Non-Small Cell Lung Cancer
Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, affecting approximately 85 out of every 100 lung cancers (85%).
For every 100 people diagnosed with NSCLC, 10 will be diagnosed with large cell carcinoma, 25 with squamous cell carcinoma, 40 with adenocarcinoma, and the remaining with other less common types.
The 3 most common subtypes of non-small cell lung cancer include:
- Adenocarcinoma: The most common subtype of NSCLC. It begins in the tissue that lines outside of the lungs.
- Squamous cell carcinoma: The next most common sub-type of NSCLC. It begins inside the lungs in the thin, flat cells that line the breathing tubes.
- Large cell carcinoma: The 3rd most common sub-type of NSCLC. It often begins in the outer regions of the lungs.
Signs and symptoms of non-small cell lung cancer
It's important to know lung cancer’s signs and symptoms. A sign is something that can be seen or heard by someone else; for example, wheezing is a sign. A symptom is something that cannot be seen by someone else but must be described by the person; for example, a headache is a symptom. Early lung cancer may not have any signs or symptoms. As lung cancer progresses, signs and symptoms may develop.
Possible signs and symptoms of lung cancer may include:
- A cough that doesn’t go away
- Shortness of breath that is not caused by activity
- Wheezing that is not caused by an illness
- Coughing up blood
- Pain in the chest
- A hoarse voice or other change in the voice
- Feeling tired all the time
- Weight loss with no known cause
- Headaches
- Painful lumps in the neck, armpits, or groin
These signs and symptoms can also result from other diseases and conditions, not just lung cancer. However, if you experience several of them, see your healthcare team right away.
What causes non-small cell lung cancer?
Some causes of lung cancer—both non-small cell and small cell—are well known. Others continue to be studied. A risk factor is something that increases the chance of a disease occurring.
Known risk factors for lung cancer include:
- Smoking cigarettes, now or in the past.
- Being exposed to radon gas. Radon is a gas that has no smell, taste, or color that occurs naturally in soil and rocks and seeps into the air through groundwater.
- Having other lung illnesses such as emphysema, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, or tuberculosis.
- Being exposed to heavy metals and chemicals such as arsenic, asbestos, beryllium, uranium, and Agent Orange.
- Being exposed to secondhand smoke.
- Having a family history of lung cancer.
Process of diagnosing non-small cell lung cancer
Diagnosing non-small cell lung cancer involves several steps and types of tests to confirm the presence of cancer and determine its stage.
Common diagnostic tests include:
- CT scans that provide detailed cross-sectional images
- PET scans that can show how active cancer cells are
- MRI scans that give detailed pictures using magnetic fields
- Bone scans to check whether cancer has spread to bones
- Biopsies to remove tissue samples for testing
Your healthcare team will likely start with scans to get pictures of your lungs. Based on the results of your scans, liquid or tissue samples may be taken and examined under a microscope by a pathologist. This process is called a biopsy, and it confirms whether cancer cells are present and determines the specific type.
The different stages of non-small cell lung cancer
Stages of lung cancer are used to describe the size of the primary tumor (the first tumor) and where cancer may have spread, including lymph nodes or other organs. Your healthcare team uses multiple tests, including your scans and biopsy results, to determine the stage.
The most common staging system uses a number (1, 2, 3, or 4) or a number with a letter (1A, 1B, etc.) to describe the stage. In this type of staging, a higher number means the cancer is more advanced and the letter provides more detail within each stage.
Understanding the stage of lung cancer is very important because it helps your healthcare team determine the best treatment options for you.
Stage I = Stage 1
Stage II = Stage 2
Stage III = Stage 3
Stage IV = Stage 4
Learn more about non-small cell lung cancer and its stages
Treatment options for non-small cell lung cancer
Non-small cell lung cancer treatment options can include surgery, radiation therapy, immunotherapy, chemotherapy, targeted therapy, or a combination of these, along with palliative care and clinical trials.
Once detailed information is gathered from your biopsy and other medical tests, your healthcare team will discuss treatment options with you. Examples of information used to determine your best treatment plan include:
- The type and stage of lung cancer
- The presence of certain biomarkers
- How well your lungs are working
- Other health conditions that may increase the side effects of treatment
- Your ability to perform the activities of daily living by yourself, such as eating, bathing, and dressing
If you’re diagnosed with NSCLC, it’s vital to ask your healthcare team for comprehensive biomarker testing. Biomarkers are specific changes or mutations in cancer cells that make them different from healthy cells and drive them to grow and spread.
Biomarker testing determines whether the cancer cells have known “actionable” or “targetable” biomarkers. Having an actionable biomarker means certain treatments, like targeted therapy or immunotherapy, are more likely to work well for your specific type of lung cancer. If your results do not show an actionable biomarker, other lung cancer treatments or clinical trials may be an option.
