If you have been diagnosed with late-stage non-small cell lung cancer, you probably have many questions and concerns about treatment. This patient treatment summary, which is based on the NCCN Clinical Practice Guidelines in Oncology™, will help you understand the best available treatments for non-small cell lung cancer that has spread beyond the lungs. Talk to your doctor about these therapies so that together you can decide on a treatment plan that is right for you.

Background

Cancer of the lung is the most frequently diagnosed cancer in the United States. Non-small cell lung cancer (especially late stage) is the most common type of lung cancer. View a separate summary for early-stage non-small cell lung cancer.

Lung cancer most often occurs in people who currently or previously smoked cigarettes or cigars. However, it can also occur in people who have never smoked.

Because non-small cell lung cancer is often diagnosed in a late stage, (ie, stage IV), when it has spread beyond the lungs to nearby tissue or other organs (heart, brain, bones), scientists are working to develop screening tests to detect early-stage lung cancer in people without symptoms.

Diagnosis

It is important that your doctor confirmed the type of lung cancer you have (non-small cell or small cell), because different types of lung cancer require different treatments. Also, some cancers, such as breast cancer and prostate cancer, can metastasize (spread) to the lung. Treatment for cancer that has spread from these locations is different from treatment for cancer that started in the lung.

Stage

Non-small cell lung cancer is divided into stages, which describe whether the cancer is confined to the lung (early-stage non-small cell lung cancer) or has spread to other organs (late stage). Stage I to IIIA is considered early-stage lung cancer; stage IIIB and IV is late-stage cancer. The stage of your cancer was determined from the sample of tissue your doctor obtained from your lung or lymph node. See Cancer Staging Guide. 

Treatment

No single lung cancer treatment is right for everyone. You can make the best decision for you by discussing the benefits, risks, and possible side effects of each treatment with your physician. 

Surgery

Your doctor may recommend conventional, open surgery to remove the tumor from the lung (or other sites) or to remove the part of the lung that contains the tumor (called a lobectomy); several lobes (partial pneumonectomy); or one of your lungs (pneumonectomy).

Some people have a tumor that cannot be removed by surgery. Others have cancer that has spread to other areas of the body, and surgery may not be effective. Others have heart disease or other health problems that make an operation too risky. These people may be offered radiation and chemotherapy (see next section).

Radiation and chemotherapy

After or instead of surgery, people with lung cancer may need some or all of the following:

• Radiation therapy. This is the use of high-energy beams that kill cancer cells, shrink the tumor, and/or decrease obstruction of major blood vessels or bronchi. It can also be used to relieve pain and to stop internal bleeding.
• Chemotherapy (cancer drugs). A single drug or a combination of drugs—such as carboplatin and paclitaxel—is given by injection into a vein. Chemotherapy is especially useful for late-stage cancer that has spread beyond the lungs. If one type of chemotherapy becomes ineffective, you and your doctor may decide on an additional course of therapy using different drugs. See Guide to Chemotherapy.
• Targeted therapy. Some treatments are more specifically directed toward certain markers on tumor cells or certain processes occurring in tumor cells. For example, Avastin (bevacizumab) is a therapy that is targeted to a substance that helps blood vessels grow. Bevacizumab is thought to help decrease the production of new blood vessels supplying the tumor or tumors, thereby helping to "starve" the tumor of nutrients. Other drugs, such as Erbitux (cetuximab), interfere with cancer growth processes occurring in tumor cells.
• Combinations of the above treatments, depending on the stage and extent of the cancer. For example, chemoradiation combines chemotherapy (such as, cisplatin and etoposide) and radiation therapy. Targeted therapies may be given in combination with specific chemotherapy drugs.
• Supportive care. Your doctor may recommend that you receive therapies to relieve disease-related symptoms and control pain. See Palliative Care Gets New Life.

Side effects

Lung cancer treatments may result in uncomfortable side effects. Talk to your doctor about what to expect from each treatment and how to manage the possible effects. For example:

• After conventional surgery, people often have pain. There is also a potential for wound infections, bleeding, pneumonia, and shortness of breath. Ask the doctor in advance how these events would be handled.
• After radiation therapy, people often have fatigue (tiredness); some may have shortness of breath. Your health-care provider can use the NCCN Cancer-Related Fatigue Guideline (see NCCN Clinical Practice Guidelines in Oncology™) to help you reduce fatigue due to cancer treatments. Also, see Fighting Cancer Fatigue.
• After chemotherapy or chemoradiation, people may have intestinal disturbances, mouth sores, hair loss, fatigue and/or loss of appetite.
• Your doctor may give you antiemetic (anti-vomiting) drugs to decrease or prevent nausea and/or vomiting. The NCCN Antiemesis Guideline can help your physician determine the most appropriate antiemetic regimen for your situation. 
• Targeted therapies (such as bevacizumab or cetuximab) can also cause side effects. For example, bevacizumab can cause an blood pressure to rise or internal bleeding. Cetuximab may cause skin rash -  but the presence of the rash is believed to be an indicator that the drug is effective.

It's important to talk to your doctor or oncology nurse about these effects as soon as they appear so that they can either assure you that the effects are normal or investigate them further; they can also help you with pain and symptom relief. 

Prognosis

In determining a prognosis—the likely course or outcome of a disease—a doctor may look at cancer survival statistics taken from studies of large groups of patients. However, such statistics:

• Are estimates only,
• Can vary widely with each cancer stage,
• Are sometimes based on older data that do not reflect recent advances in early detection and treatment,
• Cannot be used to precisely predict your survival.

Your individual prognosis will be affected by many factors, including:

• Your age,
• Your overall health,
• The type and stage of cancer you have,
• Your response to the treatment(s) being used.

New therapies and combinations of therapies are enabling people with cancer to live longer, better quality lives than ever before. Ask your doctor which treatment(s), in his or her judgment, will give you the best life expectancy and quality of life. You may want to participate in a clinical trial, in which new and experimental therapies are tested in people.