Being diagnosed with non-small-cell lung cancer (NSCLC) can be life-altering. You might feel a whirlwind of emotions — fear, confusion, and uncertainty — about what comes next. Understanding your treatment options and why you might need more than one type can help you feel more in control.
What Is NSCLC?
Non-small-cell lung cancer is the most common type of lung cancer, making up about 80%-85% of all cases. Unlike small-cell lung cancer, which tends to grow and spread quickly, NSCLC usually advances more slowly. This difference affects how your doctors approach treatment and what options are available to you.
You might have noticed some changes in your health that led you to the doctor's office, including symptoms like:
- Persistent cough
- Chest pain
- Shortness of breath
- Coughing up blood
- Unexplained weight loss
- Fatigue
- Frequent infections like bronchitis or pneumonia
Certain factors can increase your chances of developing NSCLC, including:
- Smoking
- Secondhand smoke
- Exposure to harmful substances
- Family history
How Is NSCLC Diagnosed?
Your doctor might begin by asking about your symptoms and medical history. From there, they may suggest:
- Imaging tests. These include X-rays and CT scans to see tumors in your lungs.
- Biopsy. A small piece of your lung tissue is taken and looked at under a microscope.
- Molecular testing. This checks for specific changes in your cancer cells that can affect treatment.
Different Types of NSCLC
NSCLC isn’t just one disease — it comes in several forms, each with its own characteristics. Knowing which type you have can guide your treatment options.
Squamous cell carcinoma. This type of cancer typically appears in the central part of your lungs, near the airways. It's often linked to a history of smoking and may require multiple treatments like surgery, radiation, and chemotherapy to tackle the cancer effectively.
Large-cell carcinoma. This type of cancer can show up anywhere in your lungs and is known for its rapid growth. Due to its aggressive nature, treatment usually involves a combination of surgery, chemotherapy, and radiation to manage and control its spread.
Adenocarcinoma. Adenocarcinoma often starts in the outer regions of your lungs and is more common in nonsmokers and women. If you have this type, your treatment might include surgery, targeted therapy, and chemotherapy tailored to how the cancer behaves and responds to different treatments.
Other rare forms. There are also rarer types like sarcomatoid carcinoma and adenosquamous carcinoma. These might require specialized treatments based on their unique characteristics so you get the most effective care possible.
Why You Might Need Multiple Treatments
You might wonder why treating NSCLC often involves more than one type of therapy. The answer lies in several factors that influence how the cancer behaves and how your body responds to treatment.
Stage of cancer
In the early stages (I-II), surgery might be your main treatment to remove the cancer. If your cancer is at a later stage (III), doctors often recommend combining treatments like chemotherapy and radiation to tackle the cancer from different angles.
Advanced cancer (IV) is typically managed with systemic therapies like chemotherapy, targeted therapy, or immunotherapy.
Type of cancer
Each type of NSCLC responds differently to treatments. For instance, adenocarcinoma might respond well to targeted therapies that specifically attack cancer cells with certain genetic mutations. This tailored approach can make your treatment more effective.
Your general health
Your overall health plays an important role in determining which treatments are safe and suitable for you. If you have other medical conditions, your health care team will consider these when planning your cancer treatment to make sure you can handle the therapies.
Genetic mutations
Some NSCLC cells have specific genetic mutations (abnormalities) that can be targeted with advanced therapies. Identifying these mutations allows your doctors to use treatments that are more effective and often have fewer side effects compared to traditional chemotherapy.
Other reasons
The location of your tumor can affect whether surgery or radiation is a good option. Additionally, your personal treatment goals and what matters most to you, such as maintaining your quality of life, will influence the combination of treatments you receive.
Your Treatment Options
Understanding your treatment options can help you make informed decisions. Here’s a look at the different treatments available for NSCLC.
Surgery
Surgery is often the first choice for early-stage NSCLC. It involves removing the cancerous part of the lung. Types of surgery include:
- Lobectomy. Removing an entire lobe of the lung
- Segmentectomy or wedge resection. Removing a smaller part of the lung
- Pneumonectomy. Removing an entire lung
- Sleeve resection. Removal of a part of the bronchus along with the tumor
Side effects:
- Pain after surgery
- Blood clots
- Pneumonia
- Bleeding
What to expect:
- Complete removal of cancer is possible.
- You might need chemotherapy or radiation after surgery to eliminate any remaining cancer cells.
Radiation therapy
This treatment uses high-energy rays to kill cancer cells or shrink tumors. Types of radiation include:
- External beam radiation. Directed at the tumor from outside the body
- Internal radiation (brachytherapy). Radiation sources placed inside the body near the cancer cells
- Proton therapy. Uses protons rather than X-rays, which are less likely to damage nearby organs
Side effects:
- Skin changes where the radiation is applied
- Fatigue
- Nausea and vomiting
- Loss of appetite
What to expect:
- Radiation can cure early-stage NSCLC.