Actionable biomarkers for NSCLC:
- ALK (Anaplastic Lymphoma receptor tyrosine Kinase)
- BRAF V600E (Rapidly Accelerated murine Fibrosarcoma viral oncogene homolog B)
- EGFR (Epidermal Growth Factor Receptor)
- HER2/ErbB-2 (Human Epidermal growth factor Receptor 2)
- KRAS G12C (Kirsten RAt Sarcoma viral oncogene homolog)
- MET (Mesenchymal Epithelial Transition proto-oncogene receptor tyrosine kinase)
- NTRK (Neurotrophic Tyrosine Receptor Kinase)
- RET (REarranged during Transfection proto-oncogene)
- ROS1 (c-ROS receptor tyrosine kinase proto-oncogene 1)
- NRG1 (Neuregulin 1)
Treatment options for NSCLC may include 1 or more of the following:
How to cope with non-small cell lung cancer
There’s no right or wrong way to cope with lung cancer—and no one can tell you how you should feel or react. People handle a lung cancer diagnosis in different ways. Some seek out all the information they can find. Others prefer to get their information from a few select sources. Sometimes people seek emotional support, while others turn inward. You may also have practical matters to manage, including insurance coverage, access to care, and financial issues.
As you begin to move forward after your diagnosis, remember that you are not alone. Talk to your healthcare team about resources.
Questions to ask your healthcare team about non-small cell lung cancer
The questions you ask your healthcare team can play a vital role in understanding and managing your diagnosis. If you are newly diagnosed with NSCLC, some examples of questions you may want to ask include:
How does the type of cancer I have affect my treatment options?
What is my stage of lung cancer?
How does the stage affect my treatment options?
Has cancer spread to other parts of my body? Which parts?
Will I need more tests before deciding what treatments are best for me?
Should I seek a second opinion?
Have I had comprehensive biomarker testing?
As you learn more about NSCLC and your treatment options, it’s important to ask questions so you can stay informed and play an active role in decision-making. Review a full list of questions to ask your healthcare team to help you prepare for visits.
Lung cancer resources and support groups
Support options and resources include:
- NSCLC educational materials: Download or order free materials from our online store.
- Phone Buddy program: Connect with someone who is living with NSCLC who can offer support and share experiences.
- Gathering HOPE: Join this casual virtual group where you can connect with others and find hope, friendship, and support.
- Lung cancer support groups: Find connection with others who understand.
- Lung Cancer Living Room®: Learn and connect with others through this expert speaker series that brings hope to patients and their families.
- Stories of hope: Read about experiences from other people diagnosed with lung cancer.
- Mind Over Matter: Learn and practice tools to manage the emotions that often come with a lung cancer diagnosis in this free, 5-week program. It can help to handle the fears, worries, and sadness that many people experience.
Frequently asked questions
Where can I find more resources and support?
Contact the GO2 HelpLine at 1-800-298-2436 or email support@go2.org to connect with caring and highly trained staff who listen, answer your questions, and provide support. We offer many free programs and educational resources to meet your needs.
What is palliative care and how could it help me?
Palliative care specialists help prevent and ease the symptoms and side effects of lung cancer and its treatments.
They work very closely with members of your healthcare team to:
- Palliative care specialists help prevent and ease the symptoms and side effects of lung cancer and its treatments.
- Help you feel better so you can enjoy more of what matters most to you.
Studies show that people with lung cancer who begin ongoing palliative care early in their treatment have an improved quality of life and may live longer.
How can I find a clinical trial for non-small cell lung cancer?
There are a few ways to explore clinical trials to find one that may be right for you.
- Talk with your oncologist. They know your health and treatment history best and may be aware of a trial at your current cancer center or nearby that would be a good option for you. They may also refer you to the right people to get started.
- Contact our Helpline at 1-800-298-2436 or support@go2.org. Our treatment and trial navigators can help you find clinical trial options to discuss with your oncologist.
- Explore clinicaltrials.gov, an online database of clinical trials with detailed information for researchers and the public.
What does my non-small cell lung cancer biomarker type mean?
Biomarkers are specific changes or mutations in cancer cells that make them different from healthy cells. These changes drive how cancer cells grow and spread.
What are lung cancer screening guidelines?
Lung cancer screening guidelines and guidelines is set by the US Preventive Services Task Force (USPSTF). The USPSTF recommends annual screening for lung cancer in adults aged 50 to 80 years who have a 20-pack-year smoking history and currently smoke or have quit within the past 15 years. If you have Medicare, their guidelines are slightly different. Medicare covers up to age 77 rather than 80.
There are several types of biomarkers. Having an actionable biomarker means certain treatments, like targeted therapy or immunotherapy, are more likely to work well for your specific type of lung cancer. If your results do not show an actionable biomarker, other lung cancer treatments or clinical trials may be an option. Knowing which biomarkers you have guides your healthcare team to the best treatment for you.
Where does non-small cell lung typically spread to?
Non-small cell lung cancer (NSCLC) tends to spread to the lymph nodes, bones, adrenal glands, liver, and brain. When lung cancer spreads outside of the lungs to other areas of the body, this is called metastasis or mets. Treatments such as chemotherapy, immunotherapy, and/or radiation therapy are commonly used to treat mets in the body.
Why should I think about getting a second opinion?
Seeking a second opinion when you are diagnosed, during treatment, or survivorship allows you to be more informed of your options. Reasons to get second opinion include:
- To fully understand all your treatment options.
- To explore your clinical trial options.
- To increase confidence in your treatment plan and healthcare team.
- To get an opinion from a lung cancer specialist.
- To see if there are different approaches to managing side effects, including palliative care.
- When you have concerns about the care you’re receiving.