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National Cancer Institute

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Non-small cell lung cancer


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is non-small cell lung cancer?
STAGE EXPLANATION
Stages of non-small cell lung cancer
Occult stage
Stage 0
Stage I
Stage II
Stage III
Stage IV
Recurrent
TREATMENT OPTION OVERVIEW
How non-small cell lung cancer is treated
OCCULT NON-SMALL CELL LUNG CANCER
STAGE 0 NON-SMALL CELL LUNG CANCER
STAGE I NON-SMALL CELL LUNG CANCER
STAGE II NON-SMALL CELL LUNG CANCER
STAGE III NON-SMALL CELL LUNG CANCER
STAGE IV NON-SMALL CELL LUNG CANCER
RECURRENT NON-SMALL CELL LUNG CANCER
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that gives up-to-date information on cancer and its prevention, detection, treatment, and supportive care. It is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your doctor, who knows you and has the facts about your disease. PDQ can also provide the names of additional health care professionals who specialize in treating patients with cancer.

Before you start treatment, you also may want to think about taking part in a clinical trial. PDQ can be used to learn more about these trials. A clinical trial is a research study that attempts to improve current treatments or finds information on new treatments for patients with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help patients with cancer. Information is collected about new treatments, their risks, and how well they do or do not work. When clinical trials show that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the standard treatment. Listings of current clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials are listed in PDQ.

To learn more about cancer and how it is treated, or to learn more about clinical trials for your kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


What is non-small cell lung cancer?

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. (A separate patient information summary on small cell lung cancer is also available in PDQ).

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), adenocarcinoma, large cell carcinoma, adenosquamous carcinoma, and undifferentiated carcinoma.

Non-small cell lung cancer is a common disease. It is usually treated by surgery (taking out the cancer in an operation) or radiation therapy (using high-dose x-rays to kill cancer cells). However, chemotherapy 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.


STAGE EXPLANATION


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 lung cancer:


Occult stage

Cancer cells are found in sputum, but no tumor can be found in the lung.


Stage 0

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 in situ.


Stage I

The cancer is only in the lung, and normal tissue is around it.


Stage II

Cancer has spread to nearby lymph nodes.


Stage III

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).


Stage IV

Cancer has spread to other parts of the body.


Recurrent

Cancer has come back (recurred) after previous treatment.


TREATMENT OPTION OVERVIEW


How non-small cell lung cancer is treated

Chemotherapy uses 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 occurring.

Radiation therapy 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 the brain.

Cryosurgery freezes the tumor and kills it. Photodynamic therapy uses a certain type of light and a special chemical to kill cancer cells. Laser therapy 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 cancer. 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 a pneumonectomy.

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 being treated.

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 internally.


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 internally.


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 chemotherapy.


STAGE III NON-SMALL CELL LUNG CANCER

Stage IIIA 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).


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about lung cancer, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this toll-free number, trained information specialists can answer your questions.

The Cancer Information Service also has booklets about cancer that are available to the public and can be sent on request. The following booklets about lung cancer may be helpful:

What You Need To Know About Lung Cancer

The following general booklets related to questions on cancer may also be helpful:

What You Need To Know About Cancer
Radiation Therapy and You: A Guide to Self-Help During Treatment
Chemotherapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again

There are many other places where people can get material and information about cancer treatment and services. The social service office at a hospital can be checked for local and national agencies that help with getting information about finances, getting to and from treatment, getting care at home, and dealing with problems.

For more information from the National Cancer Institute, please write to this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Date Last Modified: 10/1999


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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