Non-small cell lung cancer

What is non-small cell lung cancer?

Lung cancers can be divided into two types: small cell lung cancer and non-small cell lung cancer. The cancer cells of each type grow and spread in different ways, and they are treated differently. Non-small cell lung cancer is usually associated with prior smoking, passive smoking, or radon exposure. The main kinds of non-small cell lung cancer are named for the type of cells found in the cancer:

• squamous cell carcinoma (also called epidermoid carcinoma)
• adenocarcinoma
• large cell carcinoma
• adenosquamous carcinoma, and
• undifferentiated carcinoma.

Non-small cell lung cancer is a common disease. It is usually treated by surgery (taking out the cancer in an operation) or radiation therapy (using high-dose x-rays to kill cancer cells). However, chemotherapy may be used in some patients. The prognosis (chance of recovery) and choice of treatment depend on the stage of the cancer (whether it is just in the lung or has spread to other places), tumor size, the type of lung cancer, whether there are symptoms, and the patient's general health.

Stages of non-small cell lung cancer

Once lung cancer has been found (diagnosis), more tests will be done to find out if the cancer has spread from the lung to other parts of the body (staging). A doctor needs to know the stage to plan treatment. The following stages are used for non-small cell lung cancer:

• Occult stage: Cancer cells are found in sputum, but no tumor can be found in the lung.
• Stage 0: Cancer is only found in a local area and only in a few layers of cells. It has not grown through the top lining of the lung. Another term for this type of lung cancer is carcinoma in situ.
• Stage I: The cancer is only in the lung, and normal tissue is around it.
• Stage II: Cancer has spread to nearby lymph nodes.
• Stage III: Cancer has spread to the chest wall or diaphragm near the lung; or the cancer has spread to the lymph nodes in the area that separates the two lungs (mediastinum); or to the lymph nodes on the other side of the chest or in the neck. Stage III is further divided into stage IIIA (usually can be operated on) and stage IIIB (usually cannot be operated on).
• Stage IV: Cancer has spread to other parts of the body.
• Recurrent : Cancer has come back (recurred) after previous treatment.

Treatment

Non-small cell lung cancer is treated with:

• Chemotherapy, the use of drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the lungs. Chemoprevention uses drugs to prevent a second cancer from occurring.
• Radiation therapy , which uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy). One new type of radiation therapy is called radiosurgery. In radiosurgery, radiation is directly focused on the tumor, and involves as little normal tissue as possible. Radiosurgery is usually used as treatment of tumors that involve the brain.
• Cryosurgery , which freezes the tumor and kills it.
• Photodynamic therapy , which uses a certain type of light and a special chemical to kill cancer cells.
• Laser therapy , which uses a narrow beam of light to kill cancer cells. Cryosurgery and photodynamic therapy are usually used in clinical trials.

Surgery, radiation therapy, and chemotherapy are used to treat non-small cell lung cancer. However, these treatments often do not cure the disease. If lung cancer is found, a patient may want to think about taking part in one of the many clinical trials being done to improve treatment. Clinical trials are ongoing in most parts of the country for all stages of non-small cell lung cancer.

Treatment choices can be discussed with a doctor. Patients with non-small cell lung cancer can be divided into three groups, depending on the stage of the cancer and the treatment that is planned. The first group (stages 0, I, and II) includes patients whose cancers can be taken out by surgery. The operation that takes out only a small part of the lung is called a wedge resection. When a whole section (lobe) of the lung is taken out, the operation is called a lobectomy. When one whole lung is taken out, it is called a pneumonectomy . Radiation therapy may be used to treat patients in this group who cannot have surgery because they have other medical problems. Like surgery, radiation therapy is called local treatment because it works only on the cells in the area being treated.

The second group of patients has lung cancer that has spread to nearby tissue or to lymph nodes. These patients can be treated with radiation therapy alone or with surgery and radiation, chemotherapy and radiation, or chemotherapy alone.

The third group of patients has lung cancer that has spread to other parts of the body. Radiation therapy may be used to shrink the cancer and to relieve pain. Chemotherapy may be used to treat some patients in this group.

• Occult non-small cell lung cancer: Tests are done to find the main tumor (cancer). Lung cancer that is found at this early stage can be cured by surgery.
• Stage 0 non-small cell lung cancer: Treatment may be one of the following: 1. Surgery to cure these very early cancers. However, these patients may get a second lung cancer that may not be able to be taken out by surgery. 2. Photodynamic therapy used internally.
• Stage I non-small cell lung cancer: Treatment may be one of the following: 1. Surgery. 2. Radiation therapy (for patients who cannot be operated on). 3. Clinical trials of chemotherapy following surgery. 4. Clinical trials of chemoprevention following other therapy. 5. Clinical trials of photodynamic therapy used internally.
• Stage II non-small cell lung cancer: Treatment may be one of the following: 1. Surgery to take out the tumor and lymph nodes. 2. Radiation therapy (for patients who cannot be operated on). 3. Surgery and/or radiation therapy with or without chemotherapy.
• Stage III non-small cell lung cancer: Stage IIIA non-small cell lung cancer Treatment may be one of the following: 1. Surgery alone. 2. Chemotherapy with other treatments. 3. Surgery and radiation therapy. 4. Radiation therapy alone. 5. Laser therapy and/or internal radiation therapy. Stage IIIB non-small cell lung cancer Treatment may be one of the following: 1. Radiation therapy alone. 2. Chemotherapy plus radiation therapy. 3. Chemotherapy plus radiation therapy followed by surgery. 4. Chemotherapy alone.
• Stage IV non-small cell lung cancer: Treatment may be one of the following: 1. Radiation therapy. 2. Chemotherapy. 3. Chemotherapy and radiation therapy. 4. Laser therapy and/or internal radiation therapy.
• Recurrent non-small cell lung cancer: Treatment may be one of the following: 1. Radiation therapy to control symptoms. 2. Chemotherapy. 3. Chemotherapy with radiation therapy. 4. For some patients who have a very small amount of tumor that has spread to the brain, surgery may be used to remove the tumor. 5. Laser therapy or internal radiation therapy. 6. Radiosurgery (for certain patients who cannot be operated on).