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Lung Cancer - Non-Small Cell - Introduction

Approved by the Cancer.Net Editorial Board, 08/2017

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Non-Small Cell Lung Cancer. Use the menu to see other pages. Think of that menu as a roadmap for this complete guide.

Lung cancer affects more than 200,000 Americans each year. Although cigarette smoking is the main cause, anyone can develop lung cancer. Lung cancer is always treatable, no matter the size, location, whether the cancer has spread, and how far it has spread.

Because lung cancer is associated with smoking, patients may feel that they won’t receive much support or help because they believe that others will think that their behavior caused the disease. The truth is that most smokers do not develop lung cancer, and not all people diagnosed with lung cancer smoke. Lung cancer is a disease that can affect anyone. In fact, most people who get lung cancer today have either stopped smoking years earlier or never smoked.

About the lungs

When a person inhales, the lungs absorb oxygen from the air and bring the oxygen into the bloodstream for delivery to the rest of the body. As the body’s cells use oxygen, they release carbon dioxide. The bloodstream carries carbon dioxide back to the lungs, and the carbon dioxide leaves the body when a person exhales. The lungs contain many different types of cells. Most cells in the lung are epithelial cells. Epithelial cells line the airways and make mucus, which lubricates and protects the lung. The lung also contains nerve cells, hormone-producing cells, blood cells, and structural or supporting cells.

About non-small cell lung cancer

There are 2 main classifications of lung cancer: small cell lung cancer and non-small cell lung cancer (NSCLC). These 2 types are treated differently. This guide contains information about NSCLC. Learn more about small cell lung cancer in a separate guide on this website.

NSCLC begins when healthy cells in the lung change and grow out of control, forming a mass called a tumor, a lesion, or a nodule. A lung tumor can begin anywhere in the lung. A tumor can be cancerous or benign. Once a cancerous lung tumor grows, it may shed cancer cells. These cells can be carried away in blood or float away in the fluid, called lymph, that surrounds lung tissue. Lymph flows through tubes called lymphatic vessels that drain into collecting stations called lymph nodes. Lymph nodes are the tiny, bean-shaped organs that help fight infection. They are located in the lungs, the center of the chest, and elsewhere in the body. The natural flow of lymph out of the lungs is toward the center of the chest, which explains why lung cancer often spreads there first. When a cancer cell moves into a lymph node or to a distant part of the body through the bloodstream, it is called metastasis.

Types of NSCLC

NSCLC begins in the epithelial cells. NSCLC may also be described based on the type of epithelial cell where the cancer starts:

  • Adenocarcinoma starts in cells that produce mucus.

  • Squamous cell carcinoma begins in the cells that line the airways.

  • Large cell carcinoma begins in cells other than the 2 types described above.

It is important for doctors to distinguish between lung cancer that begins in the squamous cells from lung cancer that begins in other cells. This information is used to determine treatment options. 

Normal lung tissue

Normal lung tissue
Click to Enlarge

Lung - Adenocarcinoma

Lung - adenocarcinoma
Click to Enlarge

Lung - Squamous cell carcinoma

Lung - squamous cell carcinoma
Click to Enlarge

These images used with permission by the College of American Pathologists.

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If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with this disease and general survival rates. You may use the menu to choose a different section to read in this guide.

Lung Cancer - Non-Small Cell - Statistics

Approved by the Cancer.Net Editorial Board, 01/2018

ON THIS PAGE: You will find information about the number of people who are diagnosed with NSCLC each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors. Use the menu to see other pages.

NSCLC is the most common type of lung cancer, accounting for 80% to 85% of all lung cancer diagnoses.

Statistics provided below for lung cancer include both small cell and NSCLC. This year, an estimated 234,030 adults (121,680 men and 112,350 women) in the United States will be diagnosed with lung cancer. Lung cancer makes up about 14% of all new cancer diagnoses. Black men are about 20% more likely to get lung cancer than white men. Black women are 10% less likely to get cancer when compared with white women.

Lung cancer is the second most common cancer and the leading cause of cancer death for men and women. It is estimated that 154,050 (83,550 men and 70,500 women) deaths from this disease will occur this year.

Due to a decrease in smoking, death rates have declined by 45% since 1990 in men and 19% in women since 2002.

The 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for all people with all types of lung cancer is 18%. The 5-year survival rate for men is 15%. The 5-year survival rate for women is 21%.

However, it is important to note that survival rates depend on several factors, including the subtype of lung cancer, and the stage of disease.

For people with stage IA1 NSCLC, the 5-year survival rate is about 92%. For stage IA2, the rate is about 83%, and for stage IA3 it is 77%. The survival rate for people with stage 1B is about 68%. It is 60% for stage IIA cancer, and 53% for stage IIB cancer. For stage IIIA NSCLC, the 5-year survival rate is about 36%, and about 26% and 13% for stage IIIB and stage IIIC, respectively. When NSCLC has spread outside of the lungs, it can be difficult to treat successfully. The 5-year survival rate for stage IV NSCLC is around 1%.

Each year, tens of thousands of people are cured of NSCLC in the United States. And, some patients with advanced lung cancer can live many years after diagnosis. Sometimes patients who are told that their lung cancer is incurable live longer than many who are told that their lung cancer is curable. The important thing to remember is that lung cancer is treatable at any stage, and these treatments have been proven to help people with lung cancer live longer with better quality of life.

Furthermore, it is important to remember that statistics on the survival rates for people with NSCLC are an estimate. The estimate comes from annual data based on the number of people with this cancer in the United States. It is not an estimate of how long a person is likely to live with cancer. Also, experts measure the survival statistics every 5 years. So the estimate may not show the results of better diagnosis or treatments that have become widely available in the past 5 years. People should talk with their doctor if they have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts & Figures 2018, and the ACS website.

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by NSCLC. Use the menu to choose a different section to read in this guide.

Lung Cancer - Non-Small Cell - Medical Illustrations

Approved by the Cancer.Net Editorial Board, 08/2017

ON THIS PAGE: You will find a basic drawing of the main body parts affected by this disease. Use the menu to see other pages.

The lungs are located under the ribs, and above the liver, the adrenal gland, and the kidneys. The lungs are made up of 2 lobes, a right lobe and left lobe. A hollow tube, the trachea, carries air to the lungs, branching throughout both lobes. Lymph nodes, tiny, bean-shaped organs, are located in the lungs, the center of the chest, and elsewhere in the body. Copyright 2004 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

For medical illustrations showing the different stages of NSCLC, please visit the Stages section.

The next section in this guide is Risk Factors and Prevention. It explains what factors may increase the chance of developing this disease. You may use the menu to choose a different section to read in this guide.

