At early stages, treating lung cancer begins with surgery.
After a diagnosis of lung cancer, your doctor will review your treatment options with you. Treating non-small cell lung cancer (NSCLC) can vary depending on the stage of your lung cancer.
What Are Lung Cancer Stages?
The stage of lung cancer refers to how the cancer is progressing. They range from stage 0 to stage IV, with stage IV being the most serious. Treating earlier stages of lung cancer may be simpler and easier. Later stages require more aggressive treatments.
Staging is complicated and there are many criteria that doctors take into account. Generally speaking, stages 0 and I have small and limited tumors. At stage II, the tumor is growing but still not spreading to other parts of the body. These are the easier stages to treat.
At stage III NSCLC, cancer cells may be affecting both lungs, invading the chest wall, and/or spreading to nearby lymph nodes. Stage IV NSCLC means the cancer has metastasized, or spread to distant organs of the body.
Treating Non-Small Cell Lung Cancer
For the early stages, surgery is the best option. Tumors in stage 0, I, and II are small and limited to one area. This makes them easy to remove by surgery since the cancer cells are all in one place.
Treating non-small cell lung cancer becomes more complicated at stage III. In many cases, the cancer is unresectable. This means surgeons cannot safely remove the cancer with surgery. Lung cancers are unresectable if the tumor is:
- Affecting both lungs
- Invading the chest wall
- Spreading into nearby lymph nodes
Instead, doctors may treat stage III NSCLC with chemoradiation. This means using chemotherapy and radiation therapy at the same time. Chemotherapy helps make the cancer cells more sensitive to radiation therapy, which improves treatment outcomes. Sometimes, chemoradiation may shrink the tumor enough that the patient may become eligible for surgery.
Doctors treat stage IV NSCLC with one or more of the following:
- Chemotherapy: A treatment that targets all rapidly dividing cells in the body, including cancer cells
- Immunotherapy: A treatment that helps the body’s own immune system to find and attack cancer cells. Two types of immunotherapy that can treat stage IV NSCLC are monoclonal antibodies and checkpoint inhibitors.
- Targeted therapy: A treatment that looks for gene mutations on cells that are linked to the cancer. Because the treatment is only targeting the cancer cells, it tends to have fewer side effects than chemotherapy.
Beyond the stage of cancer, treating non-small cell lung cancer involves many factors. You and your cancer treatment team will work together to find the treatment (or treatments) that work best for you.
Stefan Balan, MD, is an oncologist at RWJBarnabas Health in Jersey City, NJ.