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Lung Cancer - Non-Small Cell - Introduction

Approved by the Cancer.Net Editorial Board, 12/2022

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 entire guide.

Lung cancer affects more than 200,000 people in the United States and an estimated 2.3 million people around the world each year. Although cigarette smoking is the main cause, anyone can develop lung cancer. Lung cancer is highly treatable, no matter the size, location, whether the cancer has spread, and how far it has spread.

Because lung cancer has been 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 have been tobacco smokers. 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 different guide. This website also offers a separate guide on neuroendocrine tumors of the lung

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. This can begin anywhere in the lung. The tumor can be cancerous or benign. When 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 small, 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

There are different types of NSCLC. It is important to know the type of NSCLC because it can change treatment options. Doctors determine which type of NSCLC a person has based on the way the cancer looks under a microscope and the kind of cells the cancer starts in.

This is what normal lung tissue looks like:

The different types of NSCLC are:

Adenocarcinoma. This type of NSCLC begins in the epithelial cells that line the outside of the lungs. These cells make mucus. It is the most common type of lung cancer at about 40% of all NSCLC cases.

Squamous cell carcinoma. This type of cancer starts in the squamous cells, which are flat cells that line the inside of the lungs. About 30% of all NSCLC cases are squamous cell carcinoma.

Large cell carcinoma. The cells in large cell carcinoma do not look like adenocarcinoma or squamous cell carcinoma, instead they look like large cells. This is the least common type of NSCLC and as diagnostic tools get better, more large cell carcinomas are being classified as adenocarcinoma or squamous cell carcinoma.

NSCLC-NOS (not otherwise specified) or NSCLC undifferentiated. Sometimes it is difficult for doctors to determine the type of NSCLC even after testing.

Images used with permission from the College of American Pathologists.

Looking for More of an Introduction?

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 StatisticsIt helps explain the number of people who are diagnosed with NSCLC and general survival rates. 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, 03/2023

ON THIS PAGE: You will find information about the estimated number of people who will be diagnosed with non-small cell lung cancer (NSCLC) each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors, and no 2 people with cancer are the same. Use the menu to see other pages.

Every person is different, with different factors influencing their risk of being diagnosed with this cancer and the chance of recovery after a diagnosis. It is important to talk with your doctor about any questions you have around the general statistics provided below and what they may mean for you individually. The original sources for these statistics are provided at the bottom of this page.

How many people are diagnosed with NSCLC?

Worldwide, lung cancer is the second most commonly diagnosed cancer. NSCLC is the most common type of lung cancer in the United States, accounting for 81% of all lung cancer diagnoses.

In 2023, an estimated 238,340 adults (117,550 men and 120,790 women) in the United States will be diagnosed with lung cancer. Worldwide, an estimated 2,206,771 people were diagnosed with lung cancer in 2020. These statistics include both small cell lung cancer and NSCLC.

Since around 2006, incidence rates in the United States have dropped over 1% each year in women compared to 2.6% each year in men. The drop in cases for both men and women are due to fewer people smoking.

Currently, Black and White women have lower incidence rates than men. Black men, who have the highest lung cancer rates, are about 12% more likely to get lung cancer than White men. Black women are 16% less likely to get lung cancer when compared with White women.

The risk of lung cancer increases with age. An estimated 53% of all people diagnosed with the disease are age 70 or older. An estimated 83% of cases are diagnosed in people age 65 or older. Men are most likely to be diagnosed with NSCLC between the ages of 80 and 84, while most cases in women are found between the ages of 75 and 79.

Lung cancer is the leading cause of cancer death for men and women worldwide. It is estimated that 127,070 deaths (67,160 men and 59,910 women) from this disease will occur in the United States in 2023. In 2020, an estimated 1,796,144 people died worldwide from the disease.

Lung cancer makes up around 20% of cancer deaths in the United States. However, death rates for the disease through 2020 have declined by 58% since 1990 in men and 36% since 2002 in women. From 2014 to 2020, the death rates for men with lung cancer dropped by around 5% each year. The death rates for women with lung cancer declined 4% per year during the same period. Research suggests that these declines are due to fewer people starting smoking, more people quitting smoking, and advances in diagnosis and treatment.

Since 1990, Black men have experienced the largest declines in death rate for lung cancer among men. In the early 1990s, Black men were 40% more likely to be die from the disease than White men, compared to 14% during 2016 to 2020. Among women, Black women saw the sharpest drop in death rate since the early or late 2000s. In 2020, the lung cancer death rate in Black women was 17% lower than White women, compared to 4% in 1990.

What is the survival rate for NSCLC?

There are different types of statistics that can help doctors evaluate a person’s chance of recovery from NSCLC. These are called survival statistics. A specific type of survival statistic is called the relative survival rate. It is often used to predict how having cancer may affect life expectancy. Relative survival rate looks at how likely people with NSCLC are to survive for a certain amount of time after their initial diagnosis or start of treatment compared to the expected survival of similar people without this cancer.

Example: Here is an example to help explain what a relative survival rate means. Please note this is only an example and not specific to this type of cancer. Let’s assume that the 5-year relative survival rate for a specific type of cancer is 90%. “Percent” means how many out of 100. Imagine there are 1,000 people without cancer, and based on their age and other characteristics, you expect 900 of the 1,000 to be alive in 5 years. Also imagine there are another 1,000 people similar in age and other characteristics as the first 1,000, but they all have the specific type of cancer that has a 5-year survival rate of 90%. This means it is expected that 810 of the people with the specific cancer (90% of 900) will be alive in 5 years.

It is important to remember that statistics on the survival rates for people with NSCLC are only an estimate. They cannot tell an individual person if cancer will or will not shorten their life. Instead, these statistics describe trends in groups of people previously diagnosed with the same disease, including specific stages of the disease.

The 5-year relative survival rate for all types of lung cancer in the United States is 23%. For NSCLC, the 5-year relative survival rate is 28%.

The survival rates for lung cancer vary based on several factors. These include the stage of cancer, a person’s age and general health, and how well the treatment plan works. Another factor that can affect outcomes is the subtype of lung cancer.

The 5-year relative survival rate for NSCLC in women in the United States is 33%. The 5-year relative survival rate for men is 23%.

For people with localized NSCLC, which means the cancer has not spread outside the lung, the overall 5-year relative survival rate is 65%. However, around 70% of people with NSCLC are diagnosed after the cancer has spread outside the lung. For regional NSCLC, which means the cancer has spread outside of the lung to nearby lymph nodes, the 5-year relative survival rate is about 37%. When cancer has spread to distant parts of the body, called metastatic lung cancer, the 5-year relative survival rate is 9%. It is important to note that newer treatments like targeted therapies and immunotherapies (see Types of Treatment) are allowing people with metastatic lung cancer to live longer than ever before.