- It may be combined with surgery or chemotherapy for better results.
Chemotherapy
Chemotherapy uses drugs to kill cancer cells throughout your body. Some used to treat NSCLC include:
- Carboplatin
- Cisplatin
- Docetaxel
- Doxorubicin
- Etoposide
- Gemcitabine
- Paclitaxel
- Pemetrexed
- Vinorelbine
Side effects:
- Nausea and vomiting
- Hair loss
- Mouth sores
- Diarrhea or constipation
- Loss of appetite
- Fatigue
What to expect:
- Chemotherapy can shrink tumors before surgery or radiation.
- It treats cancer that has spread to other parts of your body.
Targeted therapy
This therapy works differently than traditional chemo because instead of killing cancer cells your body’s already made, targeted therapy finds and blocks cancer cells from copying. That prevents the cells from growing and making new cancer cells. Targeted therapies are used for lung cancers in the most advanced stages, and often in combination with other therapies.
Targeted therapy drugs:
- Block chemical signals that tell cancer cells to divide and grow
- Kill cancer cells by changing the proteins inside
- Prevent new new blood vessels that feed cancer cells from forming
- Tell your immune system to kill cancer cells
Types of targeted therapies for NSCLC:
- VEGF inhibitors
- KRAS inhibitors
- EGFR inhibitors
- ALK inhibitors
- ROS1 inhibitors
- RET inhibitors
- BRAF inhibitors
- MET inhibitors
- HER2 inhibitors
- TRK inhibitors
Side effects depend on the type of targeted therapy but can include:
- Diarrhea
- Nausea and vomiting
- Rash
- Fatigue
- Liver problems
- Mouth sores
- Changes in blood tests
What to expect:
- Targeted therapy can be a more effective treatment with fewer side effects than chemotherapy.
- It’s often used alongside other treatments.
Immunotherapy
Immunotherapy boosts your immune system to recognize and attack cancer cells. Types of immunotherapy to treat NSCLC include:
- Atezolizumab
- Cemiplimab-rwlc
- Durvalumab
- Ipilimumab
- Nivolumab
- Pembrolizumab
- Tremelimumab
Side effects:
- Fatigue
- Skin reactions
- Diarrhea
- Autoimmune issues (when your immune system attacks healthy cells)
What to expect:
- Immunotherapy can lead to long-term remission.
- It’s commonly used for advanced NSCLC.
Laser therapy
It uses a focused beam of light to destroy cancer cells.
Side effects:
- Bleeding
- Soreness or pain
- Infection
What to expect:
- Laser therapy is effective for tumors blocking airways.
Photodynamic therapy (PDT)
PDT uses a special drug that makes cancer cells sensitive to light and then exposes them to a special light to kill them.
Side effects:
- Sensitivity to light
- Swelling
- Bleeding
What to expect:
- PDT may be used to relieve symptoms or when surgery isn’t an option.
- It may also be used for tumors blocking airways.
Cryosurgery
This treatment involves freezing and destroying cancer cells.
Side effects:
- Sore throat
- Hoarseness
- Coughing up blood or pus
What to expect:
- This treatment may be used to shrink tumors that are blocking the airway.
- It’s sometimes used to relieve symptoms and help you breathe.
Electrocautery
Also called diathermy treatment, this therapy uses electrical currents to burn and remove cancerous tissue.
Side effects:
- Soreness or pain
- Bleeding
- Chest infection
What to expect:
- Uses a probe or needle to destroy abnormal tissues.
- For tumors blocking airways, it’s done through an endoscope.
Combination Therapy for the Best Outcomes
When your doctors use two or more treatments together, it’s called combination therapy. They choose this approach for several important reasons:
- More effective cancer control. Sometimes one treatment alone might not be enough to shrink or eliminate the cancer. Using multiple treatments increases the chances of successfully controlling the cancer.
- Enhanced treatment effects. Adding another treatment can make each one work better. For example, chemotherapy can make cancer cells more sensitive to radiation, improving the overall effectiveness of both treatments.
- Targeting different stages: Different treatments work best at different times in your treatment plan. Combining them ensures that each stage of your treatment is as effective as possible, whether it's shrinking the tumor before surgery or eliminating remaining cancer cells afterward.
How Different Treatments Work Together
By using combination therapy, your medical team can tailor your treatment to attack the cancer from multiple angles, improving the likelihood of a successful outcome.
Surgery and chemotherapy
By combining surgery with chemotherapy, you can effectively remove the tumor and target any remaining cancer cells to reduce the risk of recurrence. There are two main approaches to combined surgery and chemotherapy:
- Neoadjuvant chemotherapy: Given before surgery to shrink tumors, making them easier to remove.
