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Lung Cancer Guide photo Understanding The Issues

What is Nonsmall Cell Lung Cancer?

Squamous cell carcinoma, adenocarcinoma, and large cell carcinoma are grouped together and called "nonsmall cell lung cancer" (NSCLC). Their patterns of spread and treatment differ from small cell lung cancer. NSCLC accounts for 75% to 80% of all cases of lung cancer.

How is nonsmall cell lung cancer diagnosed?

CT scans, MRIs, X-rays, sputum cytology, and biopsies are used to diagnose nonsmall cell lung cancer.

Doctors determine how advanced a cancer is by finding out its stage, which is the medical term for the amount of cancer present.

The stage of the cancer is determined by the type of tumor, indicated by T; whether the cancer is in nearby lymph nodes, indicated by N; and whether the cancer has spread to distant parts of the body. This distant spread of the cancer is referred to as metastasis, indicated by M. This system of staging is called the TNM.

Generally, if the cancer is only in the lung, without having spread to lymph nodes, it is called Stage I, the least advanced stage. If it has spread only to the nearby lymph nodes, it is called Stage II. In stage III, the cancer has generally spread to the lymph nodes in the middle of the chest. Cancers that have spread to a distant part of the body, such as the liver, bone, brain or another site, are called Stage IV. Stage IV is the most advanced stage.

In this section there are a number of questions you may want answer for yourself. There is a form you can print out to write down your answers.

The TNM of the cancer I have:

The stage of the cancer that I have:

What are the treatments for nonsmall cell lung cancer?

The treatments for nonsmall cell lung cancer are generally the same as for other types of lung cancer and include surgery, chemotherapy, and radiation. There will likely be a number of healthcare workers involved in your treatment and care. These may include your primary care physician, a surgeon, a radiation oncologist, a medical oncologist, oncology nurses and other nurses, medical technologists, and others. At times, it may be confusing to work with all these people. You may find it helpful to select one doctor to be in charge of your overall care. This will be the person you will call with questions, and concerns and who will refer you to other doctors and therapists as you need them.

Researchers are constantly searching for new and more effective treatments for cancer. Your doctor may be involved in studies done to test these new treatments. These are called "clinical trials." You may want to ask your doctor whether or not you might be helped by being part of a clinical trial.

When would surgery be done?

Surgery is the first choice of treatment for anyone with nonsmall cell lung cancer whose disease is only in the lung (Stage I) and who can handle the surgery. If the cancer has spread to the lymph nodes in or near the lung (Stage II or early Stage III), the surgeon may still be able to remove the tumor and part or all of the lung.

There are cases where surgery is not recommended at first. For example when:

  • the cancer has spread to the other lung
  • the cancer has grown from the lung into other organs in the chest such as the heart
  • the cancer has spread to the lymph nodes in the neck, or to other organs such as the liver, kidneys, or brain.

Sometimes when the cancer has spread to the other lung or into other organs in the chest, chemotherapy and/or radiation therapy is done first. In some cases the tumor is reduced enough so that surgery can then by done.

If you are not having surgery, please skip to the next section, which is about radiation therapy.

Information about the operation I am going to have:

Day of surgery:

Time of Surgery:

Time when I need to be at the hospital:

Location (hospital) in your treatment and care.

My surgeon:

The person who will take me to the hospital:

The person who will bring me home after my operation:

What will my recovery from surgery be like?

Surgery for lung cancer is major surgery, and recovery takes time. After surgery, you may need a machine (ventilator) for a short time to help you breathe until you have recovered from the surgery and can breathe on your own. Nurses and respiratory therapists will teach you to do coughing and breathing exercises, to practice arm and leg exercises, and to use breathing equipment. These things will help you learn to live with less lung tissue. The nurse or therapist will provide a pillow or some other item to support your incision and reduce the discomfort during the exercises. You will also be encouraged to walk as much as possible. These exercises will reduce the risk of problems such as pneumonia and blood clots that can occur after surgery.

During you hospital stay, you will slowly increase your activity so that you can help to take care of yourself when you go home. Medication will be available to control pain you may have at the surgical incision. People having surgery for lung cancer are usually sent home from the hospital 7 to 10 days after the operation.

You may need extra help when you get home after your operation, because things like cooking and doing housework may seem impossible. If you are over 65, Medicare may provide home health services that include visits from a nurse or nursing assistant. Ask your doctor about home health services.

While gradually increasing your physical activity, you will need to get a lot of rest. You may be given some exercises that you can do at home to help you regain your strength and endurance. It is also very important to eat well while you recover.

My instructions for my care at home after the operation:

Exercises I can do:

Medications I will need to take:

Arrangements for help while I recover:
(may include family and friends, Meals on Wheels, housekeeping services, home health services, etc.)

What is radiation therapy?

Many patients with lung cancer will need radiation therapy at some time during their illness. Radiation therapy consists of directing a beam of high-energy rays at a tumor. By injuring cancer cells so that they cannot continue to multiply, the treatments slow down or stop tumor growth. The amount of radiation is based on the size and location of the tumor.

Radiation therapy can be used alone or in combination with surgery or chemotherapy. It may be used before surgery to shrink a tumor. After surgery it may be used to stop the growth of any cancer cells that remain. In some cases, radiation therapy, along with chemotherapy, are used instead of surgery.