Each year, tens of thousands of people are cured of NSCLC in the United States. In 2022, there were more than 650,000 people alive in the United States who have a history of lung cancer. 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.

Experts measure relative survival rate statistics for NSCLC every 5 years. This means the estimate may not reflect the results of advancements in how NSCLC is diagnosed or treated from the last 5 years. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publications, Cancer Facts & Figures 2023 and Cancer Facts & Figures 2022, the ACS website, and the International Agency for Research on Cancer website. (All sources accessed February 2023.)

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, 12/2022

ON THIS PAGE: You will find a basic drawing of the main body parts affected by non-small cell lung cancer (NSCLC). Use the menu to see other pages.

The lungs are located in the chest under the ribs. A hollow tube carries air to the lungs, branching throughout both the right and left lung. Lymph nodes, small, bean-shaped organs, are located in the lungs and the center of the chest, as well as elsewhere in the body. Other body parts commonly affected by lung cancer include the liver, the adrenal gland, the kidneys, bones, and the brain.

The next section in this guide is Risk Factors and PreventionIt describes the factors that may increase the chance of developing NSCLC. 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, 12/2022

ON THIS PAGE: You will find out more about the factors that increase the chance of developing non-small cell lung cancer (NSCLC). 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 Tobacco Smoke (ETS) 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.

  • Air pollution. Research has found that exposure to outdoor air pollution can lead to lung cancer. Almost everyone lives in a place where they are regularly exposed to air pollution. Common causes of pollution include transportation and industrial fumes, power generation, and smoke from intentional burning and wildfires. People with a history of smoking tobacco products are at an even higher risk. You can reduce some of your exposure by checking the air pollution forecast for your area and avoiding outdoor exercise when levels are high.

  • 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 increase 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. Even if they never smoke cigarettes, people with a parent, brother, or sister with lung cancer could have a higher risk of developing lung cancer themselves due to genetic changes. Research about inherited genetic mutations and lung cancer is ongoing.

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause NSCLC, including ways to prevent it. Although there is no proven way to completely prevent NSCLC, you may be able to lower your risk. Talk with your health care team 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. But even people who have smoked a long time can reduce their risk of lung cancer by stopping smokingLearn more about the health benefits of quitting smoking.

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 ScreeningIt explains how tests may find cancer before signs or symptoms appear. 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, 12/2022

ON THIS PAGE: You will find out more about screening for this type of non-small cell lung cancer (NSCLC). 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

Different organizations have looked at the scientific evidence, risks, and benefits of lung cancer screening. These groups have developed screening recommendations for people who are at risk of developing lung cancer. Recommendations can vary from organization to organization. Talk to your health care team about your smoking history and your screening options.

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 takes pictures of the inside of the body with an x-ray machine. A computer then combines these pictures into a detailed, 3-dimensional image 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. This type of lung cancer screening is approved by Medicare.

ASCO's recommendations are based on a person's age and how much they smoke. This number, called a "pack year," is equivalent to smoking 20 cigarettes or 1 pack each day for a year. 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 routinely 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.

The United States Preventive Services Task Force recommends that people age 50 to 80 who have smoked for 20 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. 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.

Always discuss whether you are eligible for regular screening with your primary care doctor.

Listen to a Cancer.Net Podcast on Understanding lung cancer screening, and find more information about lung cancer screening on the website of the National Cancer Institute.

The next section in this guide is Symptoms and SignsIt explains what changes or medical problems NSCLC can cause. 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, 12/2022

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

People with non-small cell lung cancer (NSCLC) may experience the following symptoms or signs. Symptoms are changes that you can feel in your body. Signs are changes in something measured, like by taking your blood pressure or doing a lab test. Together, symptoms and signs can help describe a medical problem. Sometimes, people with NSCLC do not have any of the symptoms and signs described below. Or, the cause of a symptom or sign may be a 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 an imaging test – such as 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. Managing symptoms may also be called "palliative care" or "supportive care." It is often started soon after diagnosis and continued throughout treatment. 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. 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, 12/2022

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 the cancer has spread, it is called metastasis. 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 if 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. Lung cancer cannot be detected by routine blood testing, but blood tests may be used to identify genetic mutations in people who are already known to have lung cancer (see "Biomarker testing of the tumor" below).

How NSCLC is diagnosed

There are many tests used for diagnosing non-small cell lung cancer (NSCLC). Not all tests described here 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 general health

  • The results of earlier medical tests

Finding out where the cancer started

NSCLC starts in the lungs. Many other types of cancer start elsewhere in the body and can 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.

The following tests may be used to diagnose and learn the stage of 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 if or where it has spread.

  • Computed tomography (CT or CAT) 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 takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image 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 or liquid to swallow.

  • Positron emission tomography (PET) scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scanHowever, 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 or liquid to swallow. However, 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. 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 amount of radiation in the tracer is too low to be harmful. 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 lighter to the camera, and areas of injury, such as those caused by cancer, stand out on the image. PET scans (see above) have been replacing bone scans to find NSCLC that has spread to the bones and may not be always recommended.

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. It is helpful to have a larger tumor sample to determine the subtype of NSCLC and perform additional molecular testing (see below). If not enough of the tumor is removed to do these tests, another biopsy may be needed. After the biopsy, a pathologist 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. Often, lymph nodes will be examined and biopsies will be taken using an ultrasound to guide the bronchoscopy. This is called an endobronchial ultrasound (EBUS). 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. This procedure is performed in the operating room, and the patient receives general anesthesia. 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. Another kind of minimally invasive surgery called "robotic-assisted surgery" maybe done instead of a thoracoscopy.

  • Mediastinoscopy. This is a surgical procedure performed in the operating room, and the patient receives general anesthesia. 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 rarely used to diagnose lung cancer, but it may be necessary to completely remove a lung tumor.

Biomarker testing of the tumor

Your doctor may recommend running tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. This may also be called molecular testing of the tumor.

There are several genes that may have changes, called mutations, in a lung tumor that can help the cancer grow and spread. These mutations are found in the tumor only and not in healthy cells in the body. This means these types of mutations are not inherited or passed down to your children.

Results from these tests and information about the stage of NSCLC you have can help determine if you can receive targeted therapy, which can be directed at specific mutations (see Types of Treatment). Targeted therapies now exist for many different genetic mutations that are known to cause lung cancer and research is ongoing to develop more (see Latest Research).

