Non-Small-Cell Lung Cancer

What Is Non-Small-Cell Lung Cancer?

Cancers are diseases in which normal cells transform so that they grow and multiply without normal controls. In many types of cancer, this results in the growth of one or more large masses, or tumors, of these transformed cells. Such transformed cells are said to have become malignant and are then called cancer cells. This can happen in almost any part of the body. When cancer starts in the cells normally found in the lungs, the disease is called lung cancer.

Lung cancer is one of the most common types of cancer and is the leading cause of death from cancer in men and in women. This is because the lungs are exposed to the external environment more than most other organs are. In many cases, cancer-causing substances (carcinogens) in the air are inhaled and cause cell damage that later becomes cancer. The most common cause of lung cancer, by far, is smoking.

The two main types of lung cancer are small-cell lung cancer and non-small-cell lung cancer. Non-small-cell lung cancer is a catchall term for all lung cancers that are the not small-cell type. They are grouped together because the treatment is often the same for all non-small-cell types. Together, non-small-cell lung cancers, or NSCLCs, make up a majority of lung cancers. Each type is named for the types of cells that were transformed to become cancer. The following are the most common types of NSCLC in the United States:

Like all cancers, lung cancer is most easily and successfully treated if it is caught early. An early stage cancer is less likely to have grown to a large size or to have spread to other parts of the body (metastasized). Large or metastasized cancers are much more difficult to treat successfully. Lung cancer can advance in severity, and these advancement measures are termed stages. Stages range from I to IV, with stage IV as being the most severe stage (see staging of lung cancers below).

What Causes Non-Small-Cell Lung Cancer?

Tobacco Smoking

  • Tobacco smoking is the cause of lung cancer in as many as 90% of cases.
  • A person who smokes is 13.3 times as likely to develop lung cancer as is a person who has never smoked. The risk also varies with the number of cigarettes smoked per day; people who smoke more than 20 cigarettes per day have a much greater risk of developing lung cancer than do those who smoke fewer than 20 cigarettes per day.
  • Once a person quits smoking, the risk of lung cancer increases for the first two years and then gradually decreases, but the risk never returns to the same level as that of a person who has never smoked.
  • Not all people who smoke develop lung cancer, and not all people with lung cancer ever smoked. Clearly, other factors, including genetic predisposition, also play a role.

Passive Smoking (Secondhand Smoke)

  • Some lung cancer cases involving nonsmokers may be caused by secondhand smoke.
  • The Environmental Protection Agency has recognized passive smoking as a potential cause of cancer.

Asbestos

  • Asbestos exposure has been linked to lung cancer and other lung diseases.
  • The silicate type of asbestos fiber is an important carcinogen.
  • Asbestos exposure increases the risk of lung cancer by as much as five times.
  • People who both smoke and have been exposed to asbestos are at an especially high risk of developing lung cancer.

Radon

  • Radon is a gas produced as a result of uranium decay. Radon exposure is a risk factor for lung cancer in uranium miners.
  • Radon exposure is believed to account for a small percentage of lung cancers each year.
  • Household exposure to radon has never been clearly shown to cause lung cancer.

Other Environmental Agents

Exposures to the following agents account, at least partly, for some cases of lung cancer:

  • Petroleum-based chemicals called aromatic polycyclic hydrocarbons
  • Beryllium
  • Nickel
  • Copper
  • Chromium
  • Cadmium
  • Diesel exhaust

Non-Small-Cell Lung Cancer Symptom

Cough

If a cough is a warning sign of an underlying cancer, the person may have a group of symptoms. If lung cancer or a cancer of the air passages is present, the person may cough up blood. Other signs and symptoms that may warn of a cancer include worsening fatigue, loss of appetite, unexplained loss of weight, or decreased ability to swallow solid or liquid foods.

What Are Non-Small-Cell Lung Cancer Symptoms and Signs?

The symptoms of lung cancer are caused by the primary tumor or by metastatic disease. The primary tumor may press on, invade, or damage surrounding tissues, blood vessels, or nerves. Metastatic lung cancer may cause similar problems in other parts of the body. As many as 10% of people with lung cancer have no symptoms. Their cancers are detected on chest X-ray films performed for other reasons.

