Non-Small Cell Lung Cancer Treatment

Lung cancer is caused by certain changes to the way lung cells function, especially how they grow and divide into new cells. There are many risk factors for lung cancer, but many do not directly cause cancer. Instead, they increase the chance of DNA damage in cells that may lead to lung cancer. Learn more about how cancer develops at What Is Cancer?

A risk factor is anything that increases the chance of getting a disease. Some risk factors for lung cancer, like smoking, can be changed. However, risk factors also include things you cannot change, like your genetics, age, and family history. Learning about risk factors for lung cancer can help you make changes that might lower your risk of getting it.

Smoking tobacco now or in the past is the most important risk factor for lung cancer. Smoking cigarettes, pipes, or cigars increases the risk of lung cancer. The earlier in life a person starts smoking, the more often a person smokes, and the more years a person smokes, the greater the risk of lung cancer.

Other risk factors for lung cancer include:

• being exposed to secondhand smoke
• being exposed to asbestos, arsenic, chromium, beryllium, nickel, soot, or tar in the workplace
• being exposed to radiation from:
  • radiation therapy to the breast or chest
  • radon in the home or workplace
  • imaging tests such as CT scans
  • atomic bomb radiation
• living where there is air pollution
• having a family history of lung cancer
• being infected with HIV
• taking beta carotene supplements and being a heavy smoker

Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.

Having one or more of these risk factors does not necessarily mean you will get lung cancer. Many people with risk factors never develop lung cancer, whereas others with no known risk factors do. Talk with your doctor if you think you might be at increased risk.

Occult (hidden) stage non-small cell lung cancer

In the occult (hidden) stage, cancer cannot be seen by imaging or bronchoscopy. Cancer cells are found in sputum or bronchial washings (a sample of cells taken from inside the airways that lead to the lungs). Cancer may have spread to other parts of the body.

Stage 0

In stage 0, abnormal cells are found in the lining of the airways. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 may be adenocarcinoma in situ (AIS) or squamous cell carcinoma in situ (SCIS).

Stage I (also called stage 1) non-small cell lung cancer

In stage I, cancer has formed. Stage I is divided into stages IA and IB.

• Stage IA:
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  Stage IA lung cancer. The tumor is in the lung only and is 3 centimeters or smaller. Cancer has not spread to the lymph nodes.
  

  The tumor is in the lung only and is 3 centimeters or smaller. Cancer has not spread to the lymph nodes.

• Stage IB:
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  Stage IB lung cancer. The tumor is larger than 3 centimeters but not larger than 4 centimeters. Cancer has not spread to the lymph nodes; OR the tumor is 4 centimeters or smaller. Cancer has not spread to the lymph nodes and one or more of the following is found: (a) cancer has spread to the main bronchus, but has not spread to the carina; and/or (b) cancer has spread to the inner membrane that covers the lung; and/or (c) part of the lung or the whole lung has collapsed or has pneumonitis (inflammation of the lung).
  

  The tumor is larger than 3 centimeters but not larger than 4 centimeters. Cancer has not spread to the lymph nodes.

  or

  The tumor is 4 centimeters or smaller and one or more of the following is found:

  • Cancer has spread to the main bronchus, but has not spread to the carina.
  • Cancer has spread to the innermost layer of the membrane that covers the lung.
  • Part of the lung or the whole lung has collapsed or has developed pneumonitis.

  Cancer has not spread to the lymph nodes.

Stage II (also called stage 2) non-small cell lung cancer

Stage II is divided into stages IIA and IIB.

• Stage IIA:
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  Stage IIA lung cancer. The tumor is larger than 4 centimeters but not larger than 5 centimeters. Cancer has not spread to the lymph nodes and one or more of the following may be found: (a) cancer has spread to the main bronchus, but has not spread to the carina; and/or (b) cancer has spread to the inner membrane that covers the lung; and/or (c) part of the lung or the whole lung has collapsed or has pneumonitis (inflammation of the lung).
  

  The tumor is larger than 4 centimeters but not larger than 5 centimeters. Cancer has not spread to the lymph nodes and one or more of the following may be found:

  • Cancer has spread to the main bronchus, but has not spread to the carina.
  • Cancer has spread to the innermost layer of the membrane that covers the lung.
  • Part of the lung or the whole lung has collapsed or has developed pneumonitis.
• Stage IIB:
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  Stage IIB lung cancer (1). The primary tumor is 5 centimeters or smaller and cancer has spread to the lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus.
  