Genetic mutations that are known to contribute to lung cancer growth often occur on 1 or more of several genes, including EGFR, ALK, KRAS, BRAF, HER2, ROS1, RET, MET, and TRK and testing the tumor for these genes is now common. Certain mutations that can be treated with targeted therapy are much more likely to occur in people with adenocarcinoma NSCLC and those who never smoked. However, people whose have a history of smoking may also have genetic mutations that can be treated with targeted therapy, therefore, it is essential to test for molecular mutations, regardless of a history of smoking.

Your doctor may also recommend PD-L1 testing. PD-L1 is a protein found on the surface of some cancer cells and some of the body's immune cells. This protein stops the body's immune cells from destroying the cancer. Knowing if the tumor has PD-L1 will help your doctor decide if certain types of immunotherapy are more or less likely to be helpful (see Types of Treatment).

Currently, there are different biomarker tests that can be done to determine if you have any genetic changes. Sometimes, there may not be enough tissue to test for all of the mutations. Your health care team may decide to test for the most likely changes or they may need to do another biopsy to get enough tissue. Learn more about biomarker testing in lung cancer.

Liquid biopsy. A type of blood test called a "liquid biopsy" is being used more and more to help diagnose specific genetic changes in people with NSCLC, but it cannot be used to diagnose the cancer itself. This test looks for a type of DNA called "circulating tumor DNA." Like healthy cells, cancer cells die and are replaced. When these dead cells break down, they are released into the bloodstream. A liquid biopsy can detect the small pieces of DNA in the bloodstream from these cells.

Liquid biopsies are less invasive than other types of biopsies and have less risks. Liquid biopsies can be done as a part of your initial diagnosis and they can be done multiple times throughout treatment. Learn more about liquid biopsy and what to expect.

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. 

Coping with an NSCLC diagnosis

For most patients, a diagnosis of NSCLC is extremely stressful. Some people who are diagnosed with NSCLC develop anxiety and, less commonly, depression. You and your families should not be afraid to talk with the health care team about how you feel. The health care team has special training and experience that can make things easier for patients and their families and is there to help.

In addition to providing information and emotional support, your doctor may include supportive services and palliative care specialists in your care. This team could include a counselor, psychologist, social worker, or psychiatrist.

You and your family may also find resources available in the community to help people living with lung cancer, such as support groups. Some patients feel comfortable discussing their disease and experiences throughout treatment with their health care team, 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, doctors can offer effective treatment for the cancer. In addition, advances being made in the diagnosis and treatment of NSCLC that provide more and more patients with a chance for a cure.

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

Stopping smoking

Even after NSCLC is diagnosed, it is still beneficial to quit 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. It is never easy to stop smoking and even harder when facing the diagnosis of NSCLC. If you smoke, 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 in a separate section of this website.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. 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, 12/2022

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.

What is cancer staging?

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 recommend the best kind of treatment 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 non-small cell lung cancer (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.

This page provides detailed information about the stage groups for NSCLC, such as stage II or stage IV, and what this means for prognosis.

Stage groups for NSCLC

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 and often nearby lymph nodes. 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 normal lung tissues or spread outside the lung.

Stage I

A stage I lung cancer is a small tumor that has not spread to any lymph nodes. 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 within the lung, called the N1 lymph nodes. A stage IIB cancer can also be a tumor more than 5 cm wide that has not spread to the lymph nodes.

Usually, stage II tumors can be removed with surgery, but often additional treatments are recommended.

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 often spread extensively to the lymph nodes, but have not spread to other distant parts of the body.

If stage III NSCLC is suspected, the doctor will want to make sure the cancer has not spread to other parts of the body. For this evaluation, ASCO recommends a physical examination, assessment of the patient’s medical history, a CT scan of the chest and upper abdomen, and a PET-CT scan and MRI of the brain (see Diagnosis). For some people, lymph nodes may also need to be tested for cancer by endoscopy or surgery. A team of cancer care specialists generally work together to recommend the most appropriate treatment plan based on the stage and other characteristics of the cancer as well as other medical conditions the patient may have.

For many stage IIIA and stage IIIB cancers, it may be difficult, or sometimes impossible, to remove the tumor completely with surgery alone. Stage IIIC cancers, in general, cannot be removed with surgery and may need to be treated with a combination of chemotherapy and radiation followed by immunotherapy. 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. Stage III NSCLC that cannot be treated with surgery is generally treated with systemic therapy and radiation therapy (see Types of Treatment).

This information is based on the ASCO guideline, “Management of Stage III NSCLC.” Please note that this link takes you to a different ASCO website.

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 usually not an option for most stage IIIB, IIIC, or IV lung cancers. It can be difficult to remove lung cancer that has spread to the lymph nodes above the collarbone or into vital structures within the chest. These include the heart, large blood vessels, or the main breathing tubes leading to the lungs. In these situations, the doctor will carefully consider if surgery is an option or recommend other treatment options. Surgery is usually not be recommended if the tumor cannot be completely removed. But for some people with stage IV lung cancer that have a good response to treatment, surgery and/or radiation therapy may be offered to treat the remaining sites of cancer.

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.

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Prognosis

The type and stage of NSCLC and the patient’s overall health influence the prognosis. NSCLC is treatable at any stage and new treatments in recent years have led to improvements in overall survival for people with all stages of NSCLC. But only some people with certain stages can be cured.

Your doctor may use an index known as "performance status" or "functional status" to guide your treatment and determine your prognosis. This index measures a person's general strength and health. People who are strong enough to continue daily activities without assistance can safely receive cancer medication, radiation therapy, or surgery. For people with bone or liver metastases from lung cancer, excessive weight loss, ongoing tobacco use, or certain pre-existing medical conditions, such as heart disease or emphysema, treatment may not be as safe or effective.

It is important to note that a person's age has never been useful in predicting to predict if a person will benefit from treatment for NSCLC. The average age of people with lung cancer in the United States is 71. 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.

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

Lung Cancer - Non-Small Cell - Types of Treatment

Approved by the Cancer.Net Editorial Board, 12/2022

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with non-small cell lung cancer (NSCLC). Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for NSCLC. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials are an option. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials 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. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How NSCLC is treated

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 teamCancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

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. 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. These types of talks are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is particularly important for NSCLC because there are different treatment options. Learn more about making treatment decisions.

The common types of treatments used for NSCLC are described below, followed by an outline of the common treatment plans by stage. Your care plan also includes treatment for symptoms and side effects, an important part of cancer care.

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. 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 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. A lobectomy is the removal of an entire lobe of the lung. It is currently thought to be the most effective type of surgery, even when the lung tumor is very small. Clinical trials are underway to study if less extensive surgeries have similar outcomes for tumors that are 2 centimeters or smaller.

