Lung Cancer (Non-Small Cell)


General Information


What is non-small cell lung cancer?

Non-small cell lung cancer is a disease in which malignant (cancer) cells form in the tissues of the lung. The lungs are a pair of cone-shaped breathing organs that are found within the chest. The lungs bring oxygen into the body and take out carbon dioxide, which is a waste product of the body's cells. There is a right lung and a left lung. Each lung has sections called lobes. The left lung has two lobes. The right lung, which is slightly larger, has three. A thin membrane called the pleura surrounds the lungs. Two tubes called bronchi lead from the trachea (windpipe) to the right and left lungs. Tiny air sacs called alveoli and small tubes called bronchioles make up the inside of the lungs. The bronchi are sometimes also involved in lung cancer.

There are two types of lung cancer: non-small cell lung cancer and small cell lung cancer. (Refer to Small Cell Lung Cancer Treatment for more information.)

There are five types of non-small cell lung cancer. The five types of non-small cell lung cancer have different kinds of cancer cells. The cancer cells of each type grow and spread in different ways. The types of non-small cell lung cancer are named for the kinds of cells found in the cancer and how the cells look when viewed under a microscope:

Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that look like fish scales. This is also called epidermoid carcinoma.

Adenocarcinoma: Cancer that begins in cells that have glandular (secretory) properties.

Large cell carcinoma: Cancer in which the cells are large and look abnormal when viewed under a microscope.

Adenosquamous carcinoma: Cancer that begins in cells that look flattened when viewed under a microscope. These cells also have glandular (secretory) properties.

Undifferentiated carcinoma: Cancer cells that do not look like normal cells and multiply uncontrollably.

Certain factors affect treatment options and prognosis (chance of recovery). The treatment options and prognosis (chance of recovery) depend on the stage of the cancer (whether it is in the lung only or has spread to other places in the body), tumor size, the type of lung cancer, whether there are symptoms, and the patient's general health.

For most patients with non-small cell lung cancer, current treatments do not cure the cancer. If lung cancer is found, participation in one of the many clinical trials being done to improve treatment should be considered. Clinical trials are taking place in most parts of the country for patients with all stages of non-small cell lung cancer.

Stages of Non-small Cell Lung Cancer

After lung cancer has been diagnosed, tests are done to find out if cancer cells have spread within the lungs or to other parts of the body.
The process used to find out if cancer has spread within the lungs or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan the best treatment. The following tests and procedures may be used in the staging process:

Physical examination: A check of general signs of health, including looking for anything unusual such as lumps or growths.

Radiologic examinations: The use of radiation or other imaging methods to detect signs of cancer.

Radiologic tests for non-small cell lung cancer include:

Chest x-ray: Brief exposure of the chest to radiation to produce an image of the chest and its internal structures.

CT scan (CAT scan): A CT scan creates a series of detailed pictures of areas inside the body, taken from different angles. The pictures are created by a computer linked to an x-ray machine. This test is also called computed tomography, computerized tomography, or computerized axial tomography.

PET scan (positron emission tomography scan): A PET scan creates a picture showing the location of tumor cells in the body. A substance called radionuclide glucose (sugar) is injected into the patient through a vein and the PET scanner rotates around the patient to create the picture. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells.

Laboratory tests: Medical procedures that involve testing samples of blood, urine, or other substances or tissues in the body to help determine the diagnosis, plan and check treatment, or monitor the course of disease over time.

Lymph node biopsy: The removal of lymph nodes for examination under a microscope to check for cancer cells. Lymph nodes are small, bean-shaped structures found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease.

Bronchoscopy: A procedure in which a thin, lighted tube is inserted through the nose or mouth into the trachea (windpipe) and bronchi (air passages that lead to the lung). This allows the inside of the trachea, bronchi, and lung to be examined.

Mediastinoscopy: A procedure in which a tube is inserted into the chest to view the organs in the area between the lungs and nearby lymph nodes. The tube is inserted through an incision above the breastbone. This procedure is usually used to get a tissue sample from the lymph nodes on the right side of the chest.

Anterior mediastinotomy: A procedure in which a tube is inserted into the chest to view the tissues and organs in the area between the lungs and between the breastbone and heart. The tube is inserted through an incision next to the breastbone. This procedure is usually used to get a tissue sample from the lymph nodes on the left side of the chest. It is also called the Chamberlain procedure.

The following stages are used for non-small cell lung cancer:

Occult (hidden) stage
In the occult (hidden) stage, cancer cells are found in sputum (mucus coughed up from the lungs), but no tumor can be found in the lung by imaging or bronchoscopy, or the primary tumor is too small to be assessed.

Stage 0 (carcinoma in situ)
In stage 0 (carcinoma in situ), cancer is limited to the lung and is found in a few layers of cells only. It has not grown through the top lining of the lung.

Stage I
In stage I, the cancer is in the lung only, with normal tissue around the tumor. Stage I is divided into stages IA and IB, based on the size of the tumor.

Stage II
In stage II, cancer has spread to nearby lymph nodes or to the chest wall (the ribs and muscles that make up the area of the body between the neck and the abdomen), the diaphragm (the thin muscle below the lungs and heart that separates the chest from the abdomen), the mediastinal pleura (the thin membrane that covers the outside of the lungs in the area near the heart), or the parietal pericardium (the outer layer of tissue that surrounds the heart). Stage II is divided into stage IIA and stage IIB, based on the size of the tumor and whether it has spread to the lymph nodes.

Stage III
In stage III, cancer has either:

-spread to the lymph nodes in the mediastinum (the middle area between the lungs that contains the heart, major blood vessels, and other structures); or
-spread to the lymph nodes on the opposite side of the chest or in the lower neck.