If your doctor thinks you need radiation therapy, he or she will consult with a radiation oncologist, a physician who specializes in radiation therapy. The radiation oncologist will decide which kind of radiation will be best for you, how much radiation you will need, and how often you should have treatments. Before your first treatment, you will probably meet with the radiation-treatment team. A member of the team will place marks, either with ink or in small tattoos, on the area to be treated to guide the X-ray instruments and to ensure that treatment will be targeted exactly to the cancer. It is important that these marks not be washed off.

Treatment schedules for radiation therapy vary. The radiation oncologist figures out the total amount of radiation you will need. That amount is divided into small daily doses to increase the effectiveness of the radiation and to decrease the damage to normal cells. For example, a common schedule is daily treatments, 5 days a week, for 5 to 7 weeks. Sometimes you might get a treatment twice a day. Another schedule might call for daily treatments for 1 to 3 weeks, a "rest" period of 2 to 4 weeks, followed by a second course of daily treatments for the next 1 to 3 weeks.

My schedule for radiation therapy:

Will I have side effects from radiation?

Radiation is used to harm or destroy cancer cells, but it can also harm normal cells, which can cause side effects.

Most people begin feeling tired after one or two weeks of radiation treatment. This feeling may slowly increase as you continue therapy. It does not mean that your condition is getting worse, but you should get more rest while you are having treatment. The tiredness usually wears off within a week after you are finished with your treatments.

A dry or sore throat and difficulty in swallowing are minor, temporary complications of radiation therapy. These problems may be noticed within a few days to two weeks after treatment has begun. Some people may fear that this discomfort means that the cancer is growing in their throats - but it is not. These symptoms are caused by the radiation irritating the tissues in the throat. The symptoms usually last only a week or two.

It is important to get plenty to eat at this time. A soft or liquid diet may be helpful until the discomfort subsides in your throat. Milkshakes, cream soups, or prepared liquid supplements are good choices.

The skin may be affected by radiation treatments. You may notice that your skin in the treatment area may begin to look red, irritated, sunburned, or tanned. Loss of hair (only in the treated area) may occur, but it will grow back after about three months.

During radiation therapy you will need to be very gentle with the skin in the treatment area. When you wash, use only lukewarm water and mild soap. It's important not to rub, scrub, or scratch any sensitive spots. Ask your doctor or nurse for advice on relieving any itching or discomfort you might have. Don't use any powders, creams, perfumes, deodorants, body oils, ointments, or lotions on the treatment area while you're being treated and for several weeks afterward (unless approved by your doctor or nurse). And remember not to wash off the marks that will be used to guide the radiation therapy.

Some people will experience a slight hardening of the shoulder and chest muscles that causes aching and stiffness. Your nurse or doctor may recomment exercises such as "walking" your hand up a wall or simple stretches to prevent this while you are receiving the treatments.

Radiation therapy does not usually cause nausea, but if it does occur, your physician can give you antinausea medications.

Side effects I am having from my radiation treatments:

Special instructions from my doctor and/or nurse while I am getting radiation treatments:

What is chemotherapy and when would my doctor recommend it?

Chemotherapy is the use of drugs to treat cancer. Because cancer cells usually grow faster than normal cells, they are more likely to be damaged and destroyed by these drugs. Chemotherapy drugs are made to kill cancer cells, so they may cure the cancer or at least control the growth of the tumor.

Drug treatment programs are tailored to the needs of each person. Your specific combination of chemotherapy drugs and a schedule for treatment will be recommended by your doctor. She or he will develop your chemotherapy treatment plan by considering thing such as the kind of lung cancer you have, how widespread it is, and your general state of health.

Depending on the type of cancer and its stage of development, chemotherapy can be used:

  • to relieve symptoms that may be caused by the cancer
  • to slow the cancer's growth
  • to keep the cancer from spreading
  • to attempt a cure

Even if chemotherapy does not cure the disease, it may help you live longer and more comfortably.

The kinds of chemotherapy I will receive:

My chemotherapy treatment schedule:

What are the side effects of chemotherapy?

Not every person gets every side effect, and some people get only a few, if any. In addition, the severity of side effects varies greatly from person to person. Whether you have a particular side effect, and how severe it will be, depends on the kind and dose of chemotherapy you are given and how your body reacts.

Because cancer cells grow and divide rapidly, anticancer drugs are made to kill fast-growing cells. But certain normal, healthy cells also multiply quickly, and chemotherapy can effect these cells too. When it does, there may be side effects.

The most likely cells to be affected by chemotherapy are blood cells forming in the bone marrow, and cells in the digestive tract, reproductive system, and hair follicles. The most common side effects of chemotherapy include nausea and vomiting, hair loss, and fatigue. Nausea and vomiting can often be controlled or lessened with medication. Getting plenty of rest, limiting your activities, and eating as much as you can may help reduce fatigue. And it is very important to drink lots of fluids to prevent or reduce constipation.

Be sure to talk to your doctor and nurse about which side effects you are most likely to experience with your chemotherapy, how long they might last, how serious they might be, and when you should seek medical attention for them.

Most normal cells recover quickly when chemotherapy is over, so most side effects gradually disappear after treatment ends and the healthy cells have a chance to grow normally. The time it takes to get over some side effects and regain energy varies from person to person.

Side effects to expect from my chemotherapy:

Special instructions from my doctor and/or nurse about my chemotherapy treatments:











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