  • 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. Typically, more lung tissue and lymph nodes are removed during a segmentectomy compared to a wedge resection.

  • Pneumonectomy. If the tumor is close to the center of the chest, the surgeon may have to remove the entire lung. A pneumonectomy has more risks than a lobectomy and your doctor will need to consider the health of your heart and lungs before performing this surgery.

The time it takes to recover from lung surgery depends on how much of the lung is removed and the person's health before surgery. Exercise can be an important part of preparing for and recovering from surgery. It can help prevent or relieve side effects and shorten time in the hospital. Ask your doctor what type of exercise is recommended for you. While many patients can safely exercise on their own, some may need to exercise with the guidance of a member of the health care team or to participate in a cancer rehabilitation program before exercising on their own.

Many of these surgeries are now minimally invasive compared to the past. 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.

Additional treatments can be given before and after your surgery to help lower the risk of recurrence.

Neoadjuvant therapy, also known as induction therapy, is a therapy given before your surgery. In addition to treating the primary tumor and lowering your risk of recurrence, this type of therapy is also used to help reduce the extent of surgery.

Adjuvant therapy is treatment that is given after surgery. It is intended to get rid of any lung cancer cells that may still be in the body after surgery. This helps lower the risk of recurrence, though there is always some risk that the cancer will come back.

These types of adjuvant therapy used for NSCLC include radiation therapy and systemic therapies, such as chemotherapy, targeted therapy, and immunotherapy. Sometimes adjuvant therapies will combine treatments, such as chemotherapy and immunotherapy. Each therapy is described below.

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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 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. The most common type of radiation is intensity modulated radiation therapy (IMRT). For some people, their tumors require a specialized type of radiation such as stereotactic body radiation therapy (SBRT) or proton therapy. These types of radiation therapy use CT scans or PET scans to plan out exactly where to direct the radiation beam to lower the risk of damaging healthy parts of the body. It is not an option for all patients, but it may be used for early-stage disease and for a small tumor when surgery is not an option.

Some people with stage I NSCLC or people who cannot have surgery may be treated with stereotactic radiation therapy instead of surgery.

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

Side effects of radiation therapy

People 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, side effects can include a sore throat and difficulty swallowing. Patients may also 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 (Rayos).

Radiation therapy may also cause permanent scarring of the lung tissue near where the original tumor was located. The scarring does not usually 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.

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Therapies using medication

The treatment plan may include medications to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body. 

This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Medications are often given through an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). If you are given oral medications, be sure to ask your health care team about how to safely store and handle them.

The types of medications used for NSCLC include:

  • Chemotherapy

  • Targeted therapy

  • Immunotherapy

Each of these types of therapies are discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

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. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. It has been shown to improve both the length and quality of life for people with lung cancer of all stages.

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 recommended for chemotherapy. When adjuvant chemotherapy is given after surgery, it is usually given for a shorter period of time (such as 4 cycles) than for those with stage IV lung cancer.

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 (available as a generic drug)

  • Cisplatin (available as a generic drug)

  • Docetaxel (Taxotere)

  • Etoposide (available as a generic drug)

  • 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 person 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. Some lung cancer chemotherapy treatments do not cause significant hair loss. Your medical oncologist can often prescribe drugs to help relieve many of these side effects. Nausea and vomiting are also often avoidable. Learn more about preventing nausea and vomiting caused by cancer treatment. In many cases, side effects usually go away after treatment is finished.

Learn more about the basics of chemotherapy.

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Targeted therapy

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 and limits damage to healthy cells.

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, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.

Treatment with targeted therapy for NSCLC is changing rapidly due to the pace of scientific research. New targeted therapies are being studied in clinical trials now. Talk with your doctor about additional options that may be available to you.

Targeted therapy for NSCLC includes:

Epidermal growth factor receptor (EGFR) inhibitors. About 10% to 15% of all lung cancers are EGFR-positive. Researchers have found that drugs that block specific EGFR mutations may be effective for stopping or slowing the growth of lung cancer when the cancer cells have that EGFR specific mutation. The following EGFR inhibitors are approved by the FDA:

  • Afatinib (Gilotrif)

  • Dacomitinib (Vizimpro)

  • Erlotinib (Tarceva)

  • Gefitinib (Iressa)

  • Osimertinib (Tagrisso)

Drugs targeting the EGFR exon 20 insertion. Some people have a specific change to the EGFR gene in the exon 20. This is called an EGFR exon 20 insertion. The following drug has been approved to target EGFR exon 20 insertion as a second-line treatment:

  • Amivantamab (Rybrevant)

Drugs targeting HER2 mutations. Human epidermal growth factor receptor 2 (HER2) mutations help cancer cells grow and spread. HER2 mutations have been found in 1% to 4% of NSCLC cases. One drug is approved to target HER2 mutations in people who have received a prior systemic therapy, when confirmed by an FDA-approved test:

  • Fam-trastuzumab deruxtecan-nxki (Enhertu)

Anaplastic lymphoma kinase (ALK) inhibitors. ALK is a protein that is a part of the cell growth process. When present, this helps cancer cells grow. ALK inhibitors help stop this process. Changes in the ALK gene are found in about 4% of people with NSCLC. The following drugs are currently available to target this genetic change:

  • Alectinib (Alecensa)

  • Brigatinib (Alunbrig)

  • Ceritinib (Zykadia)

  • Crizotinib (Xalkori)

  • Lorlatinib (Lorbrena)

Drugs targeting ROS1 fusion. Rare changes to the ROS1 gene called ROS1 fusion or ROS1 rearrangement can cause problems with cell growth and cell differentiation. Cell differentiation is the process by cells use to change from one type of cell into another. ROS1 fusion is found in 1% to 2% of people with lung cancer. Drugs targeting changes to the ROS1 gene include:

  • Ceritinib (Zykadia)

  • Crizotinib (Xalkori)

  • Entrectinib (Rozlytrek)

Drugs targeting KRAS G12C mutations. The KRAS G12C is one of the most common genetic mutations found in people with NSCLC. About 20 to 25% of people with lung cancer have a KRAS mutation. Two drugs are approved to target KRAS G12C mutations in the second-line setting, after receiving immunotherapy alone or in combination with chemotherapy:

  • Adagrasib (Krazati)

  • Sotorasib (Lumakras)

Drugs targeting NTRK fusion. This type of genetic change is found in a range of cancers and causes cancer cell growth. It is rare in lung cancer (less than 1%). One drug is approved to target NTRK fusion:

  • Entrectinib (Rozlytrek)