The symptoms depend on the primary tumor's size, its location in the lung, the surrounding areas affected by the tumor, and the sites of tumor metastasis, if any. Symptoms and signs related to the primary tumor may include any of the following:

  • Cough
  • Shortness of breath
  • Difficulty taking a deep breath
  • Wheezing
  • Coughing or spitting blood (hemoptysis)
  • Pneumonia or other recurrent respiratory infection
  • Pain in the chest, side, or back (usually due to infiltration by the tumor of areas surrounding the lungs) that sometimes worsens with taking a breath
  • Hoarseness, difficulty swallowing, or other symptoms in the face, neck, or arms due to infiltration by a tumor

Symptoms of metastatic lung tumors depend on location and size. Lung cancer most often spreads to the liver, the adrenal glands, the bones, and the brain. About 30%-40% of people with lung cancer have some symptoms or signs of metastatic disease.

  • Metastatic lung cancer in the liver usually does not cause any symptoms, at least at the time of diagnosis.
  • Typically, metastatic lung cancer in the adrenal glands also causes no symptoms at the time of diagnosis.
  • Metastasis to the bones is most common with small-cell lung cancer but can occur with NSCLC. Lung cancer that has metastasized to the bone causes deep pain, usually in the backbone (vertebrae), thighbones, and ribs.
  • Lung cancer that spreads to the brain can cause difficulties with vision, weakness on one side of the body, seizures, or unusual headaches. Any or all of these may occur together.
  • Weight loss may be a symptom of metastatic disease.

Paraneoplastic syndromes are conditions that the disease causes indirectly. These are less common with NSCLC than with small-cell lung cancers, but they do occur.

  • High levels of calcium in the blood (hypercalcemia) can cause problems with muscle and nerve functioning.
  • Increased production of one or more otherwise normally occurring hormones
  • Increased blood coagulation (hypercoagulability) increases the risk of blood clots.

When Should Someone See a Doctor for Non-Small-Cell Lung Cancer?

Any pain in the chest, side, or back, breathing problem, or cough that persists, worsens, or produces blood warrants an immediate visit to a health-care professional, especially if you are or ever were a smoker.

What Exams and Tests Diagnose Non-Small-Cell Lung Cancer?

Medical Evaluation and Tests

The symptoms of lung cancer can be caused by many different medical conditions. Even a chest X-ray film that shows what looks like a tumor is not enough to make the diagnosis of lung cancer. The health-care provider's job is to gather all available information and to make the diagnosis. Correct and prompt diagnosis is essential so that appropriate treatment can be started as soon as possible.

The first step in the evaluation is the medical interview. The health-care provider asks the patient questions about symptoms and when they started, current or past medical problems, medications taken, family medical problems and family cancer history, work and travel history, and habits and lifestyle. This is followed by a thorough physical examination.

The remainder of the evaluation focuses on confirming the presence of lung cancer and staging the tumor. Although primary-care providers are able to conduct this evaluation, they may prefer to refer the patient to a specialist in lung diseases (pulmonologist) or cancer (oncologist).

Lab Tests

No blood test can confirm that a patient has lung cancer. Blood tests are performed to check the patient's general health, to rule out other conditions that might cause similar symptoms, and to detect certain paraneoplastic syndromes. The usual blood tests include the following:

  • Complete blood cell counts
  • Liver and kidney function tests
  • Blood chemistry and electrolyte levels

Imaging Studies

Respiratory (breathing) symptoms are usually evaluated with a chest X-ray film, CT scan of the chest, or both. X-ray films are limited in the amount of detail they provide, but they clearly show some tumors. CT scans shows much greater detail in a 3-D format. A CT scan is needed if the X-ray film findings are not definitive. If imaging studies show evidence of a tumor, further testing is needed.

Other Tests

Sputum analysis: Sputum is mucus in the lungs. Sputum is the body's natural system for removing small particles and contaminants from the airways. Many people, especially those who smoke, produce sputum when they cough. In some cases of lung cancer, tumor cells are sloughed off into the sputum and can be detected by cytologic (cell) testing of the sputum. For this test, the patient is asked to cough, and the sputum is collected and examined.