  The tumor is 5 centimeters or smaller and cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus. Also, one or more of the following may be found:

  • Cancer has spread to the main bronchus, but has not spread to the carina.
  • Cancer has spread to the innermost layer of the membrane that covers the lung.
  • Part of the lung or the whole lung has collapsed or has developed pneumonitis.

  or

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  Stage IIB lung cancer (2). Cancer has not spread to lymph nodes and one or more of the following is found: (a) the primary tumor is larger than 5 centimeters but not larger than 7 centimeters; and/or (b) there are one or more separate tumors in the same lobe of the lung as the primary tumor; and/or cancer has spread to any of the following: (c) the chest wall and/or the membrane that lines the inside of the chest wall, (d) the nerve that controls the diaphragm, and/or (e) the outer layer of tissue of the sac around the heart.
  

  Cancer has not spread to the lymph nodes and one or more of the following is found:

  • The tumor is larger than 5 centimeters but not larger than 7 centimeters.
  • There are one or more separate tumors in the same lobe of the lung as the primary tumor.
  • Cancer has spread to any of the following:
    • the membrane that lines the inside of the chest wall
    • the chest wall
    • the nerve that controls the diaphragm
    • the outer layer of tissue of the sac around the heart

Stage III (also called stage 3) non-small cell lung cancer

Stage III is divided into stages IIIA, IIIB, and IIIC.

• Stage IIIA:
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  Stage IIIA lung cancer (1). The tumor is 5 centimeters or smaller and cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are around the trachea or aorta (not shown), or where the trachea divides into the bronchi. Also, one or more of the following may be found: (a) cancer has spread to the main bronchus, but has not spread to the carina; and/or (b) cancer has spread to the inner membrane that covers the lung; and/or (c) part of the lung or the whole lung has collapsed or has pneumonitis (inflammation of the lung).
  

  The tumor is 5 centimeters or smaller and cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are around the trachea or aorta, or where the trachea divides into the bronchi. Also, one or more of the following may be found:

  • Cancer has spread to the main bronchus, but has not spread to the carina.
  • Cancer has spread to the innermost layer of the membrane that covers the lung.
  • Part of the lung or the whole lung has collapsed or has developed pneumonitis.

  or

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  Stage IIIA lung cancer (2). Cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus. Also, one or more of the following is found: (a) the tumor is larger than 5 centimeters but not larger than 7 centimeters; and/or (b) there are one or more separate tumors in the same lobe of the lung as the primary tumor; and/or cancer has spread to any of the following: (c) the chest wall and/or the membrane that lines the inside of the chest wall, (d) the nerve that controls the diaphragm, and/or (e) the outer layer of tissue of the sac around the heart.
  

  Cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus. Also, one or more of the following is found:

  • The tumor is larger than 5 centimeters but not larger than 7 centimeters.
  • There are one or more separate tumors in the same lobe of the lung as the primary tumor.
  • Cancer has spread to any of the following:
    • the membrane that lines the inside of the chest wall
    • the chest wall
    • the nerve that controls the diaphragm
    • the outer layer of tissue of the sac around the heart

  or

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  Stage IIIA lung cancer (3). Cancer may have spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus. Also, one or more of the following is found: (a) the primary tumor is larger than 7 centimeters; and/or (b) there are one or more separate tumors in a different lobe of the lung with the primary tumor; and/or the tumor is any size and cancer has spread to any of the following: (c) trachea, (d) carina, (e) esophagus, (f) breastbone or backbone, (g) diaphragm, (h) heart, (i) major blood vessels that lead to or from the heart (aorta or vena cava), or the nerve that controls the larynx (not shown).
  

  Cancer may have spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus. Also, one or more of the following is found:

  • The tumor is larger than 7 centimeters.
  • There are one or more separate tumors in a different lobe of the lung with the primary tumor.
  • The tumor is any size and cancer has spread to any of the following:
    • the trachea
    • the carina
    • the esophagus
    • the breastbone or backbone
    • the diaphragm
    • the heart
    • the major blood vessels that lead to or from the heart (aorta or vena cava)
    • the nerve that controls the larynx (voice box)
• Stage IIIB:
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  Stage IIIB lung cancer (1). The primary tumor is 5 centimeters or smaller and cancer has spread to lymph nodes above the collarbone on the same side of the chest as the primary tumor or to any lymph nodes on the opposite side of the chest as the primary tumor. Also, one or more of the following may be found: (a) cancer has spread to the main bronchus, but has not spread to the carina; and/or (b) cancer has spread to the inner membrane that covers the lung; and/or (c) part of the lung or the whole lung has collapsed or has pneumonitis (inflammation of the lung).
  

