What is non-small-cell lung cancer?
The two main types of lung cancer are small-cell lung cancer and non-small-cell lung cancer. Non-small-cell lung cancer is a catchall term for all lung cancers that are the not small-cell type. They are grouped together because the treatment is often the same for all non-small-cell types. Together, non-small-cell lung cancers, or NSCLCs, make up a majority of lung cancers. Each type is named for the types of cells that were transformed to become cancer.
There are 3 common types of non-small cell lung cancer:
- Adenocarcinomas are often found in an outer area of the lung.
- Squamous cell carcinomas are usually found in the center of the lung next to an air tube (bronchus).
- Large cell carcinomas can occur in any part of the lung. They tend to grow and spread faster than the other 2 types.
How common is non-small-cell lung cancer?
About 80% to 85% of lung cancers are non-small cell lung cancer. Please discuss with your doctor for further information.
What are the symptoms of non-small-cell lung cancer?
The common symptoms of non-small-cell lung cancer are:
- Chest discomfort or pain.
- A cough that doesn’t go away or gets worse over time.
- Trouble breathing.
- Blood in sputum (mucus coughed up from the lungs).
- Loss of appetite.
- Weight loss for no known reason.
- Feeling very tired.
- Trouble swallowing.
- Swelling in the face and/or veins in the neck.
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes non-small-cell lung cancer?
Tobacco smoking is the cause of lung cancer in as many as 90% of cases.
A person who smokes is 13.3 times as likely to develop lung cancer as is a person who has never smoked. The risk also varies with the number of cigarettes smoked per day; people who smoke more than 20 cigarettes per day have a much greater risk of developing lung cancer than do those who smoke fewer than 20 cigarettes per day.
Once a person quits smoking, the risk of lung cancer increases for the first two years and then gradually decreases, but the risk never returns to the same level as that of a person who has never smoked.
Not all people who smoke develop lung cancer, and not all people with lung cancer ever smoked. Clearly, other factors, including genetic predisposition, also play a role.
Passive smoking (secondhand smoke)
Some lung cancer cases involving nonsmokers may be caused by secondhand smoke.
The Environmental Protection Agency has recognized passive smoking as a potential cause of cancer.
Asbestos exposure has been linked to lung cancer and other lung diseases.
The silicate type of asbestos fiber is an important carcinogen.
Asbestos exposure increases the risk of lung cancer by as much as five times.
People who both smoke and have been exposed to asbestos are at an especially high risk of developing lung cancer.
Radon is a gas produced as a result of uranium decay. Radon exposure is a risk factor for lung cancer in uranium miners.
Radon exposure is believed to account for a small percentage of lung cancers each year.
Household exposure to radon has never been clearly shown to cause lung cancer.
Other environmental agents
Exposures to the following agents account, at least partly, for some cases of lung cancer:
- Petroleum-based chemicals called aromatic polycyclic hydrocarbons
- Diesel exhaust
What increases my risk for non-small-cell lung cancer?
There are many risk factors for non-small-cell lung cancer, such as:
- Smoking cigarettes, pipes, or cigars, now or in the past. This is the most important risk factor for lung cancer. The earlier in life a person starts smoking, the more often a person smokes, and the more years a person smokes, the greater the risk of lung cancer.
- Being exposed to secondhand smoke.
- Being exposed to radiation from any of the following:
- Radiation therapy to the breast or chest.
- Radon in the home or workplace.
- Imaging tests such as CT scans.
- Atomic bomb radiation.
- Being exposed to asbestos, chromium, nickel, beryllium, arsenic, soot, or tar in the workplace.
- Living where there is air pollution.
- Having a family history of lung cancer.
- Being infected with the human immunodeficiency virus (HIV).
- Taking beta carotene supplements and being a heavy smoker.
Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.
When smoking is combined with other risk factors, the risk of lung cancer is increased.
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is non-small-cell lung cancer diagnosed?
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 patient’s 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 other substances 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.
- 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 vein 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 the lung 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 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.
- 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.
- 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 can’t 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.
- Immunohistochemistry : A test that uses antibodies to check for certain antigens in a sample of tissue. The antibody is usually linked to a radioactive substance or a dye that causes the tissue to light up under a microscope. This type of test may be used to tell the difference between different types of cancer.
How is non-small-cell lung cancer treated?
Tissue diagnosis is mandatory prior to any treatment. The goals of treatment are to remove or shrink the tumor, to kill all residual tumor cells, to prevent or minimize complications and paraneoplastic syndromes, and to relieve the symptoms and side effects associated with the disease and treatment. Available therapies cure only a small number of people with lung cancer. Other people’s tumors shrink substantially or even disappear, although residual cancer cells remain in the body. Such people are said to be in remission. Most people feel well during remission and are able to resume their everyday activities. Remissions can last a few months, a few years, or even indefinitely. If and when the disease comes back, it is called recurrence or relapse. The disease may recur in the lung or in another part of the body.
What is the medical treatment for non-small-cell lung cancer?
