Once you’ve been diagnosed with non-small cell lung cancer (NSCLC), your primary focus will be treating your condition. But first, your doctor needs to know a few things about your cancer.
NSCLC is grouped into three main types based on the cell where the cancer started:
- Adenocarcinoma is the most common type of NSCLC. It makes up 40 percent of all lung cancers. This cancer starts in mucus-releasing cells in the lungs.
- Squamous cell carcinoma accounts for 25 to 30 percent of lung cancers. It grows from thin, flat cells that line the airways.
- Large cell carcinoma makes up 10 to 15 percent of lung cancers. It gets its name from the large size of the cancer cells when viewed under a microscope. This type of NSCLC tends to grow quickly.
The stage of your cancer is also important. Staging takes into account the size of your cancer and how far your cancer has spread.
Your doctor will assign your cancer a stage number from 1 to 4. The higher the number, the more the cancer has spread. Stage four NSCLC has spread outside of the lung where it started, and possibly to other organs.
Your doctor will recommend a treatment based on the type and stage of your cancer, as well as your overall health. Treatments include surgery, chemotherapy, radiation, targeted drugs, and immunotherapy.
Here are six things to know as you get ready to start treatment.
A few different surgical procedures treat NSCLC. The kind you have depends on the size and location of your cancer. The surgeon can remove only part of a lobe (wedge resection), an entire lobe (lobectomy), or the whole lung (pneumonectomy). Expect to spend five to seven days in the hospital after open lung surgery.
Some early-stage cancers are treatable with video-assisted thoracic surgery, which uses a camera and small incisions. The hospital stay afterward is shorter — only four to five days.
Chemotherapy uses strong medications to kill cancer cells throughout your body. You can get chemo as a stand-alone treatment, or together with radiation or surgery.
Doctors give chemotherapy in cycles. You’ll get the drug for one to three days and then stop for a few days to give your body time to recover. Each chemo cycle lasts for three to four weeks. If you have late-stage cancer, you’ll get about four to six cycles of chemo.
Radiation uses high-energy waves to kill cancer cells. It’s sometimes the main treatment for people with NSCLC who can’t have surgery.
Radiation is also given before surgery to shrink the tumor, or after surgery to remove any cancer cells that were left behind.
You’ll get radiation treatments five days a week for five to seven weeks. Each treatment only takes a few minutes.
Stereotactic body radiation therapy (SBRT) speeds the process. Instead of small doses of radiation over several days, you get a very focused, higher dose. SBRT takes one to five sessions.
Immunotherapy stimulates your body’s immune system to track down and destroy cancer cells. Drugs called checkpoint inhibitors — which include nivolumab (Opdivo) and pembrolizumab (Keytruda) —prevent the cancer from hiding from your immune system.
Your doctor might recommend one of these drugs if your cancer starts to grow again after you’ve had chemotherapy or other treatments. Immunotherapy comes as an infusion that you get through a vein in your arm. You’ll get this treatment once every one to three weeks.
Unlike chemo and radiation, which can’t tell the difference between cancer cells and healthy cells, targeted drugs only destroy cancer cells. These drugs work by blocking substances that help the cancer cells grow and spread.
EGFR-inhibitor drugs like erlotinib (Tarceva) and afatinib (Gilotrif) block a receptor called EGFR that’s on the surface of NSCLC cells. EGFR helps the cancer grow.
You take these drugs as a pill by mouth. You’ll need to keep taking them long-term to prevent the cancer from spreading again.
After your treatment ends, you’ll still have to see your doctor for regular follow-up visits. These checkups are done to look for signs that your NSCLC has come back. If your cancer does return, your doctor will start you on treatment again.
You should have an exam and a chest CT scan once every 6 to 12 months for the first two years. After that, you’ll see your doctor once a year.
Treatment for NSCLC is based on the type and stage of the cancer. The length of treatment can be different for each person.
As you plan out treatment with your doctor, find out what to expect. Ask how long each treatment will take, and how often you’ll need to come back afterward for follow-up exams.