  • This simple test, if the result is positive for tumor cells, confirms the diagnosis of cancer. A result negative for tumor cells, however, does not confirm that no cancer is present.
  • In either case, further testing is needed: if positive for tumor cells, to determine the type of cancer; if negative for tumor cells, to seek definitive evidence of whether a tumor is present.

Bronchoscopy: This is the use of a device called an endoscope to view the lungs directly. An endoscope is a thin tube with a light and a tiny camera on the end. The endoscope is inserted through the mouth or nose into the bronchus (airway) and down to the lung. The camera transmits pictures of the inside of the patient's airways that can be viewed on a video screen.

  • Bronchoscopy allows the doctor to look directly at the tumor (if one is present). This allows the doctor to determine the tumor's size and the extent to which it is blocking the airway.
  • The bronchoscope can also be used to collect a biopsy. A biopsy is a small sample of the tumor or any abnormal-appearing lung tissue that health-care professionals remove for further testing.
  • The biopsy is examined under a microscope by a pathologist, a specialist in diagnosing diseases in this way. The pathologist confirms whether the sample taken from the mass is cancer and, if so, the type of cancer.
  • This technique is also used to examine the area around the main airway, between the lungs in the middle of the chest (mediastinum). The cancer can infiltrate the lymph nodes in this area. The endoscope is inserted through a small incision just above or to the side of the breastbone. This technique is called mediastinoscopy. Enlarged lymph nodes and other abnormal tissues can be removed during this procedure.

Endobronchial ultrasound (EBUS): This technique that combines bronchoscopy with an ultrasound, allowing good visualization of lymph nodes and biopsy without an incision.

Fine-needle aspiration or core needle biopsy: These techniques allow sampling of abnormal tissue without the need for open surgery, using ultrasound, or CT scanning to localize the abnormal area. It is used for tumors that cannot be reached with a bronchoscope, usually because they are in the outer part of the lung. Again, this material is examined to confirm the presence of a tumor and to determine the type of tumor.

Testing of the Tumor Material

For certain NSCLC, genetic testing to look for mutations in the DNA of the tumor are recommended to determine whether targeted therapy (see below) may be effective. Current treatment practice is to recommend analysis of either the original tumor or of a metastasis in the case of late-stage disease, for epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) for all patients whose tumor is of a subtype known as adenocarcinoma. Testing for other tumor markers may be performed to help determine which specific drugs will be most effective for a given tumor. This testing is performed in the laboratory using biopsy tissue samples.

Biopsies from other sites: Material can also be obtained from other sites with abnormalities to confirm the diagnosis. These sites include enlarged lymph nodes or liver and collections of fluid around the lung (pleural effusion) or heart (pericardial effusion).

How Do Health-Care Professionals Determine the Stage of Non-Small-Cell Lung Cancer?

Staging is a system of classifying cancers based on the extent of the disease. In general, the lower the stage, the better the outlook for remission and survival. In NSCLC, staging is based on the size of the primary tumor, the number of cancerous lymph nodes, and the presence of any metastatic tumors. Accurate staging is essential in NSCLC because the stage of the cancer determines which treatment may offer the best results.

For people with lung cancer, the first step is to undergo a staging evaluation. The patient's medical team cannot make recommendations for the best treatment until they know the cancer's exact stage.

This evaluation includes many of the tests already described. Other tests are as follows:

  • CT scan of the chest and upper abdomen: The purposes of this scan are to measure the exact size of the primary tumor, to look for enlarged lymph nodes that may be cancerous, and to look for signs of metastatic disease in the liver and adrenal glands.
  • CT scan or MRI of the brain: This is needed only if the patient is experiencing neurologic symptoms that suggest that the cancer has metastasized to the brain.
  • Positron emission tomography (PET) scan: This scan detects cancer cells throughout the body based on the rate they use glucose (sugar); this rate is higher than that of normal cells. PET scan is relatively widely available and of major importance for proper staging and treatment planning.
  • Bone scan: This test, formally known as scintigraphy, looks for metastasis to the bones. A harmless radioactive substance is inserted into the bloodstream. It concentrates in areas where the infiltrating cancer has weakened the bone. A scan of the entire skeleton highlights these areas. Generally, this test is performed only if the patient is experiencing bone pain or other signs of bony metastasis.
  • MRI of the spine: MRI is the best test for detecting compression of the spinal cord. This happens when the metastatic disease puts pressure on the spinal cord. Cancer that has spread to the spinal column of bones can weaken the bones and lead to this complication. This is a serious complication of lung cancer. It usually causes pain in the neck, back, or hip. Compression of the spinal cord can also cause numbness or paralysis in the arms, legs, or both, problems controlling the bladder or bowels, and other problems. If not quickly relieved, the damage can become permanent.