  • Larotrectinib (Vitrakvi)

Drugs targeting BRAF V600E mutations. The BRAF gene makes a protein that is involved in cell growth and can cause cancer cells to grow and spread. BRAF mutations have been found in 4% of NSCLC cases. Metastatic NSCLC with BRAF V600E mutations can be targeted with the following drugs:

  • A combination of dabrafenib (Tafinlar) and trametinib (Mekinist)

  • A combination of ecorafenib (Braftovi) and binimetinib (Mektovi)

Drugs targeting MET exon 14 skipping. MET exon 14 skipping is a genetic mutation found in over 3% of NSCLC cases. Drugs approved to treat MET exon 14 skipping include:

  • Capmatinib (Tabrecta)

  • Tepotinib (Tepmetko)

Drugs targeting RET fusion. Up to 2% of all NSCLC cases are RET fusion positive. Drugs approved to target RET fusion positive NSCLC include:

  • Pralsetinib (Gavreto)

  • Selpercatinib (Retevmo)

Anti-angiogenesis therapy. Anti-angiogenesis therapy stops 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, Mvasi), in combination with chemotherapy and atezolizumab (Tecentriq), an immunotherapy drug (see below)

  • Ramucirumab (Cyramza), in combination with the chemotherapy drug docetaxel

Immunotherapy (updated 04/2023)

Immunotherapy uses the body's natural defenses to fight cancer by improving your immune system's ability to attack cancer cells.

People who receive treatment using immunotherapy for NSCLC may receive only 1 drug, a combination of immunotherapy drugs, or it may be combined with chemotherapy. When advanced NSCLC cannot be treated with a targeted therapy (see above), immunotherapy or immunotherapy plus chemotherapy is often the preferred initial treatment.

There are different ways immunotherapy can use the body's immune system to treat cancer.

Drugs that block the PD-1 pathway. The PD-1 pathway may be very important 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 immunotherapy drugs block this pathway and are approved to treat NSCLC:

  • Atezolizumab (Tecentriq)

  • Durvalumab (Imfinzi)

  • Cemiplimab-rwlc (Libtayo)

  • Nivolumab (Opdivo)

  • Pembrolizumab (Keytruda)

In certain cases, immunotherapy may be combined with platinum-based chemotherapy, such as cemipilmab-rwlc or durvalumab.

Drugs that block the CTLA-4 pathway. Another immune pathway that may be targeted is the CTLA-4 pathway:

  • Ipilimumab (Yervoy). Ipilimumab is given in combination with nivolumab, which blocks the PD-1 pathway. This combination can also be used with chemotherapy.

  • Tremelimumab (Imjudo). Tremelimumab may be given in combination with durvalumab and chemotherapy. This combination is used to treat metastatic NSCLC without a targeted mutation in the EGFR or ALK genes. 

Different types of immunotherapy can cause different side effects but, in general, severe side effects are less common than with chemotherapy. Immune-related side effects are possible with immunotherapy and include skin reactions, flu-like symptoms, diarrhea, shortness of breath from lung inflammation, and weight changes. The risk of immune-related side effects is higher if a PD-1/PD-L1 inhibitor is combined with a CTLA-4 inhibitor. Talk with your doctor about possible side effects for the immunotherapy recommended for you.

Learn more about the basics of immunotherapy and its side effects.

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Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

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 or pulmonologist 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 can reduce inflammation caused by lung cancer or radiation therapy and improve breathing. Dexamethasone can be used for pain caused by bone metastases, to reduce inflammation or edema from brain and spinal cord metastases, or be used to improve apetite and increase energy.

  • 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 doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

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Treatment by stage of NSCLC

Different treatments may be recommended for each stage of NSCLC. The general options by stage are described below. For more detailed descriptions, see "How NSCLC is treated," above. Your doctor will work with you to develop a specific treatment plan based on your specific diagnosis and needs. Clinical trials may also be a treatment option for each stage. 

Stage I and II NSCLC (updated 01/2023)

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 also meet with a medical oncologist. Some people with a large tumor or signs that the tumor has spread to the lymph nodes may benefit from treatments with medication, sometimes called systemic treatments, including chemotherapy, immunotherapy, and/or targeted therapies. Medication may be given before the surgery, called neoadjuvant therapy or induction therapy. Additional treatment may also be given after surgery, called adjuvant therapy, to reduce the chance that the cancer will return. The decision to use neoadjuvant therapy before surgery or adjuvant therapy after surgery is the most appropriate approach is complex. It often requires a multidisciplinary discussion between surgeons, medical oncologists, radiation oncologists, radiologists, pulmonologists, and pathologists. These discussions usually occur at a type of meeting called a tumor board. This discussion will be done after all information from the initial biopsies and imaging are available for review and before a surgery or systemic therapy is started.

Adjuvant chemotherapy with cisplatin is not recommended for patients with stage IA NSCLC that was completely removed with surgery. Patients with stage IB cancers should talk with their doctors about whether chemotherapy is right for them after surgery. For those with stage IB cancer with an activating EGFR mutation, ASCO recommends targeted therapy with adjuvant osimertinib for up to 3 years. 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. If there is not an activating EGFR mutation, treatment with atezolizumab for up to 1 year may be recommended, particularly if the tumor's PD-L1 expression is high. Recently, the FDA also approved the use of pembrolizumab after surgery in patients with stage IB to stage III NSCLC.

For patients with stage I or II lung cancer who cannot or prefer not to undergo surgery, radiation therapy, such as stereotactic ablative radiotherapy (SABR) or stereotactic body radiotherapy (SBRT), may be offered.

Stage III NSCLC (updated 06/2023)

More than 30,000 people 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

  • Immunotherapy

  • Targeted therapy

  • Surgery

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.

If the stage III NSCLC cannot be removed with surgery, ASCO recommends concurrent chemoradiotherapy using a platinum-based chemotherapy combination. If concurrent chemoradiotherapy has slowed or stopped the cancer’s growth, immunotherapy with durvalumab for up to 1 year after completion of chemoradiotherapy is recommended. If concurrent chemoradiotherapy is not an option, ASCO recommends sequential chemoradiotherapy instead.

Surgery may be an option for some people with stage III NSCLC if the tumor and lymph nodes can be removed without leaving cancer behind and the side effects and complications from the surgery are expected to be low. If surgery is an option, systemic therapy using chemotherapy, immunotherapy, and/or concurrent chemoradiotherapy will usually be given before the surgery. After surgery, adjuvant platinum-based chemotherapy and/or osimertinib or atezolizumab may be offered, including for people with common EGFR mutations. Recently, the FDA also approved the use of pembrolizumab after surgery in patients with stage IB to stage III NSCLC. Radiation therapy is not generally recommended after surgery, though it may be recommended in some cases where cancer cells are left behind after surgery.

