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)
large cell carcinoma
adenosquamous carcinoma, and
Non-small cell lung cancer is a common disease. It is usually
(taking out the cancer in an operation)
(using high-dose x-rays to kill cancer
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
Cancer cells are found in sputum, but no
tumor can be found in the lung.
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
The cancer is only in the lung, and normal
tissue is around it.
Cancer has spread to nearby lymph nodes.
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).
Cancer has spread to other parts of the
: Cancer has come back (recurred) after
Non-small cell lung cancer is treated with:
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
, 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
, which freezes the tumor and kills it.
, which uses a certain type of light
and a special chemical to kill cancer cells.
, 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
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
. 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
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
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
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
Stage III non-small cell lung cancer:
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).
Adapted from The National Cancer
Institute, October, 1999
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a