day and are helping people live longer and better with lung cancer. Speak with your doctor to see if any targeted therapies are right for you.

Immunotherapy

Immunotherapy, or biologic therapy, aims to use your body’s immune system to fight cancer cell growth. This type of therapy is often recommended for later-stage cancer or when other therapies aren’t the preferred treatment.

Combined therapies including immunotherapy are often used to achieve better results.

Treatments will vary based on many factors, and your doctor will tailor your treatment specifically to you, sometimes with combined therapies. But here are some common treatment options in different stages of NSCLC:

NSCLC stageCommon treatments
Stage 0surgery, photodynamic therapy (PDT), laser therapy, brachytherapy (internal radiation)
Stage 1surgery, radiation, chemotherapy
Stage 2surgery (sometimes including nearby lymph nodes), radiation, chemotherapy, targeted therapies
Stage 3Asurgery, chemotherapy (often combined with radiation), targeted therapies, immunotherapy
Stage 3Bsurgery, chemotherapy (often combined with radiation), targeted therapies, immunotherapy
Stage 4Asurgery if health is stable, chemotherapy, radiation, targeted therapies, and immunotherapy to prolong life (other treatments, including PDT or laser therapy, may reduce symptoms)
Stage 4Btargeted therapies, immunotherapy, chemotherapy, radiation to help prolong life (clinical trials for new therapies are a good option)

Cancers can recur after successful treatment. Treatment options will depend on the location and severity of the recurrence. It’s important to understand your diagnosis and the goals of treatment after a recurrence.

Your doctor may try a different type of treatment if the initial treatment has stopped working. Tumors can sometimes be treated with surgery while progression to the lymph nodes may warrant chemotherapy.

In later stages, targeted therapies and immunotherapy offer an alternative for a recurrence. For cancer that recurs at a distant site from the initial diagnosis, chemotherapy, targeted therapies, and immunotherapy are likely choices for continued treatment.

In the instance of a recurrence, your doctor would develop a specific treatment plan for your needs that may include multiple treatment types.

Your outlook depends on a variety of factors. Some people who are diagnosed with NSCLC are successfully treated and go on to live normal lives. Early detection and treatment is one of the best ways to recover from NSCLC.

New treatments for lung cancer are being developed every day, and clinical trials may be an option. Speak with your doctor about your goals and potential treatments to help you live a longer, healthier life.

JPeei Clinic