  The tumor is 5 centimeters or smaller and cancer has spread to lymph nodes above the collarbone on the same side of the chest as the primary tumor or to any lymph nodes on the opposite side of the chest as the primary tumor. Also, one or more of the following may be found:

  • Cancer has spread to the main bronchus, but has not spread to the carina.
  • Cancer has spread to the innermost layer of the membrane that covers the lung.
  • Part of the lung or the whole lung has collapsed or has developed pneumonitis.

  or

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  Stage IIIB lung cancer (2). The tumor may be any size and cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are around the trachea or aorta (not shown), or where the trachea divides into the bronchi. Also, one or more of the following is found: (a) there are one or more separate tumors in the same lobe or a different lobe of the lung with the primary tumor; and/or (b) cancer has spread to any of the following: the chest wall or the membrane that lines the inside of the chest wall, the nerve that controls the voice box, the trachea, the carina, the esophagus, the breastbone or backbone (not shown), the diaphragm, the nerve that controls the diaphragm, the heart, the major blood vessels that lead to or from the heart (aorta or vena cava), or the outer layer of tissue of the sac around the heart.
  

  The tumor may be any size and cancer has spread to lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are around the trachea or aorta, or where the trachea divides into the bronchi. Also, one or more of the following is found:

  • There are one or more separate tumors in the same lobe or a different lobe of the lung with the primary tumor.
  • Cancer has spread to any of the following:
    • the membrane that lines the inside of the chest wall
    • the chest wall
    • the nerve that controls the diaphragm
    • the outer layer of tissue of the sac around the heart
    • the trachea
    • the carina
    • the esophagus
    • the breastbone or backbone
    • the diaphragm
    • the heart
    • the major blood vessels that lead to or from the heart (aorta or vena cava)
    • the nerve that controls the larynx (voice box)
• Stage IIIC:
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  Stage IIIC lung cancer. The tumor may be any size and cancer has spread to lymph nodes above the collarbone on the same side of the chest as the primary tumor or to any lymph nodes on the opposite side of the chest as the primary tumor. Also, one or more of the following is found: (a) there are one or more separate tumors in the same lobe or a different lobe of the lung with the primary tumor; and/or (b) cancer has spread to any of the following: the chest wall or the membrane that lines the inside of the chest wall, the nerve that controls the voice box, the trachea, the carina, the esophagus, the breastbone or backbone (not shown), the diaphragm, the nerve that controls the diaphragm, the heart, the major blood vessels that lead to or from the heart (aorta or vena cava), or the outer layer of tissue of the sac around the heart.
  

  The tumor may be any size and cancer has spread to lymph nodes above the collarbone on the same side of the chest as the primary tumor or to any lymph nodes on the opposite side of the chest as the primary tumor. Also, one or more of the following is found:

  • There are one or more separate tumors in the same lobe or a different lobe of the lung with the primary tumor.
  • Cancer has spread to any of the following:
    • the membrane that lines the inside of the chest wall
    • the chest wall
    • the nerve that controls the diaphragm
    • the outer layer of tissue of the sac around the heart
    • the trachea
    • the carina
    • the esophagus
    • the breastbone or backbone
    • the diaphragm
    • the heart
    • the major blood vessels that lead to or from the heart (aorta or vena cava)
    • the nerve that controls the larynx (voice box)

Stage IV (also called stage 4) non-small cell lung cancer

Stage IV is divided into stages IVA and IVB.

• Stage IVA:
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  Stage IVA lung cancer. The tumor may be any size and cancer may have spread to the lymph nodes. One or more of the following is found: (a) there are one or more tumors in the lung that does not have the primary tumor; and/or (b) cancer is found in fluid around the lungs or heart or there are cancer nodules in the lining around the lungs or the sac around the heart; and/or (c) cancer has spread to one place in an organ or tissue not near the lung, such as the brain, adrenal gland, kidney, liver, or bone, or to a lymph node that is not near the lung.
  

  The tumor may be any size and cancer may have spread to the lymph nodes. One or more of the following is found:

  • There are one or more tumors in the lung that does not have the primary tumor.
  • Cancer is found in the lining around the lungs or the sac around the heart.
  • Cancer is found in fluid around the lungs or the heart.
  • Cancer has spread to one place in an organ not near the lung, such as the brain, liver, adrenal gland, kidney, bone, or to a lymph node that is not near the lung.
• Stage IVB:
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  Stage IVB lung cancer. The cancer has spread to multiple places in one or more organs that are not near the lung, such as the brain, adrenal gland, kidney, liver, distant lymph nodes, or bone.
  

  Cancer has spread to multiple places in one or more organs that are not near the lung.

Surgery

Four types of surgery are used to treat lung cancer:

• Wedge resection is surgery to remove a tumor and some of the normal tissue around it. When a slightly larger amount of tissue is taken, it is called a segmental resection.
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  Wedge resection of the lung. Part of the lung lobe containing the cancer and a small amount of healthy tissue around it is removed.
  

• Lobectomy is surgery to remove a whole lobe (section) of the lung.
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  Lobectomy. A lobe of the lung is removed.
  