The stage is determined by a combination of the following three characteristics:

  • T: Size and extent of primary tumor
  • N: Involvement of lymph nodes in the region of the lungs
  • M: Metastatic involvement or spread to distant organs

NSCLC has four stages, designated I, II, III, and IV.

  • Stage I tumors are limited to the lung.
  • Stage II tumors have spread to lymph nodes or airways at the root of the lung or to the external lining of the lung.
  • Stage III means that the cancer has spread to the lymph nodes in the middle of the chest or above the collarbones (supraclavicular nodes) and/or spread to adjacent organs or tissues.
  • Stage IV tumors have spread to the other lung or to distant sites within the body.

What Is the Treatment for Non-Small-Cell Lung Cancer?

Tissue diagnosis is mandatory prior to any treatment. The goals of treatment are to remove or shrink the tumor, to kill all residual tumor cells, to prevent or minimize complications and paraneoplastic syndromes, and to relieve the symptoms and side effects associated with the disease and treatment. Available therapies cure only a small number of people with lung cancer. Other people's tumors shrink substantially or even disappear, although residual cancer cells remain in the body. Such people are said to be in remission. Most people feel well during remission and are able to resume their everyday activities. Remissions can last a few months, a few years, or even indefinitely. If and when the disease comes back, it is called recurrence or relapse. The disease may recur in the lung or in another part of the body.

What Is the Medical Treatment for Non-Small-Cell Lung Cancer?

Traditionally, the three major therapies used for NSCLC were surgery, chemotherapy, and radiation therapy. Targeted therapy is a new form of treatment that is specifically designed to treat defects in the cancer cells and requires testing of the tumor tissue to determine what specific abnormalities are present. Immunotherapy is also a newer method often used to treat NSCLC.

  • Surgery: The tumor is removed through an incision in the skin and muscle.
  • Chemotherapy: Strong chemicals and drugs are taken internally, either by mouth or through a vein into the bloodstream, to kill tumor cells.
  • Radiation therapy: A powerful radiation beam is pointed at the tumor (external beam) or a radiation source is placed within the body next to the tumor (internal beam). The radiation kills the tumor cells.
  • Targeted therapy: Special drugs are designed to target a specific molecule or defect in the cancer cell.
  • Immunotherapy: Immunotherapy drugs work with your own immune system to help destroy cancer cells.

Each person with NSCLC should be offered a customized treatment regimen, which should consist of some combination of these therapies depending on disease stage and location, as well as the particular genetic abnormalities or so-called tumor biomarkers found in the individual tumor.

After the staging evaluation, a decision is made whether the tumor is operable. Operable (or resectable) tumors are those that can be removed completely or almost completely by surgery. Generally, only stage I and some stage II and III tumors can be removed by surgery. Sometimes, people with stage III or IV inoperable disease undergo surgery, but this is usually performed to remove enough of the tumor to relieve symptoms such as breathing problems or severe pain. Surgery does not cure people with stage IV or most stage III diseases.

Chemotherapy

NSCLC is only moderately sensitive to chemotherapy. Chemotherapy alone does not have the potential to cure people with NSCLC. When the goal is cure, chemotherapy is given in combination with surgery or radiation therapy. Chemotherapy alone is given only to people who cannot undergo surgery or radiation therapy or, in some cases, people whose disease has relapsed after surgery. When given in combination with surgery, the chemotherapy is usually given after surgery (adjuvant chemotherapy). Adjuvant chemotherapy is recommended to treat cancer in stages I-III after surgery has been performed to remove the cancer. In general, chemotherapy is given in cycles. Treatment usually lasts a few days and is then followed by a recovery period of a few weeks. When side effects have subsided and blood cell counts have started to return to normal, the next cycle begins. Usually, chemotherapy is given in regimens of two or four cycles. After these cycles are over, the patient undergoes repeat CT scans and other tests to see what effect the chemotherapy has had on the tumor.