Stage III is divided into stage IIIA (which is sometimes treated with surgery) and stage IIIB (which is rarely treated with surgery).

Stage IV
In stage IV, cancer has spread to other parts of the body or to another lobe of the lungs.

Recurrent Non-Small Cell Lung Cancer
Recurrent non-small cell lung cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the brain, lung, or other parts of the body.

Treatment Option Overview

At diagnosis, patients can be divided into three treatment groups based on the stage of the cancer:

Non-small cell lung cancer that can be treated with surgery.
Stage 0, stage I, and stage II non-small cell lung cancer can often be removed by surgery. Radiation therapy may be used to treat patients who have other medical problems and cannot have surgery.

Non-small cell lung cancer that has spread to nearby tissue or to lymph nodes.
Non-small cell lung cancer that has spread to nearby tissue or to lymph nodes can be treated with one of the following:

1.Radiation therapy alone.
2.Radiation therapy and chemotherapy or other kinds of treatment.
3.Surgery alone.

Non-small cell lung cancer that has spread to other parts of the body or to another lobe of the lungs. Radiation therapy may be used to shrink the cancer and to relieve pain in patients who have non-small cell lung cancer that has spread to other parts of the body. Chemotherapy may be used to treat some patients.

Three types of standard treatment are used:

Surgery

Three types of surgery are used:

Wedge resection: Surgery to remove only a small part of the lung.

Lobectomy: Surgery to remove a whole lobe (section) of the lung.

Pneumonectomy: Surgery to remove one whole lung.

Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.

Radiation therapy
Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Radiation may be used in addition to surgery, chemotherapy, or both. Non-small cell lung cancer is treated with internal radiation.

Other types of treatment and prevention are being tested in clinical trials. These include the following:

Photodynamic therapy (PDT)
Photodynamic therapy (PDT) is a treatment with drugs that become active and kill cancer cells when exposed to light.

Laser therapy
Laser therapy is a treatment that uses a very powerful beam of light to kill cancer cells.

Chemoprevention
Chemoprevention is the use of drugs, vitamins, or other agents to try to reduce the risk of, or delay the growth or recurrence of, cancer.

New treatments
New combinations of treatments are being studied in clinical trials.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options By Stage

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 usually be cured by surgery. Tests may include the following:

Chest x-ray: Brief exposure of the chest to radiation to produce an image of the chest and its internal structures.

Bronchoscopy: A procedure in which a thin, lighted tube is inserted through the nose or mouth into the trachea (windpipe) and bronchi (air passages that lead to the lung). This allows the inside of the trachea, bronchi, and lung to be examined.

CT scan (CAT scan): A CT scan creates a series of detailed pictures of areas inside the body, taken from different angles. The pictures are created by a computer linked to an x-ray machine. This test is also called computed tomography, computerized tomography, or computerized axial tomography.

Stage 0 Non-small Cell Lung Cancer
Treatment of stage 0 non-small cell lung cancer may include the following:

1.Surgery to remove a small portion of the lung where the cancer cells are found.
2.Photodynamic therapy using an endoscope. Photodynamic therapy uses drugs that become active and kill cancer cells when exposed to light. An endoscope is a thin, lighted tube used to look at tissues inside the body.


Stage I Non-small Cell Lung Cancer
Treatment of stage I non-small cell lung cancer may include the following:

1.Surgery to remove a small portion of the lung or a lobe of the lung.
2.Radiation therapy (for patients who cannot have surgery or choose not to have surgery).
3.Clinical trials of chemotherapy following surgery.
4.Clinical trials of chemoprevention following other therapy.
6.Clinical trials of photodynamic therapy using an endoscope.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage II Non-Small Cell Lung Cancer
Treatment of stage II non-small cell lung cancer may include the following:

1.Surgery to remove the tumor (a small portion of the lung, a lobe of the lung, or an entire lung) and lymph nodes.
2.Radiation therapy (for patients who cannot have surgery or choose not to have surgery).
3.Clinical trials of chemotherapy following surgery.
4.Clinical trials of radiation therapy following surgery.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage III Non-Small Cell Lung Cancer (Stages IIIA and IIIB)
Treatment of stage IIIA non-small cell lung cancer may include the following:

1.Surgery alone.
2.Radiation therapy alone.
3.Chemotherapy combined with other treatments.
4.Surgery and radiation therapy.
5.Clinical trials of combined treatments.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment of stage IIIB non-small cell lung cancer may include the following:

1.Radiation therapy alone.
2.Chemotherapy combined with radiation therapy.
3.Chemotherapy combined with radiation therapy, followed by surgery.
4.Chemotherapy alone.
5.Clinical trials of combined treatments.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage IV Non-Small Cell Lung Cancer
Treatment of recurrent stage IV non-small cell lung cancer may include the following:

1.Radiation therapy, for relief of pain and other symptoms.
2.Chemotherapy.
3.Laser therapy and/or internal radiation therapy.
4.Clinical trials of chemotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options for Recurrent Non-small Cell Lung Cancer
Treatment of recurrent non-small cell lung cancer may include the following:

1.Radiation therapy for relief of pain and other symptoms.
2.Chemotherapy alone.
3.Surgery may be used for some patients who have a very small amount of cancer spread to the brain.
4.Laser therapy or internal radiation.
5.Radiosurgery (for certain patients who cannot have standard surgery).
6.Clinical trials of new treatments.






The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.

The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation.

The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The MSCF disclaims all obligations and liabilities for damages arising from the use or attempted use of the information, including but not limited to direct, indirect, special, and consequential damages, attorneys' and experts' fees and court costs. Any use of the information will be at the risk of the user.






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