In general treatment for non-small cell lung (NSCLC) may require surgery, radiation, and/or systemic therapy with chemotherapy, immunotherapy or precision cancer medicines. The specific treatment for each person is individualized and is based on the stage of the cancer and its genomic profile.
For patients with NSCLC have cancer that is limited to the chest surgical resection is not only an important therapeutic modality, but in many cases, the most effective method of controlling the disease. Patients with stages I-II localized cancer without spread to lymph nodes are considered to have early stage lung cancer and are almost always treated with a thoracotomy, which is a surgical procedure to open the chest and remove cancerous lung tissue. This surgical procedure is performed under general anesthesia. Some individuals with stage IIIA NSCLC can be treated with surgery as well however surgery for stage IIIB and IV disease is ineffective because the lung cancer has already spread.
Learn more about surgery here.
Radiation therapy uses high-powered energy beams, such as X-rays or protons, to kill cancer cells. Radiation therapy may be used alone or with chemotherapy before surgery to shrink a tumor or after surgery to kill any remaining cancer cells.
Learn more about radiation here.
Systemic Therapy: Precision Cancer Medicine, Chemotherapy
Systemic therapy is any treatment directed at destroying cancer cells throughout the body. Many patients with NSCLC already have small amounts of cancer that have spread outside the lungs that cannot be treated with surgery or radiation. These cancer cells cannot be detected with any of the currently available tests and are referred to as micrometastases. The presence of micrometastases causes NSCLC recurrence following local treatment with surgery and/or radiation therapy alone. An effective systemic treatment is needed to cleanse the body of micrometastases in order to improve a patient’s duration of survival and potential for cure.
Systemic therapies commonly used in the treatment of NSCLC include:
Precision Cancer Medicines
The purpose of precision cancer medicine is to define the genomic alterations in the cancers DNA that are driving that specific cancer. Precision cancer medicine utilizes molecular diagnostic testing, including DNA sequencing, to identify cancer-driving abnormalities in a cancer’s genome. Once a genetic abnormality is identified, a specific targeted therapy can be designed to attack a specific mutation or other cancer-related change in the DNA programming of the cancer cells. Precision cancer medicine uses targeted drugs and immunotherapies engineered to directly attack the cancer cells with specific abnormalities, leaving normal cells largely unharmed. Precision medicines are being developed for the treatment of lung cancer and patients should ask their doctor about whether testing is appropriate.
Learn more about precision cancer medicines here.
Chemotherapy uses medications that can be taken orally as a pill or are injected into a vein to kill cancer cells. In some situations chemotherapy is combined with radiation therapy or other precision cancer medicines to achieve the best results.
Treatment of Non Small Cell Lung Cancer by Stage
Stage I: The cancer measures 5 centimeters or smaller and does not involve the lymph nodes.
Stage II: The cancer has not spread to the lymph nodes but is larger than 5 centimeters or involves structures near the lung such as the chest wall or diaphragm. NSCLC is also considered to be Stage II if it measures 7 centimeters or less and involves the lymph nodes within the lung or near the bronchus.
Stage IIIA: The cancer involves lymph nodes in the space between the lungs (mediastinum) or near where the windpipe divides; is large or extensive but the only lymph node involvement is within the lung or near the bronchus; or there is no lymph node involvement but the cancer extends to other organs or tissues such as the heart, great vessels, trachea, or other lobes of the lung.
Stage IIIB: The cancer involves lymph nodes on the opposite side of the chest or above the collar bone, or is extensive (involves organs such as the heart or trachea) and also involves lymph nodes in the center of the chest (mediastinum) or near where the windpipe divides.
Stage IV: Cancer is found in both lungs, in the fluid that surrounds the lungs or heart, or has spread to other parts of the body such as the liver, brain, or bones.
Recurrent/Relapsed: Cancer has progressed or returned (recurred/relapsed) following an initial treatment with surgery, radiation therapy and/or chemotherapy.
American Cancer Society. Cancer Facts & Figures 2017.