Radiation Therapy

Radiation therapy may be given in combination with surgery or chemotherapy or alone. Generally, radiation therapy is given alone only for people who are not candidates for surgery. Radiation therapy may be used for different aspects of treatment, including preoperatively to reduce the size of a tumor for surgical removal, after surgery to kill any remaining tumor cells, or in later-stage disease to relieve the patient's symptoms.

Targeted Therapy

Targeted therapy involves testing a patient's tumor tissue to identify specific genetic alterations or mutations that can be targeted with specifically designed drugs. Targeted therapy may be given alone or in combination with chemotherapy. Many NSCLC have genetic changes that include mutations or other changes in specific genes; examples of the genetic changes are EGFR mutation, ALK fusion oncogene, and mutations in genes known as ROS1, BRAF, and KRAS. A small number of NSCLC have mutations in the gene that codes for the HER2 protein. Targeted therapy drugs that attack cells with these specific changes are constantly being developed, and many of these drugs are available today.

Immunotherapy

Immunotherapy is a type of therapy that helps your immune system work to destroy tumor cells. Specific testing, known as biomarker testing, is sometimes required to determine if your particular tumor will respond to certain immunotherapy drugs.

What Medications Treat Non-Small-Cell Lung Cancer?

Inoperable NSCLC is treated with chemotherapy or a combination of chemotherapy and radiation therapy. Chemotherapy usually requires other supportive medications to prevent or treat side effects such as nausea and vomiting, anemia (low red blood cell count), bleeding (from low platelet count), and neutropenia (low numbers of infection-fighting types of white blood cells called neutrophils). Because neutropenia increases the risk of infections, antibiotics may also be given. Growth factors are often given to promote the production of red and white blood cells and platelets. The agents most widely used to prevent or treat nausea and vomiting are corticosteroids (dexamethasone [Decadron]) and the serotonin receptor antagonists, which include ondansetron (Zofran), granisetron (Kytril), and dolasetron (Anzemet).

Examples of chemotherapy agents that are currently used to treat NSCLC include the following:

  • Cisplatin (Platinol): This agent damages the DNA of the tumor cells. It can also damage healthy cells, which accounts for some of the side effects such as hair loss and nausea. This drug can be harmful to the kidneys and must be given with extreme caution to people with kidney problems. It also can damage the ears and diminish hearing.
  • Carboplatin (Paraplatin): This drug is similar to cisplatin but generally causes fewer side effects.
  • Vinorelbine (Navelbine): This agent stops tumor cell growth by interfering with cell division.
  • Paclitaxel (Taxol): This drug also interferes with cell division.
  • Gemcitabine (Gemzar): This drug interferes with formation of DNA in cells so they cannot reproduce.
  • Docetaxel (Taxotere): This agent prevents cell division by interfering with the cell's preparations to divide.
  • Pemetrexed disodium (Alimta): This chemotherapy agent disrupts metabolic processes essential for cell production.

What Targeted Therapy Drugs Treat NSCLC?

Examples of targeted therapy agents that are currently used to treat NSCLC include the following:

  • Gefitinib (Iressa), erlotinib (Tarceva), and Afatinib (Gilotrif): These are new targeted drugs used to treat advanced NSCLC that is resistant to more conventional chemotherapy agents. These drugs are referred to as tyrosine kinase inhibitors. They inhibit the activity of a substance called epidermal growth factor receptor tyrosine kinase, which is located on the surface of cells and is needed for growth.
  • Crizotinib (Xalkori) and ceritinib (Zykadia) are drugs that are anaplastic lymphoma kinase tyrosine kinase inhibitors; they are used to treat tumors that harbor the (ALK) fusion oncogene (ALK-positive) NSCLC.

What Immunotherapy Medications Treat NSCLC?