Lung Cancer - Non-Small Cell - Risk Factors and Prevention

Approved by the Cancer.Net Editorial Board, 08/2017

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. Use the menu to see other pages.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices. NSCLC occurs most often in people who smoke or in those who have smoked in the past. However, people who don’t smoke can also develop NSCLC, so it is important for all people to learn about the risk factors and signs and symptoms of NSCLC.

The following factors may raise a person’s risk of developing NSCLC:

  • Tobacco and smoking. Tobacco smoke damages cells in the lungs, causing the cells to grow abnormally. The risk that smoking will lead to cancer is higher for people who smoke heavily and/or for a long time. Regular exposure to smoke from someone else’s cigarettes, cigars, or pipes can increase a person’s risk of lung cancer, even if that person does not smoke. This is called environmental or “secondhand” tobacco smoke.

    Smoking marijuana and using electronic cigarettes may also increase the risk of lung cancer, but the actual risk is unknown.

  • Asbestos. These are hair-like crystals found in many types of rock and are often used as fireproof insulation in buildings. When asbestos fibers are inhaled, they can irritate the lungs. Many studies show that the combination of smoking and asbestos exposure is particularly dangerous. People who work with asbestos in a job such as shipbuilding, asbestos mining, insulation, or automotive brake repair and who smoke have a higher risk of developing NSCLC. Using protective breathing equipment reduces this risk.

  • Radon. This is an invisible, odorless gas naturally released by some soil and rocks. Exposure to radon has been associated with an increased risk of some types of cancer, including lung cancer. Most hardware stores have kits that test home radon levels, and basements can be ventilated to reduce radon exposure.

  • Other substances. Other substances such as gases or chemicals at work or in the environment can increase a person’s risk of developing lung cancer. In some parts of the world, people exposed to cooking flames from coal or wood might have increased risk of lung cancer. Also, fumes from diesel gas or from soldering metals could increase the risk of lung cancer. Other factors that may increase the risk of lung cancer include exposure to radiation, arsenic, nickel, and chromium.

  • Genetics. Some people have a genetic predisposition for lung cancer. People with parents, brothers, or sisters with lung cancer could have a higher risk of developing lung cancer themselves.


Different factors cause different types of cancer. Researchers continue to look into what factors cause this type of cancer. Although there is no proven way to completely prevent this disease, you may be able to lower your risk. Talk with your doctor for more information about your personal risk of cancer.

The most important way to prevent lung cancer is to avoid tobacco smoke. People who never smoke have the lowest risk of lung cancer. People who smoke can reduce their risk of lung cancer by stopping smoking, but their risk of lung cancer will still be higher than people who never smoked.

Attempts to prevent lung cancer with vitamins or other treatments have not worked. For instance, beta-carotene, a drug related to vitamin A, has been tested for the prevention of lung cancer. It did not reduce the risk of cancer. In people who continued to smoke, beta-carotene actually increased the risk of lung cancer.

The next section in this guide is Screening. It explains how tests may find cancer before signs or symptoms appear. You may use the menu to choose a different section to read in this guide

Lung Cancer - Non-Small Cell - Screening

Approved by the Cancer.Net Editorial Board, 08/2017

ON THIS PAGE: You will find out more about screening for this type of cancer. You will also learn the risks and benefits of screening. Use the menu to see other pages.

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer. The overall goals of cancer screening are to lower the number of people who die from the disease or eliminate deaths from cancer altogether.

Learn more about the basics of cancer screening.

Screening information for lung cancer

Based on results from the National Lung Screening Trial, several groups, including ASCO, have developed recommendations for lung cancer screening. In addition, lung cancer screening is approved by Medicare. Recommended screening for lung cancer is done with a test called a low-dose helical or spiral computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors.

CT scanning is not recommended for every person who smokes. The current recommendations are discussed below. It is also important to receive screening at an approved and experienced center.

ASCO recommends the following lung cancer screening schedules for people who currently smoke or who have quit smoking:

  • Yearly screening with a low-dose CT scan is recommended for people age 55 to 74 who have smoked for 30 pack years or more. It is also recommended for those age 55 to 74 who have quit within the past 15 years.

  • CT screening is not recommended for people who have smoked for less than 30 pack years, are younger than 55 or older than 74, have quit smoking more than 15 years ago, or have a serious condition that could affect cancer treatment or shorten a person's life.

A pack year is equal to smoking 20 cigarettes (1 pack) a day each year.

The United States Preventive Services Task Force recommends that people age 55 to 80 who have smoked for 30 pack years or more or who have quit within the past 15 years receive screening for lung cancer with low-dose CT scans each year, and screening can stop after a person has not smoked for 15 years or develops a health problem that would shorten their life or prevent them from being able to have surgery for lung cancer.

Learn more about ASCO’s recommendations for lung cancer screening in current or former smokers and information on lung cancer screening from the National Cancer Institute. Also, you can listen to a Cancer.Net Podcast on Understanding Cancer Screening.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems this disease can cause. You may use the menu to choose a different section to read in this guide.  

Lung Cancer - Non-Small Cell - Symptoms and Signs

Approved by the Cancer.Net Editorial Board, 08/2017

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

People with NSCLC may experience the following symptoms or signs. Sometimes people with NSCLC do not have any of these changes. Or, the cause of a symptom may be a different medical condition that is not cancer.

  • Fatigue

  • Cough

  • Shortness of breath

  • Chest pain, if a tumor spreads to the lining of the lung or other parts of the body near the lungs

  • Loss of appetite

  • Coughing up phlegm or mucus

  • Coughing up blood

  • Unintentional weight loss

  • Hoarseness

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis.

For people with NSCLC who have no symptoms, the cancer may be noticed on a chest x-ray or CT scan performed for some other reason, such as checking for heart disease. Most people with NSCLC are diagnosed when the tumor grows, takes up space, or begins to cause problems with parts of the body near the lungs. A lung tumor may also make fluid that can build up in the lung or the space around the lung or push the air out of the lungs and cause the lung to collapse. This prevents oxygen from getting in the body and carbon dioxide from leaving the body by blocking the flow of air into the lungs, or by using up the space normally required for oxygen to come in and carbon dioxide to go out of the lung.

NSCLC can spread anywhere in the body through a process called metastasis. It most commonly spreads to the lymph nodes, other parts of the lungs, bones, brain, liver, and structures near the kidneys called the adrenal glands. Metastases from NSCLC can cause:

  • More breathing difficulties

  • Bone pain

  • Abdominal or back pain

  • Headache

  • Weakness

  • Seizures

  • Speech difficulties

  • Rarely, a lung tumor can release hormones that cause problems such as low blood sodium levels or high blood calcium levels.

Symptoms such as fatigue, feeling out-of-sorts or unwell, and loss of appetite are not necessarily caused by metastases. Cancer anywhere in the body can cause a person to feel unwell in a general way. Loss of appetite can cause weight loss and muscle loss. Fatigue and weakness can further worsen a person’s ability to breathe. Muscle loss also contributes to weakness and loss of mobility.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. You may use the menu to choose a different section to read in this guide.

