There are 2 types of lung cancer:
- Non-Small Cell Lung Cancer
- Small Cell Lung Cancer.
This only describes treatment options for non-small cell lung cancer, a common type of lung cancer.
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 Non-Small Cell Lung Cancer
- Stage I Non-Small Cell Lung Cancer
- Stage II Non-Small Cell Lung Cancer
- Stage III Non-Small Cell Lung Cancer (Stages IIIA and IIIB)
- Stage IV Non-Small Cell Lung Cancer
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 5 types of 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 that are found within the chest. The lungs bring oxygen into the body and take out carbon dioxide, which is a waste product of the body’s cells. Each lung has sections called lobes. The left lung has 2 lobes.
The right lung, which is slightly larger, has 3 lobes. A thin membrane called the pleura surrounds the lungs. Two tubes called bronchi lead from the trachea (windpipe) to the right and left lungs. The bronchi are sometimes also involved in lung cancer. Tiny air sacs called alveoli and small tubes called bronchioles make up the inside of the lungs.
There are 5 types of non-small cell lung cancer. The 5 types of non-small cell lung cancer have different kinds of cancer cells. The cancer cells of each type grow and spread in different ways. The types of non-small cell lung cancer are named for the kinds of cells found in the cancer and how the cells look when viewed under a microscope:
- Squamous Cell Carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that look like fish scales. This is also called epidermoid carcinoma.
- Adenocarcinoma: Cancer that begins in cells that have glandular (secretory) properties.
- Large Cell Carcinoma: Cancer in which the cells are large and look abnormal when viewed under a microscope.
- Adenosquamous Carcinoma: Cancer that begins in cells that look flattened when viewed under a microscope. These cells also have glandular (secretory) properties.
- Undifferentiated Carcinoma: Cancer cells that do not look like normal cells and multiply uncontrollably.
Prognosis (Chance of recovery): 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 (whether it is in the lung only or has spread to other places in the body).
- The tumor size.
- The type of lung cancer.
- Whether there are symptoms.
- The patient’s general health.
For most patients with non-small cell lung cancer, current treatments do not cure the cancer. If lung cancer is found, participation in one of the many clinical trials being done to improve treatment should 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 cancer web site www.cancer.gov/clinicaltrials.
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. The following stages are used for non-small cell lung cancer:
- Occult (hidden) stage
- Stage 0 (carcinoma in situ)
- Stage I
- Stage II
- Stage III
- Stage IV
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. The process used to find out if cancer has spread within the lungs or to other parts of the body is called 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. The following tests and procedures may be used in the staging process:
- 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 and past illnesses and treatments will also be taken.
- Radiologic Exams: The use of radiation or other imaging methods to find signs of cancer. Radiologic tests for non-small cell lung cancer include:
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- 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, 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. - PET Scan (Positron Emission Tomography Scan): A procedure to find malignant tumor cells in the body. A small amount of radionuclide 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.
- 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.
- Lymph Node Biopsy: The removal of all: The removal of part of a lymph node.
- Core Biopsy: The removal of part of a lymph node using a wide needle.
- Needle Biopsy: The removal of part of a lymph node using a thin needle. This procedure is also called a fine-needle aspiration biopsy.
- Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope (a thin, lighted tube) is inserted through the nose or mouth into the trachea and lungs. Tissue samples may be taken for biopsy.
- 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 thin, lighted tube is inserted into the chest. Tissue and lymph node samples may be taken for biopsy.
- Anterior Mediastinotomy: A surgical procedure to look at the organs and tissues between the lungs and between the breastbone and spine for abnormal areas. An incision (cut) is made next to the breastbone and a thin, lighted tube is inserted into the chest. Tissue and lymph node samples may be taken for biopsy. This is also called the Chamberlain procedure.
Treatment Option Overview
Key Points for This Section
This summary section provides an overview of treatment options and may refer to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI web site www.cancer.gov/clinical trials. At diagnosis, patients can be divided into 3 treatment groups based on the stage of the cancer:
- Non-small cell lung cancer that can be treated with surgery.
- Non-small cell lung cancer that has spread to nearby tissue or to lymph nodes.
- Non-small cell lung cancer that has spread to other parts of the body or to another lobe of the lungs.