Examples of immunotherapy agents that are currently used to treat NSCLC include the following:

  • Nivolumab (Opdivo) and pembrolizumab (Keytruda): These drugs are examples of immune checkpoint inhibitors. These treatments work by stimulating the immune system. These drugs target the immune checkpoint known as PD-1.
  • Bevacizumab (Avastin) and ramucirumab (Cyramza) are monoclonal antibody drugs that preventing tumors from growing new blood vessels, a process called angiogenesis.
  • Ipilimumab (Yervoy) is a checkpoint inhibitor that targets a checkpoint known as CTLA-4

When Is Surgery Appropriate for Non-Small-Cell Lung Cancer?

Surgical removal of the tumor provides the best chance of long-term, disease-free survival and the possibility of a cure. In stages I and II NSCLC, removal of the tumor by surgery is almost always possible unless the person is ineligible for surgery because of other medical conditions or complications of the tumor. (These patients usually receive radiation therapy.) Generally, only some stage III cancers are operable. People with most stage III or IV tumors are generally not candidates for surgery.

Less than half of people with NSCLC have operable tumors. Approximately half of people who undergo surgery have a relapse after surgery.

Before a patient can undergo surgery for lung cancer, pulmonary function tests are carried out to make sure the lung function is sufficient.

The standard operations for lung cancer include lobectomy (removal of one lobe of the lung) or pneumonectomy (removal of the whole lung). Attempts to remove a smaller part of the lung (wedge resections) carry a higher risk of recurrence and poor outcome.

Like all operations, these procedures have benefits and risks. All operations carry a risk of complications, both from the operation itself and from the anesthesia. The surgeon discusses these benefits and risks with the patient. Together, they decide whether the patient is a candidate for surgery.

What Are Other Therapies for Non-Small-Cell Lung Cancer?

Clinical trials should always be considered as an alternative in the treatment of advanced non-small-cell lung cancer. Clinical trials are always under way to test new medications, including new targeted therapy and immunotherapy drugs, as well as new combinations of drugs.

Non-Small-Cell Lung Cancer Follow-up

Following surgery for any operable lung cancer, the patient has a risk of developing a second primary lung cancer. Following any treatment, the original tumor may come back.

  • Many lung cancers come back within the first two years after treatment.
  • The patient should undergo regular testing so that any recurrence can be identified as early as possible.
  • The patient should be checked every three to four months for the first two years and every six to 12 months afterward.

Palliative and Terminal Care

Palliative care refers to medical or nursing care whose goal is to reduce symptoms and suffering without attempting to cure the underlying disease. Because only a small number of people with lung cancer are cured, relief of suffering becomes the primary goal for many. Palliative care consultation can prolong survival in patients with advanced inoperable lung cancer.

  • Whenever possible, the patient should receive a palliative care consultation early in the course of their treatment.
  • Planning should begin with a conversation between the patient (or someone representing the patient if she is too ill to participate) and her health-care provider.
  • During these meetings, the patient can discuss likely outcomes, medical issues, and any fears or uncertainties he or she may have.

Palliative care may be undertaken through the provider's office, and care may be given at home. Palliative care consists of both counseling and coordination of care to be sure that the patients understand the goals of treatment and participates in their treatment decisions at each step. It also helps to manage symptoms optimally and coordinates care of preexistent conditions in the face of the cancer diagnosis.

Palliative care is not the same as hospice care.

End-of-life care with the aid of hospice providers usually comes at the point when palliative measures, including active treatments with chemotherapy and radiation, are generally recognized as no longer effective even in palliating the disease or halting its progression. At that point, an early referral to hospice is appropriate. Hospice providers can coordinate and manage symptoms at home in a special hospice facility, or when necessary, a nursing home or hospital.

  • Breathlessness is treated with oxygen and medications such as opioids (narcotic drugs such as opium, morphine, codeine, methadone, and heroin).
  • Pain treatment includes anti-inflammatory medications and opioids. The patient is encouraged to participate in determining doses of the pain medication because the amount needed to block pain varies from day to day.
  • Other symptoms such as anxiety, lack of sleep, and depression are treated with appropriate medications and, in some cases, complementary therapies.

Is It Possible to Prevent Non-Small-Cell Lung Cancer?