Lung Cancer - Non-Small Cell - Diagnosis

Approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread, but they can never be used alone to diagnose NSCLC. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This list describes options for diagnosing this type of cancer. Not all tests listed below will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and medical condition

  • The results of earlier medical tests

In addition to a physical examination, the following tests may be used to diagnose and stage lung cancer:

Imaging tests

Imaging scans are very important in the care of people with NSCLC. However, no test is perfect, and no scan can diagnose NSCLC. Only a biopsy can do that (see below). Chest x-ray and scan results must be combined with a person’s medical history, a physical examination, blood tests, and information from the biopsy to form a complete story about where the cancer began and whether or where it has spread.

  • CT scan. A CT scan produces images that allow doctors to see the size and location of a lung tumor and/or lung cancer metastases. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow.

  • Positron emission tomography (PET) scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.  

  • Magnetic resonance imaging (MRI) scan. An MRI also produces images that allow doctors to see the location of a lung tumor and/or lung cancer metastases and measure the tumor’s size. An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow. MRI scanning does not work well to take pictures of parts of the body that are moving, like your lungs, which move with each breath you take. For that reason, MRI is rarely used to look at the lungs. However, it may be helpful to find lung cancer that has spread to the brain or bones.

  • Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer, appear dark. PET scans (see above) have been replacing bone scans to find NSCLC that has spread to the bones.

The procedures that doctors use to collect tissue to diagnose lung cancer and plan treatment are listed below:

  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. In recent years, doctors have learned it is helpful to have a larger tumor sample in order to determine the subtype of NSCLC and to do additional molecular testing (see below). If not enough of the tumor is removed to do these tests, another biopsy may be needed. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

  • Bronchoscopy. In a bronchoscopy, the doctor passes a thin, flexible tube with a light on the end into the mouth or nose, down through the main windpipe, and into the breathing passages of the lungs. A surgeon or a pulmonologist may perform this procedure. A pulmonologist is a medical doctor who specializes in the diagnosis and treatment of lung disease. The tube lets the doctor see inside the lungs. Tiny tools inside the tube can take samples of fluid or tissue so the pathologist can examine them. Patients are given mild anesthesia during a bronchoscopy. Anesthesia is medication to block the awareness of pain.

  • Needle aspiration/core biopsy. After numbing the skin, a special type of radiologist, called an interventional radiologist, removes a sample of the lung tumor for testing. This can be done with a smaller needle or a larger needle depending on how large of a sample is needed. The doctor uses the needle to remove a sample of tissue for testing. Often, the radiologist uses a chest CT scan or special x-ray machine called a fluoroscope to guide the needle. In general, a core biopsy provides a larger amount of tissue than a needle aspiration. As explained above, doctors have learned that more tissue is needed in NSCLC for diagnosis and molecular testing.

  • Thoracentesis. After numbing the skin on the chest, a needle is inserted through the chest wall and into the space between the lung and the wall of the chest where fluid can collect. The fluid is removed and checked for cancer cells by the pathologist.

  • Thoracoscopy. Through a small cut in the skin of the chest wall, a surgeon can insert a special instrument and a small video camera to assist in the examination of the inside of the chest. Patients need general anesthesia for this procedure, but recovery time may be shorter with a thoracoscopy because of the smaller incisions that are used. This procedure may be referred to as video-assisted thoracoscopic surgery or VATS.

  • Mediastinoscopy. A surgeon examines and takes a sample of the lymph nodes in the center of the chest underneath the breastbone by making a small incision at the top of the breastbone. This procedure also requires general anesthesia and is done in an operating room.

  • Thoracotomy. This procedure is performed in an operating room, and the patient receives general anesthesia. A surgeon then makes an incision in the chest, examines the lung directly, and takes tissue samples for testing. A thoracotomy is the procedure surgeons most often use to completely remove a lung tumor.

Molecular testing of the tumor

Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor.

There are several genes that may be changed, called mutations, in a lung tumor that can help the cancer grow and spread. These mutations are found in the tumor, and not in healthy cells in the body. This means that they are not inherited or passed down to your children. Mutations that are known to contribute to lung cancer growth often occur on 1 or more of several genes, including EGFRALKKRASBRAFHER2, ROS1, and RET. Testing the tumor for some of these genes is now common for later-stage NSCLC. Testing for these genes may also be done for earlier stages of the disease.

Results from these molecular tests help decide whether your treatment options include a type of treatment called targeted therapy, which can be directed at specific mutations (see Treatment Options). Mutations for which targeted therapies exist are much more likely to occur in patients with the adenocarcinoma type of NSCLC and in patients who never smoked.

If you have later-stage NSCLC, your doctor may also recommend PD-L1 testing. PD-L1 is found on the surface of cancer cells. This protein stops the body’s immune cells from destroying the cancer. Knowing if the tumor has PD-L1 helps your doctor decide whether your treatment options include certain types of immunotherapy (see Treatment Options). These types of immunotherapy block PD-L1 and allow the immune system to target the cancer.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

Finding out where the cancer started

NSCLC starts in the lungs. Many other types of cancer start elsewhere in the body and spread to the lungs when they metastasize. For example, breast cancer that has spread to the lungs is still called breast cancer. Therefore, it is important for doctors to know if the cancer started in the lungs or elsewhere.

To find where the cancer started, your doctor will take into account your symptoms and medical history, physical examination, how the tumor looks on x-rays and scans, and your risk factors for cancer. A pathologist can perform tests on the biopsy sample to help find out where the cancer began. Your doctor may recommend other tests to rule out specific types of cancer. If, after these considerations, the doctor is still not sure where the cancer started, the doctor may give a diagnosis of metastatic cancer “of unknown primary.” Most treatments for metastatic cancer of unknown primary that are first found in the chest are the same as those for metastatic lung cancer.

Coping with a NSCLC diagnosis

For most patients, a diagnosis of NSCLC is extremely stressful. Some patients develop anxiety and, less commonly, depression. Patients and their families should not be afraid to express the way they are feeling to doctors, nurses, and social workers. The health care team is there to help, and many team members have special training and experience that can make things easier for patients and their families.

In addition to emotional support and education, the doctor may prescribe anti-anxiety medication and occasionally, an antidepressant. He or she may refer the patient to a counselor, psychologist, social worker, or psychiatrist. Furthermore, patients and their families should be aware that there are resources available in the community to help people living with lung cancer. Some patients feel comfortable discussing their disease and experiences throughout treatment with their doctor, nurse, family, friends, or other patients through a support group. These patients may also join a support group or advocacy group in order to increase awareness about lung cancer and to help fellow patients who are living with this disease.

