Non-Small Cell Lung Cancer

What is non-small cell lung cancer?

Non-small cell lung cancer (NSCLC) occurs when abnormal cells form and multiply in your lung tissues. NSCLC is one of two main types of lung cancer. The other is small cell lung cancer.

Small cell vs non-small cell lung cancer: What’s the difference?

Small cell lung cancer gets its name because the cancer cells look small and round under a microscope. With non-small cell lung cancer, the cancer cells are larger. Typically, small cell lung cancer grows faster than non-small cell lung cancer. Even so, non-small cell lung cancer is often diagnosed after the cancer has spread to other areas of your body. That’s why early detection and treatment are so important.

What are the types of non-small cell lung cancer?

There are three main types of non-small cell lung cancer:

• Adenocarcinoma. This type of lung cancer forms in cells that secrete mucus and other substances. It usually develops in the outer portions of your lung. Adenocarcinoma of the lung mostly affects people who currently smoke or those who used to smoke. But it can develop in people who’ve never smoked as well. It’s also more likely to occur at a younger age compared to other types of lung cancer.
• Squamous cell carcinoma. Starting in squamous cells (the flat cells that line the inside of your airways), squamous cell carcinoma usually forms in the central part of your lungs. It’s typically associated with a history of smoking.
• Large cell carcinoma. Also called undifferentiated carcinoma, this type of cancer can form in any portion of the lung. It’s more difficult to treat because it grows and spreads quickly.

There are other types of non-small cell lung cancer, including sarcomatoid carcinoma and adenosquamous carcinoma. These subtypes are much less common.

How common is non-small cell lung cancer?

NSCLC is the most common type of lung cancer, making up about 85% of all lung cancer cases.

What are the symptoms of non-small cell lung cancer?

The most common warning signs for non-small cell lung cancer include shortness of breath and a cough that doesn’t go away. Other non-small cell lung cancer symptoms may include:

• Chest pain or discomfort.
• A cough that doesn’t go away or gets worse over time.
• Trouble breathing.
• Wheezing.
• Coughing up blood.
• Hoarseness.
• Loss of appetite.
• Weight loss for no known reason.
• Tiredness.
• Difficulty swallowing.
• Swelling in your face or the veins in your neck.

Sometimes, lung cancer doesn’t cause any symptoms and is discovered during routine X-rays or screenings.

What causes non-small cell lung cancer?

Experts don’t know exactly what causes NSCLC, but they’ve identified some risk factors. For example, many people with NSCLC either smoke currently or have a history of smoking. Other non-small cell lung cancer risk factors include:

• Asbestos exposure.
• Exposure to metal and mineral dust.
• Radon, a naturally occurring radioactive gas.
• Chronic obstructive pulmonary disease (COPD).
• Air pollution.
• Pulmonary fibrosis.
• HIV/AIDS.
• Radiation therapy to your breast or chest.

Does non-small cell lung cancer spread?

Yes. Like many other cancers, non-small cell lung cancer can spread (metastasize) to other parts of your body. NSCLC most commonly spreads to your bones, brain, liver, skin, lymph nodes or adrenal glands. When this happens, it’s called metastatic non-small cell lung cancer.

How is non-small cell lung cancer diagnosed?

Your healthcare provider will perform a physical examination and ask you about your symptoms and health history. If they suspect non-small cell lung cancer, they’ll recommend certain tests to diagnose and stage the disease. These tests may include:

• Laboratory tests, such as blood or urine analyses.
• Chest X-rays, which help your healthcare provider see what’s going on inside of your lungs.
• CT scans, which take detailed, 3D images of your organs, blood vessels, muscles and bones.
• A biopsy of your lung tissue or fluid.
• Sputum cytology, which tests a sample of mucus that’s been coughed up from your lungs.
• Bronchoscopy, which allows your healthcare provider to look inside of your airways.
• Thoracoscopy, or video-assisted thoracic surgery (VATS), which allows your medical team to get a better look inside of your chest.
• Thoracentesis, which involves testing the fluid between the lining of your chest and lung.

What can you tell me about non-small cell lung cancer staging?

After a lung cancer diagnosis, tests are performed to find out if cancer cells have spread within your lungs or to other parts of your body. This process is called staging.

• Stage 0: A group of abnormal cells have appeared in the top layers of your lung tissue. However, these cells haven’t spread anywhere else.
• Stage I: The tumor is small and it’s fully contained inside of your lung.
• Stage II: The cancer hasn’t spread, but the tumor is larger than in Stage I. Some of the cancer cells may have spread into nearby lymph nodes.
• Stage III: The tumor is large and has possibly spread into surrounding tissues and lymph nodes.
• Stage IV: Cancer cells from the original tumor have broken off and traveled from your lung to another area of your body. The cancer cells are carried through your bloodstream or lymphatic system. This is also called metastatic non-small cell lung cancer.