Lung cancer remains a highly preventable disease because 85% of lung cancers occur in people who smoke or used to smoke. The best way to prevent lung cancer is not to smoke.

  • Cigarette smoking is highly addictive, and quitting often proves to be difficult. However, smoking rates have decreased recently in North America and in other parts of the world.
  • People who smoke who use a combination of supplemental nicotine, group therapy, and behavioral training show a significant drop in smoking rates.
  • People who smoke who use a sustained-release form of the antidepressant bupropion (Wellbutrin, Zyban) have a much higher quitting rate than average and a higher abstinence rate after one year.

Screening for Lung Cancer

  • The American Cancer Society does not currently recommend routine chest X-ray screening for lung cancer. This means that many health-insurance plans do not cover screening chest X-ray films.
  • Low-dose CT scans of the chest annually in those age 55 to 74 who have been smokers or continue to smoke -- especially more than one pack a day for more than 30 years, or the equivalent, and have no history of lung cancer -- now appear to increase the detection of early stage lung cancers in those screened. The testing is relatively expensive and debate continues on this subject.
  • People who smoke or used to smoke may want to have a periodic chest X-ray film anyway. They should discuss this with their health-care providers.

What Is the Prognosis, Life Expectancy, and Survival Rate for Non-Small-Cell Lung Cancer?

Overall, 14% of people with NSCLC survive for at least five years.

  • People who have stage I NSCLC and undergo surgery have a 70% chance of surviving five years.
  • People with extensive inoperable NSCLC have an average survival duration of nine months.

How well the person with NSCLC functions can have a strong effect on the survival duration. A person with small-cell lung cancer who functions well has an advantage over someone who cannot work or pursue normal activities.

Complications of NSCLC

  • Spinal cord compression
  • Bone pain
  • Hormone or electrolyte imbalances
  • Problems with mental functioning or concentration
  • Visual problems
  • Liver failure
  • Pain in right side from enlarged liver
  • Weight loss
  • Severe hemoptysis (coughing up blood)

Complications of Chemotherapy

  • Unexplained fever (due to neutropenia or infection)
  • Bleeding (due to low platelet count)
  • Electrolyte imbalances
  • Kidney failure
  • Peripheral neuropathy (tingling, numbness, pain in extremities)
  • Hearing problems

Support Groups and Counseling for Non-Small-Cell Lung Cancer

Living with cancer presents many new challenges, both for you and for your family and friends.

  • You will probably have many worries about how the cancer will affect you and your ability to live a normal life: to care for your family and home, to hold your job, and to continue the friendships and activities you enjoy.
  • Many people feel anxious and depressed. Some people feel angry and resentful; others feel helpless and defeated.

For most people with cancer, talking about their feelings and concerns helps.

  • Your friends and family members can be very supportive. They may be hesitant to offer support until they see how you are coping. Do not wait for them to bring it up. If you want to talk about your concerns, let them know.
  • Some people do not want to "burden" their loved ones, or they prefer talking about their concerns with a more neutral professional. A social worker, counselor, or member of the clergy can be helpful if you want to discuss your feelings and concerns about having cancer. Your primary-care doctor, surgeon, or oncologist should be able to recommend someone.
  • Many people with cancer are profoundly helped by talking to other people who have cancer. Sharing your concerns with others who have been through the same thing can be remarkably reassuring. Support groups of people with cancer may be available through the medical center where you are receiving your treatment. The American Cancer Society also has information about support groups all over the United States.

For more information about support groups, contact the following agencies:

  • Alliance for Lung Cancer Advocacy, Support, and Education: 800-298-2436
  • American Cancer Society: 800-ACS-2345
  • National Cancer Institute, Cancer Information Service: 800-4-CANCER (800-422-6237); TTY (for deaf and hard of hearing callers) 800-332-8615

For More Information on Non-Small-Cell Lung Cancer

American Cancer Society

American Lung Association

National Cancer Institute, General Information About Non-Small Cell Lung Cancer

It's Time to Focus on Lung Cancer, Lung Cancer 101

Reviewed on 11/21/2017

REFERENCE:

American Cancer Society. "Lung cancer (non-small cell)." May 16, 2016. <http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-treating-targeted-therapies>.

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