A NSCLC diagnosis is serious. However, patients can be hopeful that their doctors can offer them effective treatment. They may also be able to take some comfort knowing that the advances being made in the diagnosis and treatment of NSCLC will provide more and more patients with a chance for cure.

Learn more about the counselingfinding a support group, and being a cancer advocate.

Stopping smoking

Even after NSCLC is diagnosed, it is still beneficial to quit cigarette smoking. People who stop smoking have an easier time with all treatments, feel better, live longer, and have a lower risk of developing a second lung cancer or other health problems. Stopping smoking is never easy and even harder when facing the diagnosis of NSCLC. People who smoke should seek help from family, friends, programs for quitting smoking, and health care professionals. None of the products available to quit smoking interfere with cancer treatment. Learn more about stopping tobacco use after a cancer diagnosis.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. You may use the menu to choose a different section to read in this guide.

Lung Cancer - Non-Small Cell - Stages

Approved by the Cancer.Net Editorial Board, 08/2017

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. Use the menu to see other pages.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

In general, a lower number stage of NSCLC is linked with a better outcome. However, no doctor can predict how long a patient will live with lung cancer based only on the stage of disease. This is because lung cancer is different in each person and treatment works differently for each tumor.

Cancer stage grouping

The stage of NSCLC is based on a combination of several factors, including:

  • The size and location of the tumor

  • Whether it has spread to the lymph nodes and/or other parts of the body.

There are 5 stages for NSCLC: stage 0 (zero) and stages I through IV (1 through 4). One way to determine the staging of NSCLC is to find out whether the cancer can be completely removed by a surgeon. To completely remove the lung cancer, the surgeon must remove the cancer, along with the surrounding, healthy lung tissue. Learn more about treatment options for NSCLC.

Stage 0

This is called in situ disease, meaning the cancer is “in place” and has not grown into nearby tissues and spread outside the lung.

Stage I

A stage I lung cancer is a small tumor that has not spread to any lymph nodes, making it possible for a surgeon to completely remove it. Stage I is divided into 2 substages based on the size of the tumor:

  • Stage IA tumors are 3 centimeters (cm) or less in size. Stage IA tumors may be further divided into IA1, IA2, or IA3 based on the size of the tumor.

  • Stage IB tumors are more than 3 cm but 4 cm or less in size.

Stage II

Stage II lung cancer is divided into 2 substages:

  • A stage IIA cancer describes a tumor larger than 4 cm but 5 cm or less in size that has not spread to the nearby lymph nodes.

  • Stage IIB lung cancer describes a tumor that is 5 cm or less in size that has spread to the lymph nodes. Or, a stage IIB cancer can be a tumor more than 5 cm wide that has not spread to the lymph nodes.

Sometimes, stage II tumors can be removed with surgery, and other times, more treatments are needed.

Stage III

Stage III lung cancers are classified as either stage IIIA, IIIB, or IIIC. The stage is based on the size of the tumor and which lymph nodes the cancer has spread to. Stage III cancers have not spread to other distant parts of the body.

For many stage IIIA cancers and nearly all stage IIIB cancers, the tumor is difficult, and sometimes impossible, to remove with surgery. For example, the lung cancer may have spread to the lymph nodes located in the center of the chest, which is outside the lung. Or, the tumor may have grown into nearby structures in the lung. In either situation, it is less likely that the surgeon can completely remove the cancer because removal of the cancer must be performed bit by bit.

Stage IV

Stage IV means the lung cancer has spread to more than 1 area in the other lung, the fluid surrounding the lung or the heart, or distant parts of the body through the bloodstream. Once cancer cells get into the blood, the cancer can spread anywhere in the body. But, NSCLC is more likely to spread to the brain, bones, liver, and adrenal glands. Stage IV NSCLC is divided into 2 substages:

  • Stage IVA cancer has spread within the chest and/or has spread to 1 area outside of the chest.

  • Stage IVB has spread outside of the chest to more than 1 place in 1 organ or to more than 1 organ.

In general, surgery is not successful for most stage III or IV lung cancers. Lung cancer can also be impossible to remove if it has spread to the lymph nodes above the collarbone. It can also be impossible to remove if it has grown into vital structures within the chest. These vital structures include the heart, large blood vessels, or the main breathing tubes leading to the lungs. In these situations, the doctor will recommend other treatment options.

Recurrent NSCLC

Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing.


The type and stage of NSCLC and the patient’s overall health influence prognosis. Although NSCLC is treatable at any stage, only some people with certain stages can be cured.

Doctors measure a patient’s general strength and health using an index known as performance status. Patients who are strong enough to go about their daily activities without assistance and work outside the home can safely receive chemotherapy, radiation therapy, and/or surgery. Treatment may not be as effective for patients with bone or liver metastases from lung cancer, excessive weight loss, ongoing cigarette use, or pre-existing medical conditions, such as heart disease or emphysema.

It is important to note that a patient’s age has never been useful in predicting whether a patient will benefit from treatment. The average age of patients with lung cancer in the United States is 71. A patient’s age should never be used as the only reason for deciding what treatment is best, especially for older patients who are otherwise physically fit and have no medical problems besides lung cancer.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. You may use the menu to choose a different section to read in this guide.

Lung Cancer - Non-Small Cell - Treatment Options

Approved by the Cancer.Net Editorial Board, 08/2017

ON THIS PAGE: You will learn about the different treatments doctors use for people with NSCLC. Use the menu to see other pages.

This section tells you the treatments that are the standard of care for this type of cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others. 

Patients should have a sense that their doctors have a coordinated plan of care and are working effectively with one another. If patients do not feel that the members of their health care team are communicating effectively with them or each other about the goals of treatment and the plan of care, patients should discuss this with their doctors or seek additional medical opinions before treatment.

There are 5 basic ways to treat NSCLC:

  • Surgery

  • Radiation therapy

  • Chemotherapy

  • Targeted therapy

  • Immunotherapy

Each treatment option is described below, followed by an outline of common treatment plans by the stage of NSCLC. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. Learn more about making treatment decisions.


A surgical oncologist is a doctor who specializes in treating cancer using surgery. A thoracic surgeon is specially trained to perform lung cancer surgery. The goal of surgery is to completely remove the lung tumor and the nearby lymph nodes in the chest. The tumor must be removed with a surrounding border or margin of healthy lung tissue. A “negative margin” means that when the pathologist examined the lung or a piece of lung that was removed by the surgeon, no cancer was found in the healthy tissue surrounding the tumor.

The following types of surgery may be used for NSCLC:

  • Lobectomy. The lungs have 5 lobes, 3 in the right lung and 2 in the left lung. The removal of an entire lobe of the lung in a procedure called a lobectomy is currently thought to be the most effective type of surgery, even when the lung tumor is very small.

  • A wedge resection. If the surgeon cannot remove an entire lobe of the lung, the surgeon can remove the tumor, surrounded by a margin of healthy lung.

