Non-Small Cell Lung Cancer

What is non-small cell lung cancer?

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for about 85% of all lung cancer cases.

The pace of growth for this disease is highly variable, but in general, it tends to grow at a slower rate than small cell lung cancer (SCLC). However, like SCLC, it can spread to other parts of the body.

Non-small cell lung cancer is more prevalent in people who have smoked, but other factors can cause the disease to develop.

Our approach to lung cancer care

At the Mass General Brigham Cancer Institute, you receive care from an experienced team dedicated to diagnosing and treating lung cancer. Together, they develop a personalized treatment plan based on the type and stage of cancer, genetic and molecular findings, and your overall health and goals.

What are the types of non-small cell lung cancer?

There are three main types of non-small cell lung cancer. Each has distinct characteristics and growth patterns.

• Adenocarcinoma: The disease accounts for about 40% of all non-small cell lung cancers and affects both people who have smoked and those who have not smoked. It typically starts in the outer part of the lungs in mucus-producing cells lining the lungs’ small air sacs.
• Squamous cell carcinoma: This type of non-small cell lung cancer is slightly less common than adenocarcinoma and is strongly linked to smoking. Squamous cell carcinoma grows in the central part of the lungs and may form a mass that blocks the airways.
• Large cell carcinoma: The rarest form of non-small cell lung cancer is named for its large, abnormal-looking cells that can form anywhere in the lungs.

What are the symptoms of non-small cell lung cancer?

Because non-small cell lung cancer can spread to other parts of the body, early diagnosis may help prevent or slow its progression.

Common NSCLC symptoms include:

• Persistent cough that lingers or worsens over time
• Shortness of breath
• Coughing up mucus, phlegm, or blood
• Chest pain
• Fatigue and muscle weakness
• Loss of appetite or unintentional weight loss
• Hoarseness or wheezing

Other non-small cell lung cancer signs and symptoms to watch for include:

• Recurring respiratory infections
• Bone pain
• Headaches

If you experience any of these symptoms, particularly if you have smoked, see your health care provider for an evaluation and testing.

What causes non-small cell lung cancer?

Although smoking is responsible for most non-small cell lung cancer cases, there are other causes of NSCLC. You may be at risk of developing non-small cell lung cancer if you regularly inhale secondhand smoke or are exposed to workplace carcinogens or toxins like asbestos or radiation.

Risk prevention for non-small cell lung cancer

Taking preventive measures can help lower the risk of developing non-small cell lung cancer. To reduce your chances of getting NSCLC, follow these preemptive steps:

• Quit smoking: If you are someone who has smoked cigarettes or used other tobacco products, the most effective way to decrease your risk of getting non-small cell lung cancer is to quit smoking. Smoking is the leading cause of NSCLC. Even if you are someone who has smoked for a long time, immediately quitting can lower the risk of developing lung cancer.
• Avoid secondhand smoke: Exposure to secondhand smoke can increase your risk of lung cancer by 20% to 30%. Steer clear of secondhand smoke, particularly indoors or in confined spaces, to lower your risk of developing lung and other health problems.
• Limit exposure to environmental hazards: It’s essential to avoid harmful toxins and carcinogens such as asbestos, diesel exhaust, and radiation. If you work in a high-risk environment, take precautions when handling and disposing of dangerous chemicals.
• Make healthy lifestyle choices: Eating a well-balanced diet, exercising regularly, and maintaining a healthy weight are all ways to reduce your chance of developing various health problems and diseases, including non-small cell lung cancer.
• Get screened regularly: If you’re at risk of developing lung cancer due to lifestyle, workplace, or hereditary factors, your health care provider may recommend participating in cancer screening programs or clinical trials. You’ll also learn prevention strategies and early detection methods.

Diagnosing non-small cell lung cancer

The first steps typically involve a consultation and physical exam. Your health care provider will go over your medical and family history and determine potential risk factors, including whether you have smoked or if your line of work exposes you to toxins or carcinogens.