- Adjuvant chemotherapy: Given after surgery to kill any remaining cancer cells.
Radiation and chemotherapy
In advanced stages of NSCLC, radiation and chemotherapy are often used together. This combination, known as concurrent chemoradiation, can be more effective in controlling the cancer and relieving symptoms than using either treatment alone. By combining these therapies, chemotherapy helps make cancer cells more sensitive to radiation, enhancing the overall effectiveness of the treatment.
This approach can help shrink tumors, slow the growth of cancer, and improve your quality of life. However, it's important to discuss with your medical team whether this combination is right for you, as it may also lead to more side effects.
Targeted therapy and immunotherapy
Combining targeted therapy with immunotherapy attacks your cancer in different ways, making treatment more effective. Targeted therapy drugs focus on specific genetic changes in your cancer cells, stopping them from growing and spreading.
Meanwhile, immunotherapy helps your immune system recognize and fight the cancer. This dual approach can lead to better outcomes by reducing the chances of the cancer returning and may also help lower side effects compared to using each treatment alone.
Personalized treatment plans
Your treatment plan will be customized to fit your specific type of NSCLC, any genetic mutations, your overall health, and your personal preferences. Your medical team will guide you through each step to ensure you receive the best possible care.
Recovering From NSCLC
Recovering from NSCLC is a big step in your journey. Whether your treatment has removed the cancer or you are managing it for the long term, recovery involves both healing your body and finding emotional support.
Living as a lung cancer survivor
After finishing your treatment, you might feel both relieved and anxious. It's normal to worry about the cancer coming back, even if your doctors think it's gone. For some people, treatment can completely remove the cancer, giving you hope for the future. But for others, the cancer might stay and you may need ongoing treatments like chemotherapy or radiation to keep it under control. Living with ongoing cancer can be tough, but with the right support, you can handle these feelings and stay positive.
Even after your treatment ends, regular checkups are very important. These appointments help your doctors monitor your health, check for any signs of the cancer returning, and manage any long-term side effects from your treatment.
During follow-up visits, you might have tests like CT scans, MRIs, and blood tests to make sure everything is OK. It’s crucial to go to all your scheduled checkups and talk openly with your health care team about any new symptoms or worries you have.
Lowering your risk of recurrence
There are things you can do to lower the chance of your cancer coming back, including:
- Quitting smoking
- Eating a healthy diet of fruits and vegetables
- Staying active
- Maintaining a healthy weight
If your cancer returns
If your cancer comes back, your treatment options will depend on where the cancer is and what treatments you’ve already had. Your health care team will work with you to create a new treatment plan, which may include surgery, radiation, chemotherapy, targeted therapy, or immunotherapy.
Creating a survivorship care plan
A survivorship care plan is your personal guide for life after cancer treatment. It includes a summary of the treatments you received, possible long-term effects, and a schedule for follow-up tests.
This plan also gives tips for staying healthy, like eating a balanced diet, staying active, and avoiding tobacco. Working with your health care team to create and update this plan makes sure that all parts of your health are taken care of, helping you thrive after NSCLC.
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
Yale Medicine: “How Non-Small Cell Lung Cancer (NSCLC) Treatment is Improving.”
American Lung Association: “Types of Lung Cancer,” “Targeted Therapies for Lung Cancer.”
American Cancer Society: “Signs and Symptoms of Lung Cancer,” “Tests for Lung Cancer,” “Lung Cancer Risk Factors,” “What is Lung Cancer?” “Targeted Drug Therapy for Non-Small Cell Lung Cancer,” “Surgery for Non-Small Cell Lung Cancer,” “Chemotherapy for Non-Small Cell Lung Cancer,” “Radiation Therapy for Non-Small Cell Lung Cancer,” “Immunotherapy for Non-Small Cell Lung Cancer,” “Treatment Choices for Non-Small Cell Lung Cancer, by Stage,” “Living as a Lung Cancer Survivor,” “How Targeted Therapies Are Used to Treat Cancer.”
MD Anderson Cancer Center: “Squamous cell carcinoma of the lungs: 5 things to know.”
Moffitt Cancer Center: “Large Cell Carcinoma (Lung Cancer).”
Lung Cancer Foundation of America: “Adenocarcinoma of the Lung.”
Cancer Research UK: “Treatment options for non-small cell lung cancer,” “Laser therapy for lung cancer,” “Photodynamic therapy (PDT) for lung cancer,” “Cryotherapy for lung cancer,” Diathermy (electrocautery) for lung cancer,” “Targeted and immunotherapy treatment for lung cancer.”
National Cancer Institute: “Non-Small Cell Lung Cancer Treatment (PDQ) – Patient Version.”
Lung Cancer Foundation of America: “Combination Therapy.”