  • Segmentectomy. This is another way to remove the cancer when an entire lobe of the lung cannot be removed. In a segmentectomy, the surgeon removes the portion of the lung where the cancer developed.

  • Pneumonectomy. If the tumor is close to the center of the chest, the surgeon may have to remove the entire lung.

The time it takes to recover from lung surgery depends on how much of the lung is removed and the health of the patient before surgery. Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of cancer surgery.

Adjuvant therapy

“Adjuvant therapy” is treatment that is given after surgery to lower the risk of the lung cancer returning. Adjuvant therapy may include radiation therapy, chemotherapy, targeted therapy, or immunotherapy. Each therapy is described below. It is intended to get rid of any lung cancer cells that may still be in the body after surgery. It also helps lower the risk of recurrence, though there is always some risk that the cancer will come back.

Radiation therapy

Radiation therapy is the use of high energy x-rays or other particles to destroy cancer cells. If you need radiation therapy, you will be asked to see a specialist called a radiation oncologist. A radiation oncologist is the doctor who specializes in giving radiation therapy to treat cancer. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. This can vary from just a few days of treatment to several weeks.

Like surgery, radiation therapy cannot be used to treat widespread cancer. Radiation therapy only destroys cancer cells directly in the path of the radiation beam. It also damages the healthy cells in its path. For this reason, it cannot be used to treat large areas of the body.

Sometimes, CT scans (see Diagnosis) are used to plan out exactly where to direct the radiation to lower the risk of damaging healthy parts of the body. This is called intensity modulated radiation therapy (IMRT) or stereotactic body radiation therapy (SBRT). It is not an option for all patients, but it may be used for patients with early-stage disease and small tumors when surgery is not an option.

Listen to a Cancer.Net Podcast on ASCO’s recommendations for radiation therapy for NSCLC.

Side effects of radiation therapy

Patients with lung cancer who receive radiation therapy often experience fatigue and loss of appetite. If radiation therapy is given to the neck or center of the chest, patients may develop a sore throat and have difficulty swallowing. Patients may notice skin irritation, similar to sunburn, where the radiation therapy was directed. Most side effects go away soon after treatment is finished.

If the radiation therapy irritates or inflames the lung, patients may develop a cough, fever, or shortness of breath months and sometimes years after the radiation therapy ends. About 15% of patients develop this condition, called radiation pneumonitis. If it is mild, radiation pneumonitis does not need treatment and goes away on its own. If it is severe, a patient may need treatment for radiation pneumonitis with steroid medications, such as prednisone (multiple brand names). Radiation therapy may also cause permanent scarring of the lung tissue near where the original tumor was located. Typically, the scarring does not cause symptoms. However, severe scarring can cause a permanent cough and shortness of breath. For this reason, radiation oncologists carefully plan the treatments using CT scans of the chest to lessen the amount of healthy lung tissue exposed to radiation (see above).

Learn more about the basics of radiation therapy.


Chemotherapy is the use of drugs to destroy cancer cells, usually by ending the cancer cells’ ability to grow and divide. It has been shown to improve both the length and quality of life for people with lung cancer of all stages. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). Most types of chemotherapy used for lung cancer are given by IV injection.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. The type of lung cancer you have, such as adenocarcinoma or squamous cell carcinoma, affects which drugs are used for chemotherapy.

Common drugs used to treat lung cancer include either 2 or 3 drugs given together or 1 drug given by itself. Some common drugs include:

  • Carboplatin (Paraplatin) or cisplatin (Platinol)

  • Docetaxel (Docefrez, Taxotere)

  • Gemcitabine (Gemzar)

  • Nab-paclitaxel (Abraxane)

  • Paclitaxel (Taxol)

  • Pemetrexed (Alimta)

  • Vinorelbine (Navelbine)

Chemotherapy may also damage healthy cells in the body, including blood cells, skin cells, and nerve cells. The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, low numbers of blood cells, risk of infection, mouth sores, nausea and vomiting, loss of appetite, diarrhea, numbness and tingling in the hands and feet, and hair loss. Your medical oncologist can often prescribe drugs to help relieve many of these side effects. Hormone injections are used to prevent white and red blood cell counts from becoming too low. Nausea and vomiting are also often avoidable. Learn more about preventing nausea and vomiting caused by cancer treatment. These side effects usually go away after treatment is finished.

Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Targeted therapy (updated 11/2018)

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in the tumor. For some lung cancers, abnormal proteins are found in unusually large amounts in the cancer cells. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.

For NSCLC, the following types of targeted therapy may be used, particularly in clinical trials. Talk with your doctor about possible side effects for a specific medication and how they can be managed.

  • Anti-angiogenesis therapy. Anti-angiogenesis therapy is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor. The following anti-angiogenic drugs may be options for lung cancer:

    • Bevacizumab (Avastin) is an anti-angiogenic drug given along with chemotherapy for lung cancer. The risk of serious bleeding for patients taking bevacizumab is about 2%. However, it is more common for patients with squamous cell carcinoma, so bevacizumab is not recommended for patients with this type of NSCLC.

    • Ramucirumab (Cyramza) is approved for NSCLC along with the chemotherapy docetaxel.

  • Epidermal growth factor receptor (EGFR) inhibitors. Researchers have found that drugs that block EGFR may be effective for stopping or slowing the growth of lung cancer.

    • Afatinib (Gilotrif) is an initial treatment option for NSCLC. It is a type of drug called a tyrosine kinase inhibitor (TKI).

    • Erlotinib (Tarceva) has been shown to work better than chemotherapy if the lung cancer has a mutation in the EGFR gene. It is an option for patients with locally advanced and metastatic NSCLC. It may also be used as a maintenance therapy for patients with NSCLC that has not grown or spread after at least 4 cycles of chemotherapy. This medication is a pill that can be taken by mouth. The side effects of erlotinib include a rash that looks like acne, and diarrhea.

    • Gefitinib (Iressa) is another option that was only available in Europe and Asia but now is also available in the United States.

    • Necitumumab (Portrazza) may be an option along with chemotherapy for squamous cell lung cancer.

    • Osimertinib (Tagrisso) is a first treatment option for some people with NSCLC whose tumors have EGFR mutations as detected by an FDA-approved test. Osimertinib is also approved for the treatment of metastatic NSCLC with an EGFR mutation when the other drugs listed above no longer work.