Talk with your health care team about the best treatment options for you.

This information is based on the ASCO guideline, “Management of Stage III NSCLC.” Please note that this link takes you to a different ASCO website.

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. Clinical trials might also 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. In some cases, radiation to treat a specific symptom or particularly problematic area may be used.

People with stage IV disease have a very high risk of the cancer spreading or growing in another location. Most patients with this stage of NSCLC receive systemic therapies, such as chemotherapy, targeted therapy, or immunotherapy. Palliative care will also be important to help relieve symptoms and side effects.

Systemic therapy for metastatic or stage IV NSCLC (Updated 07/2023)

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.

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 too many 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. Two key variables to consider when determining treatment are PD-L1 score and whether there are alterations in the DNA that can be targeted with certain medications.

  • No changes in the EGFR, ALK, ROS1, BRAF, MET, RET, NTRK genes

    • Non-squamous cell carcinoma with PD-L1 50% or higher:

      • Pembrolizumab alone

      • Atezolizumab alone

      • Combination of pembrolizumab, carboplatin, and pemetrexed

      • Combination of atezolizumab, carboplatin, paclitaxel, and bevacizumab

      • Combination of atezolizumab, carboplatin, and nab-paclitaxel

      • Nivolumab and ipilimumab plus platinum-based chemotherapy

      • Cemiplimab alone

      • Nivolumab plus ipilimumab

    • Non-squamous cell carcinoma and PD-L1 1% to 49%:

      • Nivolumab and ipilimumab plus platinum-based chemotherapy

      • Combination of nivolumab and ipilimumab

      • Pembrolizumab combined with carboplatin and pemetrexed

      • Combination of atezolizumab, carboplatin, paclitaxel, and bevacizumab

      • Combination of atezolizumab, carboplatin, and nab-paclitaxel.

      • Cemiplimab plus chemotherapy

      • Durvalumab and tremelimumab plus platinum-based chemotherapy

      • For people who cannot receive immunotherapy, a combination of 2 chemotherapy drugs is recommended.

      • Pembrolizumab alone may be recommended for people who cannot receive a combination of pembrolizumab with a platinum chemotherapy.

    • Non-squamous cell carcinoma and PD-L1 less than 1%:

      • Nivolumab and ipilimumab plus platinum-based chemotherapy

      • Nivolumab and ipilimumab

      • Pembrolizumab combined with carboplatin and pemetrexed

      • Combination of atezolizumab, carboplatin, paclitaxel, and bevacizumab

      • Combination of atezolizumab, carboplatin, and nab-paclitaxel

      • Cemiplimab plus chemotherapy

      • Durvalumab and tremelimumab plus platinum-based chemotherapy

      • For people who cannot receive immunotherapy, a combination of 2 chemotherapy drugs is recommended

    • Squamous cell carcinoma and PD-L1 50% or higher:

      • Atezolizumab alone

      • Cemiplimab alone

      • Pembrolizumab alone

      • Combination of nivolumab and ipilimumab

      • Nivolumab and ipilimumab plus platinum-based chemotherapy

      • Combination of pembrolizumab, carboplatin, and paclitaxel or nab-paclitaxel

    • Squamous cell carcinoma and PD-L1 1% to 49%:

      • A combination of pembrolizumab, carboplatin, and paclitaxel or nab-paclitaxel should be recommended when it is possible.

      • For people who cannot receive immunotherapy, a combination of 2 chemotherapy drugs is recommended.

      • Combination of nivolumab and ipilimumab

      • Nivolumab and ipilimumab plus platinum-based chemotherapy

      • Cemiplimab plus chemotherapy

      • Durvalumab and tremelimumab plus platinum-based chemotherapy

      • For people who cannot receive pembrolizumab plus platinum chemotherapy, pembrolizumab alone may be recommended

    • Squamous cell carcinoma and PD-L1 less than 1%:

      • A combination of pembrolizumab, carboplatin, and paclitaxel or nab-paclitaxel should be recommended when it is possible.

      • In people who cannot receive immunotherapy, a combination of 2 chemotherapy drugs is recommended.

      • Combination of nivolumab and ipilimumab

      • Nivolumab and ipilimumab plus platinum-based chemotherapy

      • Cemiplimab plus chemotherapy

      • Durvalumab and tremelimumab plus platinum-based chemotherapy

  • EGFR gene mutations. Treatments with targeted therapies called TKIs may be options. Treatment with TKIs with or without chemotherapy may also be offered to certain patients as well as chemotherapy combinations with or without bevacizumab.

    • Osimertinib

    • Dacomitinib

    • Afatinib

    • Erlotinib

    • Erlotinib and ramucirumab

    • Gefitinib

    • Icotinib (Conmana; this is not approved in United States)

    • Amivantamab (Exon 20 mutations only)

  • ALK fusions. Treatments with targeted therapies called TKIs may be options. Targeted therapy options are alectinib, brigatinib, lorlatinib, ceritinib, or crizotinib.

  • ROS1 fusions. Treatments with targeted therapies called TKIs may be options. Targeted therapy options are entrectinib, crizotinib, or chemotherapy with or without immunotherapy.

  • BRAF V600E mutations. Treatments with targeted therapies called TKIs may be options. Targeted therapy options are dabrafenib and trametinib or chemotherapy with or without immunotherapy.

  • MET exon 14 skipping mutations. Treatments with targeted therapies called TKIs may be options. Targeted therapy options are capmatinib, tepotinib, or chemotherapy with or without immunotherapy.

  • RET fusions. Treatments with targeted therapies called TKIs may be options. Targeted therapy options are selpercatinib or pralsetinib (Gavreto). Chemotherapy with or without immunotherapy, bevacizumab, or both may also be recommended.

  • NTRK fusions. Treatments with targeted therapies called TKIs may be options. Targeted therapy options are entrectinib, larotrectinib, or chemotherapy with or without immunotherapy.

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

  • No changes in the EGFR, ALK, ROS1, BRAF, MET, RET, NTRK genes. If chemotherapy and immunotherapy were already given in the first line of treatment, then docetaxel with or without ramucirumab may be given in the second line. For people with non-squamous cell carcinoma, chemotherapy plus bevacizumab may be offered.

  • EGFR gene mutations. If osimertinib was not given in the first line, it could be given in the second line. If an EGFR inhibitor was already given, then chemotherapy with or without bevacizumab, immunotherapy, or both should be given.