• Pneumonectomy is surgery to remove one whole lung.
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  Pneumonectomy. The whole lung is removed.
  

• Sleeve resection is surgery to remove part of the bronchus.

After the doctor removes all the cancer that can be seen at the time of the surgery, some people may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery to lower the risk that the cancer will come back is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

• External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.
• Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

Stereotactic body radiation therapy is a type of external radiation therapy. Special equipment is used to ensure you are in the same position for each radiation treatment. Once a day for several days, a radiation machine aims a larger than usual dose of radiation directly at the tumor. By having you in the same position for each treatment, there is less damage to nearby healthy tissue. This procedure is also called stereotactic external beam radiation therapy and stereotaxic radiation therapy.

Stereotactic radiosurgery is a type of external radiation therapy used to treat lung cancer that has spread to the brain. A rigid head frame is attached to the skull to keep the head still during the radiation treatment. A machine aims a single large dose of radiation directly at the tumor in the brain. This procedure does not involve surgery. It is also called stereotaxic radiosurgery, radiosurgery, and radiation surgery.

For tumors in the airways, radiation is given directly to the tumor through an endoscope.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. It also depends on where the cancer is found. External and internal radiation therapy are used to treat non-small cell lung cancer.

Chemotherapy

Chemotherapy (also called chemo) uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.

Chemotherapy for non-small cell lung cancer is usually systemic, meaning it is injected into a vein or given by mouth. When given this way, the drugs enter the bloodstream to reach cancer cells throughout the body. 

Chemotherapy drugs used to treat non-small cell lung cancer may include:

• carboplatin
• cisplatin
• docetaxel
• doxorubicin
• etoposide
• gemcitabine
• paclitaxel
• pemetrexed
• vinorelbine

Combinations of these chemotherapy drugs may be used. Other chemotherapy drugs not listed here may also be used.

Chemotherapy may also be combined with other kinds of treatment. For example, it may be combined with radiation therapy or immunotherapy drugs.

Learn more about how chemotherapy works, how it is given, common side effects, and more at Chemotherapy to Treat Cancer and Chemotherapy and You: Support for People With Cancer.

Targeted therapy

Targeted therapy uses drugs or other substances to identify and attack specific cancer cells. Your doctor may suggest biomarker tests to help predict your response to certain targeted therapy drugs. Learn more about Biomarker Testing for Cancer Treatment.

Targeted therapies used to treat non-small cell lung cancer include:

• adagrasib
• afatinib
• alectinib
• amivantamab
• bevacizumab
• brigatinib
• capmatinib
• ceritinib
• cetuximab
• crizotinib
• dabrafenib
• dacomitinib
• entrectinib
• erlotinib
• everolimus
• gefitinib
• larotrectinib
• lorlatinib
• necitumumab
• osimertinib
• pralsetinib
• ramucirumab
• selpercatinib
• sotorasib
• tepotinib
• trametinib

Learn more about Targeted Therapy to Treat Cancer.

Immunotherapy

Immunotherapy helps a person's immune system fight cancer. Your doctor may suggest biomarker tests to help predict your response to certain immunotherapy drugs. Learn more about Biomarker Testing for Cancer Treatment.

Immunotherapy drugs used to treat non-small cell lung cancer include:

• atezolizumab
• cemiplimab-rwlc
• durvalumab
• ipilimumab
• nivolumab
• pembrolizumab
• tremelimumab

Learn more about Immunotherapy to Treat Cancer.

Laser therapy

Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells.

Learn more about Lasers to Treat Cancer.

Photodynamic therapy (PDT)

Photodynamic therapy (PDT) is a cancer treatment that uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug collects more in cancer cells than in normal cells. Fiberoptic tubes are then used to carry the laser light to the cancer cells, where the drug becomes active and kills the cells. Photodynamic therapy causes little damage to healthy tissue. It is used mainly to treat tumors on or just under the skin or in the lining of internal organs. When the tumor is in the airways, PDT is given directly to the tumor through an endoscope.

Learn more about Photodynamic Therapy to Treat Cancer.

Cryosurgery

Cryosurgery is a treatment that uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ. This type of treatment is also called cryotherapy. For tumors in the airways, cryosurgery is done through an endoscope.

Learn more about Cryosurgery to Treat Cancer.

Electrocautery

Electrocautery is a treatment that uses a probe or needle heated by an electric current to destroy abnormal tissue. For tumors in the airways, electrocautery is done through an endoscope.

Radiosensitizers

Radiosensitizers are substances that make tumor cells easier to kill with radiation therapy. The combination of chemotherapy and radiation therapy given with a radiosensitizer is being studied in the treatment of non-small cell lung cancer.