  • Drugs that target other genetic changes. Researchers have found that targeting other genetic changes in lung tumors may help stop or slow the growth of NSCLC. An example is anaplastic lymphoma kinase (ALK) inhibitors. Mutations in the ALK gene are found in about 5% of patients with NSCLC. Another example are drugs that target changes in a gene called ROS1. The following are currently available drugs that target ALK and or ROS1 genes:

    • Alectinib (Alecensa): targets ALK gene mutations

    • Brigatinib (Alunbrig): targets ALK and EGFR gene mutations

    • Ceritinib (Zykadia): targets ALK gene mutations

    • Combination of dabrafenib (Taflinlar) and tremetinib (Mekinist): for BRAF V600E gene mutations

    • Crizotinib (Xalkori): targets ALK or ROS1 genes mutations

    • Lorlatinib (Lorbrena): targets ALK gene mutations


Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. For example, the PD-1 pathway may be critical in the immune system’s ability to control cancer growth. Blocking this pathway with PD-1 and PD-L1 antibodies has stopped or slowed the growth of NSCLC for some patients. The following drugs block this pathway:  

  • Atezolizumab (Tecentriq)

  • Nivolumab (Opdivo)

  • Pembrolizumab (Keytruda)

Different types of immunotherapy can cause different side effects. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatments intended to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. People often receive treatment for the cancer at the same time that they receive treatment to ease side effects. In fact, patients who receive both at the same time often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

The following treatments may be given to help relieve the symptoms of NSCLC:

  • A tumor in the chest that is bleeding or blocking the lung passages can be shrunk with radiation therapy.

  • During a bronchoscopy (See Diagnosis), lung passages blocked by cancer can be opened to improve breathing.

  • A surgeon can place a stent to prop open an airway or use a laser to burn away a tumor.

  • Medications are used to treat cancer pain. Most hospitals and cancer centers have pain control specialists who provide pain relief, even for severe cancer pain. Many drugs used to treat cancer pain, especially morphine, can also relieve shortness of breath caused by cancer. Learn more about managing cancer pain.

  • Medications can be used to stop a cough, open closed airways, or reduce bronchial secretions.

  • Prednisone or methylprednisolone (multiple brand names) can reduce inflammation caused by lung cancer or radiation therapy and improve breathing.

  • Extra oxygen from small, portable tanks can help make up for the lung’s reduced ability to extract oxygen from the air.

  • Medications are available to strengthen bones, lessen bone pain, and help prevent future bone metastases.

  • Appetite stimulants and nutritional supplements can improve appetite and reduce weight loss.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. During and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.

Treatment of NSCLC by stage

Stage I and II NSCLC

In general, stage I and stage II NSCLC are treated with surgery. Surgeons cure many people with an operation. Before or after surgery, a patient may meet with a medical oncologist. Some patients with large tumors or signs that the tumor has spread to the lymph nodes may benefit from chemotherapy. Chemotherapy may be given before the surgery, called neoadjuvant chemotherapy or induction chemotherapy. Or, chemotherapy may be given after surgery, called adjuvant chemotherapy, to reduce the chance the cancer will return.

Adjuvant chemotherapy with cisplatin is not recommended for patients with stage IA NSCLC that was completely removed with surgery. Patients with stage IB lung cancers should talk with their doctors about whether chemotherapy is right for them after surgery. Adjuvant cisplatin-based chemotherapy is recommended for patients with stage II NSCLC that has been completely removed with surgery. Patients with stage II NSCLC should talk with their doctor about whether this treatment is right for them.


More than 30,000 patients are diagnosed with stage III NSCLC every year, and there is no single best treatment for all of these patients. Treatment options depend on the size and location of the tumor and the lymph nodes that are involved. The options generally include:

  • Radiation therapy

  • Chemotherapy

  • Surgery

In general, people with stage III NSCLC receive at least 2 different types of treatment, sometimes 3. A combination of chemotherapy and radiation therapy is usually recommended. Chemotherapy and radiation therapy may be given together, which is called concurrent chemoradiotherapy. Or, they may be given one after the other, called sequential chemoradiotherapy. Adjuvant cisplatin-based chemotherapy is recommended for people with stage IIIA lung cancers that have been completely removed with surgery. Patients should talk with their doctor about the best treatment options for them.

Surgery may be an option after initial chemotherapy or chemotherapy with radiation therapy. Sometimes, surgery may be the first treatment, particularly when cancer is found in the lymph nodes unexpectedly after a person has originally been diagnosed with stage I or stage II cancer. If this occurs, surgery is generally followed by chemotherapy and often radiation therapy.

Metastatic or stage IV NSCLC

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Patients with stage IV NSCLC typically do not receive surgery or radiation therapy as the main treatment. Occasionally, doctors may recommend surgery for a metastasis in the brain or adrenal gland if that is the only place the cancer has spread. People with stage IV disease have a very high risk of the cancer spreading or growing in another location. Most patients at this stage of NSCLC receive chemotherapy, targeted therapy, or immunotherapy. These types of treatments are often called systemic therapy. Palliative care will also be important to help relieve symptoms and side effects.

Systemic therapy for metastatic or stage IV NSCLC

The goals of systemic therapies are to shrink the cancer, relieve discomfort caused by the cancer, prevent the cancer from spreading further, and lengthen a patient’s life. These treatments can occasionally make metastatic lung cancer disappear. However, doctors know from experience that the cancer will usually return. Therefore, patients with stage IV disease are never considered “cured” of their cancer no matter how well treatment works. Treatment often continues as long as it is controlling the cancer’s growth. Systemic therapy and palliative care have been proven to improve both length and quality of life for patients with stage IV NSCLC. If the cancer worsens or causes too many severe side effects, the treatment may be stopped. Patients would continue to receive palliative care and may be offered treatment in a clinical trial.

The first drug or combination of drugs a patient takes is called “first-line” treatment, which may be followed by “second-line” and “third-line” treatment. No specific treatment or combination of treatments works for every patient. If the first-line treatment causes unpleasant or dangerous side effects, does not appear to be working, or stops working, the doctor may recommend a change in treatment. ASCO’s recommendations for systemic therapies for NSCLC are included below. All patients should also receive palliative care.

First-line treatment. First-line systemic therapy for NSCLC often depends on the genetic changes found in the tumor.

  • For patients with tumors that do not have changes in the EGFR, ALK, or ROS1 genes, the options include:

    • Pembrolizumab for patients with tumors that have a high level of the PD-L1 protein

    • Chemotherapy with a combination of drugs for people with tumors that do not have high levels of PD-L1. This may include bevacizumab for patients with non-squamous cell carcinoma who are receiving carboplatin and paclitaxel.

    • Pembrolizumab may also be added to chemotherapy with carboplatin and pemetrexed for patients with non-squamous cell carcinoma.

  • For patients with tumors that have a genetic change on the EGFR gene, the following targeted therapies called TKIs may be options:

    • Afatinib

    • Erlotinib

    • Gefitinib

  • For patients with tumors that have a genetic change on the ALK gene, targeted therapy with alectinib, brigatinib, ceritinib, or crizotinib are options.

  • For patients with tumors that have a genetic change on the ROS1 gene, crizotinib is an option.

Second-line treatment. Second-line treatment for NSCLC depends on the gene mutations found in the tumor and the treatments patients have already received.