  • ALK fusions. If crizotinib was already given, then the next treatment should be alectinib, brigatinib, or lorlatinib. If alectinib or brigatinib was already given, then the next treatment should be lorlatinib. If lorlatinib has already been given, then chemotherapy with or without immunotherapy, bevacizumab, or both should be given.

  • EGFR exon 20 insertion. Amivantamab (Rybrevant) can be used as a second-line treatment option for people with EGFR exon 20 insertion.

  • HER2 mutation. People who have a HER2 mutation and have received a previous systemic therapy may be offered trastuzumab deruxtecan.

  • RET fusions. If targeted therapy has not already been given, then selpercatinib or pralestinib may be offered. Otherwise, treatment options include chemotherapy with or without immunotherapy, bevacizumab, or both.

  • ROS1 fusions, BRAF V600E mutations, MET exon 14 skipping mutations, and NTRK fusions. If a TKI was already used in the first line, then chemotherapy with or without immunotherapy, bevacizumab, or both should be given.

  • KRAS G12C mutations. Sotorasib (Lumakras) or adagrasib (Krazati) can be used as a second-line treatment for people with KRAS G12C mutations.

Third-line treatment. Third-line treatment for NSCLC depends on the treatments that the patient has already received.

In all cases, patients and their doctors should discuss any reasons why some patients may not be able to receive immunotherapy and other treatment options described above.

This information is based in part on several ASCO recommendations for the treatment of lung cancer. Read more about these recommendations on the ASCO website.

Treatment 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 usually treated with radiation therapy, surgery, or both. This can cause side effects such as hair loss, fatigue, redness of the scalp, and problems with thinking, memory, and attention. 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.

Newer targeted therapies have shown that they can work well to treat brain metastases. In those with an EGFR mutation in the cancer and no symptoms from the brain metastases, treatment with osimertinib may be recommended. For those with an ALK translocation and no symptoms from the brain metastases, treatment with alectinib, brigatinib, or ceritinib may be recommended. Similarly, targeted therapies that can penetrate into the brain can be used in other settings and subtypes of lung cancer that have other actionable targetable mutations, such as RET, ROS1, MET exon 14, and others. This may allow many patients to have a systemic therapy for brain metastases and avoid or delay the side effects that are associated with surgery or radiation therapy to the brain.

Below is a general summary of when and how surgery and radiation therapy are used to treat brain metastases:

  • People with 1 to 3 brain metastases generally receive stereotactic radiosurgery (SRS). If the brain metastases are large or causing symptoms due to pressure on the brain and the person is in general good health, they often receive surgery, followed by stereotactic radiation therapy.

  • Treatment for people in relatively good health and with more than 4 tumors that cannot be removed with surgery or more than 2 tumors that were removed surgically may include stereotactic radiation therapy or whole brain radiation therapy.

  • People who also have metastatic cancer in parts of the body other than the brain usually continue their treatment regimen if the disease outside the brain is not worsening. If the disease is worsening, the treatment plan may be changed based on the recommendations for that type of metastatic cancer.

The information in this section is based on a joint guideline from ASCO, the Society for Neuro-Oncology (SNO), and the American Society for Radiation Oncology (ASTRO), “Treatment for Brain Metastases.” Please note that this link takes you to a different ASCO website.

Learn about caring for someone with cancer that has spread to the brain.

Palliative and supportive care

As described above, palliative and supportive 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 people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

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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 is 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 returns 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.

If a recurrence happens, a new cycle of testing will begin again to learn as much as possible about it. After this testing is done, you and your doctor will talk about the 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 recurrent NSCLC. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

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

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If treatment does not 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 some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider 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.

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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. 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 studied 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 people with non-small cell lung cancer (NSCLC). To make scientific advances, doctors create research studies involving volunteers, called clinical trials. Every drug that is now approved by the U.S. Food and Drug Administration (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.

Clinical trials are used for all types and stages of NSCLC. Many focus on new treatments to learn if a new treatment is safe, effective, and possibly better than the existing treatments. These studies evaluate new drugs and methods of treatment, new approaches to treatment, and new prevention methods.

People 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 the chance 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.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some, 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. Others 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 people with NSCLC.

Insurance coverage and the costs of clinical trials differ by location and by study. In some programs, some of the 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.” When used, placebos are usually combined with standard treatment in most cancer clinical trials. Study participants will always be told when a placebo is used in a study. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

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

  • Describe all of the treatment 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 person in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

  • Describe the purposes of the clinical trial and what researchers are trying to learn.

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. You will need to meet all of the eligibility criteria in order to participate in a clinical trial. Learn more about eligibility criteria in clinical trials.

People who participate in a clinical trial may stop participating at any time for personal or medical reasons. 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 people 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 they choose 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 more 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, you can find a free video-based educational program about cancer clinical trials located in another section of this website.

The next section in this guide is Latest ResearchIt explains areas of scientific research for NSCLC. Use the menu to choose a different section to read in this guide.

Lung Cancer - Non-Small Cell - Latest Research

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ON THIS PAGE: You will read about the scientific research being done 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 non-small cell lung cancer (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 drug therapy. Researchers are looking at features of lung tumors that can predict whether a specific drug, such as 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 NRG fusion. Additional research is also being done to study drugs that can help patients after an initial targeted therapy stops working.

  • 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 early-stage NSCLC by lobectomy to removal by wedge resection or segmentectomy. This is to preserve nearby lung tissue. Stereotactic radiation therapy is also being studied for NSCLC. This technique is used to focus radiation therapy more directly on the cancer and avoids more of the healthy tissue. Advances in all types of treatment will improve doctors’ ability to combine medication, radiation therapy, and surgery for the treatment of all stages of NSCLC.

  • Liquid biopsies: Free-floating cancer DNA from blood tests can be used to find molecular changes in your cancer. These are typically used at initial diagnosis and at the time when certain targeted therapies are no longer working (at the time of acquired resistance to a treatment). Research is ongoing to evaluate new ways to use liquid biopsies to assess response to treatments or detect remaining cancer DNA after surgery.

  • 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 improved screening techniques, including genetic testing and blood tests to learn which people have a higher risk of lung cancer.

  • 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 diagnosed 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. Read about one recent study that confirmed stopping smoking helps people with lung cancer. Research continues into new ways to help people stop smoking.

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

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in 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, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

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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. 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 do not 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 effectsIt may help to know that your health care team will work to prevent and relieve side effects. This part of cancer treatment is called palliative care or supportive 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 non-small cell lung cancer (NSCLC) are described in the Types of Treatment section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control themChanges to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

Talk with your health care team regularly about how you are feeling. It is important to let them know about any new side effects or changes in existing side effects. If they know how you are feeling, they can find ways to relieve or manage your side effects to help you feel more comfortable and potentially keep any side effects from worsening.