What is the first line of treatment for NSCLC?

If the cancer is in early stages, then your healthcare provider may recommend surgery as a first line of treatment. Sometimes, surgery isn’t an option, especially if the cancer has spread. Other non-small cell lung cancer treatments include radiofrequency ablation, radiation therapy, chemotherapy, targeted drug therapy and immunotherapy.

Surgery

Your surgeon might remove the tumor and a small amount of healthy tissue around it. Or, they may remove an entire lobe (section) of your lung (lobectomy). In some cases, all or part of your lung may need to be removed (lung resection).

Radiofrequency ablation

Sometimes, people can’t tolerate surgery. In these cases, your healthcare provider might recommend radiofrequency ablation (RFA). During this procedure, your surgeon destroys the cancer cells by heating the tumor with high-energy radio waves.

Radiation therapy

Radiation therapy uses powerful X-ray beams to kill cancer cells or keep them from growing. Radiation therapy may be performed before surgery to shrink the tumor. It may also be used in combination with other treatments.

Chemotherapy

Chemotherapy uses drugs to stop cancer cells from growing. When chemotherapy is taken by mouth or given through an IV line, the drugs travel through your bloodstream and reach cancer cells throughout your body (systemic chemotherapy). When chemotherapy drugs are directed to a specific area of your body, the drugs target cancer cells in that region (regional chemotherapy).

Targeted drug therapy

Targeted therapy uses drugs or other substances to find and attack specific cancer cells without harming healthy cells. Monoclonal antibodies and tyrosine kinase inhibitors are two types of targeted therapy being used to treat non-small cell lung cancer.

Immunotherapy

Immunotherapy uses certain drugs to boost your own immune system so it can recognize and destroy cancer cells. The drugs used in immunotherapy are called checkpoint inhibitors, and they include medications like pembrolizumab, cemiplimab and atezolizumab.

How long does it take to recover from treatment?

Recovery after lung cancer treatment is different for everyone. It depends on several factors, including the size and location of the tumor, whether it has spread and your body’s own healing capacity. Some people may recover in a few months. For others, it could take years.

Can I prevent non-small cell lung cancer?

While you can’t prevent lung cancer altogether, you can avoid certain risk factors to reduce your chance of developing the disease. Smoking is the most common cause of both small cell and non-small cell lung cancer. People who stop smoking can significantly lower their risk for many different types of cancer.

What can I expect if I have non-small cell lung cancer?

For people with non-small cell lung cancer, prognosis depends on the stage of cancer and the subtype of NSCLC. For example, the five-year survival rate for early-stage NSCLC is 63%. This means that 63% of people diagnosed with the condition are still alive five years later. The five-year survival rate for regional NSCLC (when the cancer has spread to nearby tissues or lymph nodes) is 35%. With metastatic non-small cell lung cancer, the five-year survival rate is 7%.

Keep in mind that survival rates are just estimates. They can’t tell you how long you’ll live or how your body will respond to treatment. To learn more about survival rates, talk to your healthcare provider.

Is non-small cell lung cancer curable?

Yes. Non-small cell lung cancer is curable, especially with early detection and treatment. Certain factors can affect your overall prognosis, such as:

• The stage of the cancer (the size of the tumor and whether it is only in your lung or has spread to other places in your body).
• The type of lung cancer.
• Whether you have symptoms such as coughing or trouble breathing.
• Your general health.

Even when NSCLC isn’t curable, it’s still treatable in many cases. Many people with lung cancer manage their symptoms and live long, fulfilling lives.

When should I see my healthcare provider?

If you develop symptoms such as chest pain, chronic cough, wheezing or difficulty breathing, call your healthcare provider right away. They can run tests to determine the cause of your symptoms and recommend appropriate treatment.

What questions should I ask my healthcare provider?

Understanding your diagnosis can help you make informed decisions about your treatment. If you’ve been diagnosed with non-small cell lung cancer, you may want to ask some of the following questions:

• What type of non-small cell lung cancer do I have?
• What stage of cancer do I have?
• Where is the tumor located?
• What are my treatment options?
• Will I be able to work during treatment?
• What is my overall prognosis?
• Are there additional resources that might be useful to me?
• How likely is it that the cancer will return?
• What can I do to manage my symptoms?

A note from Cleveland Clinic

A cancer diagnosis is one of the most difficult things you’ll ever face. It’s normal to feel scared, worried or even frustrated. No matter what stage of cancer you have, treatment can play a major role in easing your symptoms and improving your quality of life. Talk to your healthcare provider about your options and consider meeting with a social worker to navigate this uncertain time. You may also want to join an online or local support group, which can help you feel less isolated and more empowered.