  • For patients with tumors that do not have changes in the EGFR, ALK, or ROS1 genes, the options include:

    • Nivolumab, pembrolizumab, or atezolizumab if they have a high level of PD-L1, received chemotherapy for first-line treatment, and have not received immunotherapy

    • Nivolumab, atezolizumab, or chemotherapy if they have a low or unknown level of PD-L1 and have already received chemotherapy  

    • Chemotherapy for patients who have already received immunotherapy

    • Docetaxel for patients who had severe side effects from immunotherapy

    • Pemetrexed for patients with non-squamous cell carcinoma who did not receive it during first-line treatment

  • For patients with tumors that have an EGFRgene mutation, the best treatment option depends on how the cancer worsened and whether the cancer developed a mutation called T790M, which makes it resistant to the TKI. Options include:

    • Osimertinib

    • Additional chemotherapy

    • Continued treatment with a TKI, plus surgery or radiation therapy to the areas where the cancer has spread

  • For patients with tumors that have a ROS1gene mutation, treatment options depend on the treatments received previously:

    • Crizotinib, if patients have not already received it

    • Chemotherapy, which may be given along with bevacizumab

  • For patients with tumors that have a BRAFmutation, options depend on whether they have already received immunotherapy:

    • Atezolizumab, nivolumab, or pembrolizumab for patients who have not already received any of these immunotherapies

    • Dabrafenib or a combination of dabrafenib and trametinib for patients who have already received immunotherapy

Third-line treatment. Third-line treatment for NSCLC is usually chemotherapy with pemetrexed or docetaxel.

Radiation therapy for brain metastases

Chemotherapy is often not as effective as radiation therapy or surgery to treat NSCLC that has spread to the brain. For this reason, NSCLC that has spread to the brain is treated with radiation therapy, surgery, or both. This can cause side effects such as hair loss, fatigue, and redness of the scalp. With a small tumor, a type of radiation therapy called stereotactic radiosurgery can focus the radiation only on the tumor in the brain and lessen the side effects.

Palliative care

Palliative care will also be important to help relieve symptoms and side effects. Radiation therapy or surgery may also be used to treat metastases that are causing pain or other symptoms. Bone metastases that weaken major bones can be treated with surgery, and the bones can be reinforced using metal implants.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED. 

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence). Most often, when there is recurrence, it is stage IV disease.

When this is a recurrence, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above such as surgery, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment doesn’t work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for many people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than 6 months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. You may use the menu to choose a different section to read in this guide.

Lung Cancer - Non-Small Cell - About Clinical Trials

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ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. Use the menu to see other pages.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for patients with NSCLC. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the FDA was tested in clinical trials. Doctors generally do clinical research in distinct phases that have different goals. Learn more about the phases of clinical trials.

Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. These studies evaluate new drugs and methods of treatment, new approaches to existing treatments, and new prevention methods. Patients who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there are some risks with a clinical trial, including possible side effects and that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.

Deciding to join a clinical trial

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are a way to contribute to the progress in treating NSCLC. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with NSCLC.

Insurance coverage of clinical trials costs differs by location and by study. In some programs, some of the patient’s expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” Placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should:

  • Describe all of the patient’s options so that the person understands how the new treatment differs from the standard treatment.

  • List all of the risks of the new treatment, which may or may not be different from the risks of standard treatment.

  • Explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends. 

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for NSCLC, learn more in the Latest Research section.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer

PRE-ACT, Preparatory Education About Clinical Trials

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research. It explains areas of scientific research currently going on for this type of cancer. You may use the menu to choose a different section to read in this guide.

Lung Cancer - Non-Small Cell - Latest Research

Approved by the Cancer.Net Editorial Board, 08/2017

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about NSCLC, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

  • Personalized therapy. Researchers are looking at features of lung tumors that can predict whether a specific chemotherapy or targeted therapy may be effective. To collect this information, patients are increasingly being asked to have additional analyses of the tumor samples taken when the disease is first diagnosed. In many patients for whom chemotherapy is recommended, the amount of tumor tissue removed during the biopsy to diagnose their cancer is not enough for these additional tests. These patients may be asked to have another biopsy to help plan treatment and, if part of a clinical trial, to help researchers find better ways to treat lung cancer. Learn more about personalized therapy.

  • Targeted therapy. Researchers are looking at gene and protein changes that could be new targets for treatment. These include changes called met exon 14 skipping mutations, NTRK translocations, HER-2 mutations, and RET translocations

  • Immunotherapy. Promising results in immunotherapy for NSCLC and the recent approval of multiple types of immunotherapy are leading to more research on using these types of drugs to help the immune system control NSCLC growth.

  • Better techniques for surgery and radiation therapy. Doctors are finding ways to improve the effectiveness of surgery and radiation therapy while reducing the side effects of these procedures. For example, a current study is comparing the removal of the cancer and the nearby lung tissue with lobectomy for early-stage NSCLC. Other studies are looking at video-assisted thoracoscopic surgery (VATS), which allows the surgery to be done through smaller openings in the chest. Stereotactic radiation therapy is also being studied for NSCLC. This technique is used to focus radiation therapy more directly on the cancer and spare healthy tissue. Advances in all types of treatment will improve doctors’ ability to combine chemotherapy, radiation therapy, and surgery for the treatment of all stages of NSCLC.

  • Improved screening. NSCLC is more successfully treated in its early stages, which has raised interest in screening people for lung cancer before it causes signs and symptoms. Researchers are studying free-floating cancer DNA from blood tests to learn if these tests could help find molecular changes that can be used to plan treatment. These tests are often called circulating tumor DNA tests and may also be referred to as a “liquid biopsy.” Genetic testing to learn which people have a higher risk of lung cancer is also being researched.

  • Stopping tobacco use. Even with the best methods for the early detection and treatment of lung cancer, the best way to save lives from lung cancer is through programs to encourage people to never begin smoking and, if they have, quit cigarette smoking. For most people, lung cancer is a highly preventable disease. Even for people with lung cancer, stopping smoking lengthens their lives, lowers side effects, and lessens their chance of getting a second lung cancer. Quitting smoking is hard at any time, and even more so during cancer treatment. The health care team can help make it easier to quit smoking with nicotine replacement and other techniques. Research continues into new ways to help people stop smoking.

  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current lung cancer treatments to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding NSCLC, explore these related items that take you outside of this guide:

The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. You may use the menu to choose a different section to read in this guide.

Lung Cancer - Non-Small Cell - Coping with Treatment

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ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. This page includes several links outside of this guide to other sections of this website. Use the menu to see other pages.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people don’t experience the same side effects even when they are given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for NSCLC are described within the Treatment Options section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as sadness, anxiety, or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people don’t know what to say in response.