You may find it helpful to keep track of your side effects so it is easier to talk about any changes to your health care team. Learn more about why tracking side effects is helpful.

Sometimes, side effects can last after treatment ends. Doctors call these long-term side effects. Side effects that occur months or years after treatment are called late effectsTreating 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 after a cancer diagnosis. This may include dealing with a variety of emotions, such as sadness, anxiety, or anger, or managing your stress level. Sometimes, people find it difficult to express how they feel to their loved ones. Some have found that talking to an oncology social worker, counselor, or member of the clergy can help them develop more effective ways of coping and talking about cancer.

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 the costs of cancer care

Cancer treatment can be expensive. It may be 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 of medical care 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.

Coping with barriers to care

Some groups of people experience different rates of new cancer cases and experience different outcomes from their cancer diagnosis. These differences are called “cancer disparities.” Disparities are caused in part by real-world barriers to quality medical care and social determinants of health, such as where a person lives and whether they have access to food and health care. Cancer disparities more often negatively affect racial and ethnic minorities, people with fewer financial resources, sexual and gender minorities (LGBTQ+), adolescent and young adult populations, older adults, and people who live in rural areas or other underserved communities.

If you are having difficulty getting the care you need, talk with a member of your health care team or explore other resources that help support medically underserved people.

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 likely to happen?

  • What can we do to prevent or relieve them?

  • When and who should we call about side effects?

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

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. Being a caregiver can also be stressful and emotionally challenging. One of the most important tasks for caregivers is caring for themselves.

Caregivers may have a range of responsibilities on a daily or as-needed basis, including:

  • Providing support and encouragement

  • Talking with the health care team

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to and from appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

A caregiving plan can help caregivers stay organized and help identify opportunities to delegate tasks to others. It may be helpful to ask the health care team how much care will be needed at home and with daily tasks during and after treatment. Use this 1-page fact sheet to help make a caregiving action plan. This free fact sheet is available as a PDF, so it is easy to print.

Learn more about caregiving or read the ASCO Answers Guide to Caring for a Loved One in English or Spanish.

Looking for More on How to Track Side Effects?

Cancer.Net offers several resources to help you keep track of your symptoms and side effects. Please note that these links will take you to other sections of Cancer.Net:

The next section in this guide is Follow-up CareIt explains the importance of checkups after cancer treatment is finished. 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 does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, 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.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services, such as physical therapy, occupational 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 as possible. Learn more about cancer rehabilitation.

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, which means that the cancer has come back. 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. 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 first diagnosed and the types of treatment given.

People who develop non-small cell lung cancer (NSCLC) are also at higher risk for developing a second lung cancer. Your doctor will recommend having future scans to watch for both a recurrence and any new lung cancer.

ASCO recommends that most people who were successfully treated for stage I to stage III NSCLC receive imaging scans every 6 months for the first 2 years after treatment to watch for a recurrence. The preferred test is a chest CT scan (see Diagnosis). After the first 2 years, people should receive a low-dose chest CT scan once a year. ASCO does not recommend using PET-CT scans with fluorodeoxyglucose (FDG), blood tests, or brain MRI as routine tests to watch for cancer recurrence.

This information is based on the ASCO guideline, "Lung Cancer Surveillance After Definitive Curative-Intent Therapy." (Please note that this link takes you to a different ASCO website.)

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

Managing long-term and late side effects

Most people expect to have 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 after treatment has ended. 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 your diagnosis, 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.

People 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 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 talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their primary care 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 them 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 SurvivorshipIt describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

Lung Cancer - Non-Small Cell - Survivorship

Approved by the Cancer.Net Editorial Board, 12/2022

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” is complicated because it 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 continues during treatment and through the rest of a person's life. 

For some, even the term “survivorship” does not feel right, and they prefer to use different language to describe and define their experience. Sometimes extended treatment will be used for months or years to manage or control cancer. Living with cancer indefinitely is not easy, and the health care team can help you manage the challenges that come with itEveryone has to find their own path to name and navigate the changes and challenges that are the results of their cancer diagnosis and treatment.

Survivors may experience a mixture of 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. Feelings of fear and anxiety may still occur as time passes, but these emotions should not be a constant part of your daily life. If they persist, be sure to talk with a member of your health care team.

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, sexual health 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.

A new perspective on your health

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

Nothing helps recovery more than stopping smokingThere 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, exercising regularly, 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 on 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.

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

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, especially if they are not 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.

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 48-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The free booklet is available as a PDF, so it is easy to print.

  • Survivorship Resources: Cancer.Net offers information and resources to help survivors cope, including specific sections for children, teens and young adults, and people over age 65. There is also a main section on survivorship for people of all ages.

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. 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

Approved by the Cancer.Net Editorial Board, 12/2022

ON THIS PAGE: You will find some questions to ask your doctor or other members of the 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 the 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. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

  • What type of non-small cell lung cancer (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 and side effects?

  • 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?

  • If I have questions or problems, who should I call?

Questions to ask about having surgery

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

  • Will my surgery be minimally invasive or open?

  • How will surgery affect my breathing?

  • 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?

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible long-term or late effects of having this surgery?

  • What can be done to prevent or relieve side the side effects?

  • Are there treatment options other than surgery for this type of cancer?

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

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

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

  • Who should I contact about any side effects I experience? And how soon?

  • What can be done to lessen these side effects?

  • Will I receive this treatment at a hospital or clinic? Or will I take it at home?

  • If I need to visit the doctor to receive the medication, how long will each visit take?

  • Will I be able to go to and return from this treatment on my own, or should I find someone to help me?

  • 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 radiation therapy 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 also receive radiation therapy?

  • Is it an option 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?

  • Who should I contact about any side effects I experience? And how soon?

  • Will I be able to go to and return from this treatment on my own, or should I find someone to help me?

  • How much will this treatment cost me? Are there less expensive treatment options that work as well?

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, compared with standard treatment? For example, are there different risks, extra tests, a different time commitment, schedule, or costs?

  • Who should I contact about any side effects I experience? And how soon?

  • 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 my treatment if I join this clinical trial?

  • What costs will I have to pay if I join this clinical 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?

  • Who should I contact about any late or long-term side effects I experience? And how soon?

  • 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 about smoking and recovery

  • 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 more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.

Lung Cancer - Non-Small Cell - Additional Resources

Approved by the Cancer.Net Editorial Board, 12/2022

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 (NSCLC). 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.

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. Use the menu to choose a different section to read in this guide.