Traditionally, the three major therapies used for NSCLC were surgery, chemotherapy, and radiation therapy. Targeted therapy is a new form of treatment that is specifically designed to treat defects in the cancer cells and requires testing of the tumor tissue to determine what specific abnormalities are present. Immunotherapy is also a newer method often used to treat NSCLC.
- Surgery: The tumor is removed through an incision in the skin and muscle.
- Chemotherapy: Strong chemicals and drugs are taken internally, either by mouth or through a vein into the bloodstream, to kill tumor cells.
- Radiation therapy: A powerful radiation beam is pointed at the tumor (external beam) or a radiation source is placed within the body next to the tumor (internal beam). The radiation kills the tumor cells.
- Targeted therapy: Special drugs are designed to target a specific molecule or defect in the cancer cell.
- Immunotherapy: Immunotherapy drugs work with your own immune system to help destroy cancer cells.
Each person with NSCLC should be offered a customized treatment regimen, which should consist of some combination of these therapies depending on disease stage and location, as well as the particular genetic abnormalities or so-called tumor biomarkers found in the individual tumor.
After the staging evaluation, a decision is made whether the tumor is operable. Operable (or resectable) tumors are those that can be removed completely or almost completely by surgery. Generally, only stage I and some stage II and III tumors can be removed by surgery. Sometimes, people with stage III or IV inoperable disease undergo surgery, but this is usually performed to remove enough of the tumor to relieve symptoms such as breathing problems or severe pain. Surgery does not cure people with stage IV or most stage III diseases.
NSCLC is only moderately sensitive to chemotherapy. Chemotherapy alone does not have the potential to cure people with NSCLC. When the goal is cure, chemotherapy is given in combination with surgery or radiation therapy. Chemotherapy alone is given only to people who cannot undergo surgery or radiation therapy or, in some cases, people whose disease has relapsed after surgery. When given in combination with surgery, the chemotherapy is usually given after surgery (adjuvant chemotherapy). Adjuvant chemotherapy is recommended to treat cancer in stages I-III after surgery has been performed to remove the cancer. In general, chemotherapy is given in cycles. Treatment usually lasts a few days and is then followed by a recovery period of a few weeks. When side effects have subsided and blood cell counts have started to return to normal, the next cycle begins. Usually, chemotherapy is given in regimens of two or four cycles. After these cycles are over, the patient undergoes repeat CT scans and other tests to see what effect the chemotherapy has had on the tumor.
Radiation therapy may be given in combination with surgery or chemotherapy or alone. Generally, radiation therapy is given alone only for people who are not candidates for surgery. Radiation therapy may be used for different aspects of treatment, including preoperatively to reduce the size of a tumor for surgical removal, after surgery to kill any remaining tumor cells, or in later-stage disease to relieve the patient’s symptoms.
Targeted therapy involves testing a patient’s tumor tissue to identify specific genetic alterations or mutations that can be targeted with specifically designed drugs. Targeted therapy may be given alone or in combination with chemotherapy. Many NSCLC have genetic changes that include mutations or other changes in specific genes; examples of the genetic changes are EGFR mutation, ALK fusion oncogene, and mutations in genes known as ROS1, BRAF, and KRAS. A small number of NSCLC have mutations in the gene that codes for the HER2 protein. Targeted therapy drugs that attack cells with these specific changes are constantly being developed, and many of these drugs are available today.
Immunotherapy is a type of therapy that helps your immune system work to destroy tumor cells. Specific testing, known as biomarker testing, is sometimes required to determine if your particular tumor will respond to certain immunotherapy drugs.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage non-small-cell lung cancer?
The following lifestyles and home remedies might help you cope with non-small-cell lung cancer:
As you follow your treatment plan, pay attention to any changes you feel. Tell your doctor how you’re doing, both physically and emotionally.
Some days, your appetite may not be great. But you’ll need to eat well to keep your strength and energy up. Try to eat several small meals throughout the day instead of a few large ones.
If you have trouble breathing, oxygen from a tank may help. So can practicing relaxation techniques, like meditation, listening to music, or picturing yourself in a peaceful place. Complementary treatments, including gentle massage and aromatherapy, may put you more at ease. Talk to your doctor about what you can do when you’re tired, in pain, or breathless.
Finding out that you have cancer is very hard to deal with. You may be afraid, angry, or sad. Strong emotions are normal. A support group or a counselor who works with people who have cancer could help you work through your feelings. Look online or in your community, or ask your doctor for suggestions and about other professionals who can help support you — perhaps social workers, nurses, clergy, or other doctors.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Review Date: October 30, 2017 | Last Modified: October 30, 2017
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Non-Small Cell Lung Cancer Treatment (PDQ®)–Patient Version. https://www.cancer.gov/types/lung/patient/non-small-cell-lung-treatment-pdq. Accessed October 30, 2017.
Non-Small-Cell Lung Cancer. https://www.emedicinehealth.com/non-small-cell_lung_cancer/. Accessed October 30, 2017.