Your physician may then order diagnostic testing based on the results of your exam and consultation. These procedures may include:

• Chest X-ray: Quick and painless, this may reveal lung abnormalities that your care team can investigate further through more in-depth imaging technologies like CT and PET scans.
• CT scan: This procedure uses computed imaging to provide detailed cross-sectional images of the chest. Your care team can visualize the lungs and surrounding structures, including soft tissues and bones.
• PET scan: These scans can diagnose lung masses or nodules using a radioactive substance. A PET scan lets your provider identify areas with increased metabolic cell activity. The scan can also help determine the stage of a cancer and detect whether it has spread to lymph nodes or other organs. This information is essential in non-small cell lung cancer treatment.
• MRI: MRI scans are useful tools for providing detailed images of soft tissues in the brain, liver, and spinal cord. MRIs are also helpful in assessing the response to NSCLC treatment and providing information about changes in brain lesions over time.
• Biopsy: This process involves removing a small tissue sample from the lung, lymph nodes or other organ to determine if any cancer is present. Biopsies can also indicate if the tumor is non-small cell lung cancer or small cell lung cancer.

Non-small cell lung cancer treatment options

If you’ve been diagnosed with non-small cell lung cancer, your health care provider will work with you on a treatment plan.

Treatment for NSCLC may involve a multidisciplinary team of health care experts. Your care team will work together to develop an individualized treatment plan based on factors such as:

• The stage and type of cancer
• Your overall health
• Your personal preferences

Local therapies

Local therapies are cancer treatments that target a specific part of the body, such as the lung, to treat cancer. Examples of local therapy for lung cancer are:

Surgery

Surgery may be a recommended course of action in non-small cell lung cancer cases where the tumor is confined to one lung and hasn’t metastasized to lymph nodes or other organs. Surgical options may vary depending on the size and location of the tumor:

• Lobectomy: The most common surgical procedure for NSCLC is a lobectomy, which involves removing a section of the lung.
• Pneumonectomy: Removal of the entire lung may be necessary if the tumor is large or centrally located on the lung.
• Segmentectomy: This is a surgical procedure that involves removing a piece of the lung. It is less extensive than a lobectomy or pneumonectomy.
• Wedge resection: This less invasive procedure involves the removal of a smaller, wedge-shaped section of lung tissue in an early or slow-growing tumor.

Radiation therapy

This form of non-small cell lung cancer therapy uses high-energy to kill or shrink cancer cells. Radiation therapy can be beneficial for early-stage or advanced NSCLC and is non-invasive. Lung cancer specialists often use this form of therapy in conjunction with chemotherapy.

The three main types of radiation therapy used to treat lung cancer are:

1. Stereotactic body radiation (SBRT) - typically delivered over 5 treatments and used in the treatment of earlier stages of lung cancer
2. Stereotactic radiosurgery (SRS) - typically delivered over 1-2 treatments and used to treat brain metastases
3. Standard fractionated radiation - typically used to treat lung cancers that have spread to lymph nodes (stage II-III); consists of daily radiation for up to 6 weeks

Thermal ablation

This procedure uses extreme temperatures to destroy cancer cells. Heat techniques include radiofrequency and microwave ablation. Cryoablation uses liquid nitrogen or argon gas to freeze tumor cells. Explore Mass General’s thermal ablation programs.

Systemic therapies

Systemic therapy is a drug treatment that can affect the entire body. Examples of systemic therapies for lung cancer are:

Chemotherapy

Chemotherapy involves the use of medicine administered orally or intravenously. The medication travels through the bloodstream to kill cancer cells or keep them from growing and spreading. Chemotherapy is often used as the primary treatment for more advanced NSCLC or in combination with surgery or radiation therapy.

Learn more about chemotherapy and lung cancer.

Immunotherapy

Immunotherapy uses immune checkpoint inhibitors to work with your body’s immune system. These inhibitors stimulate the immune system to locate and attack cancer cells.

Learn more about immunotherapy for lung cancer.

Targeted therapy

This therapy can help improve outcomes and reduce side effects compared to chemotherapy drugs. Targeted therapy may be used before surgery to make removing a tumor easier. It can also fight any remaining cancer cells after surgery.

Learn more about clinical trials for targeted drug therapy.

Your treatment care team

The multidisciplinary treatment team for non-small cell lung cancer consists of lung specialists who will provide care tailored to your specific needs.

Key members of your team may include:

• Medical and radiation oncologists
• Thoracic surgeons
• Radiologists
• Pulmonologists
• APPs
• Oncology nurses
• Palliative care specialists
• Social workers

FAQs about non-small cell lung cancer