Patients and their families are encouraged to share their feelings with a member of their health care team. You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Patients and their families are encouraged to talk about financial concerns with a member of their health care team. Learn more about managing financial considerations, in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with NSCLC. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers take care of:

  • Providing support and encouragement

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Although the main focus of caregivers is usually the person they are caring for, it is also important for caregivers to seek support. Such support may be available through family, friends, support groups specific for caregivers, or professional counselors. Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they are likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.  

The next section in this guide is Follow-up Care. It explains the importance of check-ups after cancer treatment is finished. You may use the menu to choose a different section to read in this guide.  

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ON THIS PAGE: You will read about your medical care after cancer treatment is completed, and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. During this period, tell your doctor or nurse about any new problem that lasts for more than 2 weeks. Learn more about the importance of follow-up care.

Watching for recurrence or second cancer

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors including the type and stage of cancer originally diagnosed and the types of treatment given.

People who develop NSCLC are at higher risk for developing a second lung cancer. Your doctor will recommend having future scans to monitor for a recurrence so any new cancer can be found as early as possible.

The anticipation before having a follow-up test or waiting for test results can add stress to you or a family member. This is sometimes called “scan-xiety.” Learn more about how to cope with this type of stress.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

Common post-treatment problems include pain, fatigue, and shortness of breath. Your doctor, nurse, and social worker can help you develop a plan to manage any problems that persist after treatment.

Survivors of NSCLC who have smoked cigarettes in the past also have a high risk of heart disease, stroke, emphysema, and chronic bronchitis. Certain cancer treatments can further increase these risks. Even for those who don’t smoke, healthy lifestyle choices after cancer are important for overall well-being.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. You may use the menu to choose a different section to read in this guide.

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ON THIS PAGE: You will read about how to with challenges in everyday life after a cancer diagnosis. Use the menu to see other pages.

What is survivorship?

The word “survivorship” means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain about coping with everyday life.

Survivors may feel some stress when their frequent visits to the health care team end after completing treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true when new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing

  • Thinking through solutions

  • Asking for and allowing the support of others

  • Feeling comfortable with the course of action you choose

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the place where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Caregivers may also view the transition into survivorship differently than the patient, as they may not be as actively involved in ongoing follow-up care.

Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

Nothing helps recovery more than stopping smoking. There are many tools and approaches available. Be sure to get help from your family, friends, nurses, and doctors because it is difficult to stop on your own.

People recovering from lung cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Recovering patients, even those using oxygen, are encouraged to walk for 15 to 30 minutes each day to improve their heart and lung functioning. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

It is important to have recommended medical checkups and tests (see Follow-up Care) to take care of your health. Cancer rehabilitation may be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The booklet is available as a PDF, so it is easy to print out.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment. 

  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including those in different age groups.

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. You may use the menu to choose a different section to read in this guide.  

Lung Cancer - Non-Small Cell - Questions to Ask the Health Care Team

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ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with your health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your care.

Questions to ask after getting a diagnosis

  • What type of NSCLC do I have?

  • What is the stage of the NSCLC? What does this mean?

  • Can you explain my pathology report (laboratory test results) to me?

  • What mutations does the tumor have? What does this mean?

  • Do my family members have a higher risk of NSCLC?

Questions to ask about choosing a treatment and managing side effects

  • What are my treatment options?

  • What clinical trials are available for me? Where are they located, and how do I find out more about them?

  • Who will be leading my overall treatment?

  • Who else will be part of my health care team, and what does each member do?

  • Should I see other doctors to assist in my care, such as a thoracic surgeon, radiation oncologist, medical oncologist, and/or pulmonologist? What is the role of each doctor?

  • What treatment plan do you recommend? Why?

  • Do I need additional scans or biopsies in order to plan my treatment?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • What are the possible side effects of this treatment, both in the short term and the long term?

  • In addition to treating my cancer, what can be done to treat my symptoms?

  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • Could this treatment affect my sex life? If so, how and for how long?

  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

  • If I’m worried about managing the costs of cancer care, who can help me?

  • If I’m participating in a clinical trial, what are the costs I need to pay? What is covered by my health insurance?

  • What support services are available to me? To my family?

  • What online resources do you recommend to learn more?

  • Whom should I call with questions or problems?

Questions to ask about having surgery

  • What type of surgery will I have? Will lymph nodes be removed?

  • How long will the operation take?

  • How long will I be in the hospital?

  • Can you describe what my recovery from surgery will be like?

Questions to ask about having chemotherapy, targeted therapy, or immunotherapy

  • What are the names of the drugs, and how will they be given?

  • What are the possible side effects of each medication? What side effects or problems should I watch for?

  • What can be done to lessen these side effects?

  • How often will I need to visit the doctor to receive the therapy, and how long will each visit take?

  • Will I be able to go to and return from this treatment on my own, or should I arrange to have assistance?

  • What are the recommendations for people who take their medication at home?

  • What will these medications cost me? Are there less expensive options that work as well?

Questions to ask about radiation therapy

  • How will my treatment be planned? What types of scans will be used?

  • Where will I receive radiation therapy?

  • How often will I receive radiation therapy?

  • How much time will each treatment take?

  • How much of the healthy lung will be included in the radiation field?

  • Is it possible for me to receive chemotherapy with my radiation therapy? If so, what are the added side effects of giving the chemotherapy at the same time, compared with 1 after another?

  • Will I be able to go to and return from this treatment on my own, or should I arrange to have assistance?

  • How much will this treatment cost me? What other options are available that are equally effective and possibly less expensive?

Questions to ask about clinical trials

  • What are my options for standard treatment?

  • What other treatments through clinical trials are available to me?

  • How will my experience differ if I enroll in this clinical trial, as opposed to standard treatment. For example, are there different risks, extra tests, a different time commitment, schedule, or costs?

  • What is the goal of this clinical trial? Is this a phase I, II, or III clinical trial? What does this mean?

  • Where will I receive the clinical trial treatment?

  • What costs will I have to pay if I join this trial? What costs will be covered by my insurance or the clinical trial?

Questions to ask about planning follow-up care

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

  • Is there anything more I can do to reduce the chance that my cancer will return?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • What follow-up tests will I need and how often will I need them?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be leading my follow-up care?

  • What tests will I have during my follow-up visit?

  • What survivorship support services are available to me? To my family?

Questions for patients who smoke

  • What are the benefits of me quitting smoking, even after a cancer diagnosis?

  • How can you help me to quit smoking?

The next section in this guide is Additional Resources. It offers some more resources on this website beyond this guide that may be helpful to you. You may use the menu to choose a different section to read in this guide. 

Lung Cancer - Non-Small Cell - Additional Resources

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ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Non-Small Cell Lung Cancer. Use the menu to go back and see other pages.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Non-Small Cell Lung Cancer. You may use the menu to choose a different section to read in this guide.