Four types of standard treatment are used:
- Surgery
- Chemotherapy
- Radiation Therapy
- Laser Therapy
- Other types of treatment and prevention are being tested in clinical trials. These include the following:
- Photodynamic therapy (PDT)
- Chemoprevention
- New Treatments
At diagnosis, patients can be divided into 3 treatment groups based on the stage of the cancer:
- Non-small cell lung cancer that can be treated with surgery.Stage 0, stage I, and stage II non-small cell lung cancer can often be removed by
surgery. Radiation therapy may be used to treat patients who have other medical
problems and cannot have surgery. - Non-small cell lung cancer that has spread to nearby tissue or to lymph nodes.Treatment options include one of the following:
- Radiation therapy alone.
- Radiation therapy and chemotherapy or other kinds of treatment.
- Surgery alone.
- Non-small cell lung cancer that has spread to other parts of the body or to another lobe of the lungs.Radiation therapy may be used as palliative therapy to shrink the cancer and to relieve pain in patients who have non-small cell lung cancer that has spread to other parts of the body. Chemotherapy may be used to treat some patients.
Four types of standard treatment are used:
- Surgery: Three types of surgery are used:
- Wedge resection: A surgical procedure to remove a tumor (lump) and a small amount of normal tissue around it.
- Lobectomy: A surgical procedure to remove a whole lobe (section) of the lung.
- Pneumonectomy: Surgery to remove one whole lung.
- Chemotherapy: Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells 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 in the spinal column, a body cavity such as the abdomen, or an organ, the drugs mainly affect cancer cells in those areas. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
- Radiation Therapy: Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. 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 have surgery. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
- Laser Therapy: Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells.
Other types of treatment and prevention are being tested in clinical trials. These include the following:
- Photodynamic Therapy (PDT): Photodynamic therapy (PDT) is a cancer treatment that uses a drug that is not active until it is exposed to light. When exposed to light, the cancer cells are killed.
- Chemoprevention: Chemoprevention is the use of drugs, vitamins, or other substances to reduce the risk of developing cancer or to reduce the risk cancer will recur (come back).
- New Treatments: New combinations of treatments are being studied in clinical trials. 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 Cancer.gov Web sitewww.cancer.gov/clinicaltrials.
Treatment Options by Stage
1. Occult Non-Small Cell Lung Cancer: Treatment of stage 0 non-small cell lung cancer may include the following:
- Surgery to remove a small portion of the lung where the cancer cells are found.
- Clinical trials of photodynamic therapy using an endoscope.
2. Stage I Non-Small Cell Lung Cancer: Treatment of stage I non-small cell lung cancer may include the following:
- Surgery to remove a small portion of the lung or a lobe of the lung.
- External radiation therapy (for patients who cannot have surgery or choose not to have surgery).
- Clinical trials of chemotherapy following surgery.
- Clinical trials of chemoprevention following other therapy.
- Clinical trials of photodynamic therapy using an endoscope.
3. Stage II Non-Small Cell Lung Cancer: Treatment of stage II non-small cell lung cancer may include the following:
- Surgery to remove the tumor (a small portion of the lung, a lobe of the lung, or an entire lung) and lymph nodes.
- External radiation therapy (for patients who cannot have surgery or choose not to have surgery).
- Clinical trials of chemotherapy following surgery.
- Clinical trials of external radiation therapy following surgery.
4. Stage III Non-Small Cell Lung Cancer (Stages IIIA and IIIB): Treatment of stage IIIA non-small cell lung cancer may include the following:
- Surgery alone.
- External radiation therapy alone.
- Chemotherapy combined with other treatments.
- Surgery and external radiation therapy.
- Clinical trials of combined treatments.
Treatment of stage IIIB non-small cell lung cancer may include the following:
- External radiation therapy alone.
- Chemotherapy combined with external radiation therapy.
- Chemotherapy combined with external radiation therapy, followed by surgery.
- Chemotherapy alone.
- Clinical trials of combined treatments.
5. Stage IV Non-Small Cell Lung Cancer: Treatment of stage IV non-small cell lung cancer may include the following:
- External radiation therapy as palliative therapy, to relieve pain and other symptoms and improve the quality of life.
- Chemotherapy.
- Laser therapy and/or internal radiation therapy.
- Clinical trials of chemotherapy.
Want to learn more about lung cancer treatment options?
Contact us today or call (239) 437-6670.
Or contact your oncologist or the National Cancer Institute’s (NCI’s) Cancer Information Service toll-free at:
1-800-4-CANCER (1-800-422-6237)
Monday through Friday from 9:00 a.m. to 4:30 p.m. Link to NCI lung cancer website:
www.nci.nih.gov/cancertopics/types/lung
Acknowledgement: Information for this document was obtained from National Cancer Institute
website www.cancer.gov, accessed on January 2, 2005.