Treatment for non small cell lung cancer (NSCLC)

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

Your treatment depends on:

• where your cancer is
• how far it has grown or spread (the stage)
• how abnormal the cells look under a microscope (the grade)
• your general health and level of fitness

Treatment overview

The main treatments are:

• surgery
• chemotherapy
• radiotherapy
• chemoradiotherapy – chemotherapy with radiotherapy
• targeted cancer drugs
• immunotherapy
• symptom control treatment

Your MDT will discuss your treatment, its benefits and the possible side effects with you.

You have one or more of these treatments. This depends on the stage of your cancer. And how well the treatment works after some time.

Treatment by stage

Stage 1

Stage 1 means your cancer is small and is contained inside the lung. It hasn’t spread to lymph nodes.

Surgery is the main treatment. Your surgeon might remove:

• part of your lung (a lobectomy)
• all of the lung (pneumonectomy)

You might have chemotherapy or possibly a targeted cancer drug after your operation. This is to help lower the chance of your cancer coming back.

If you aren’t fit enough for surgery you might have:

• radiotherapy
• radiofrequency ablation

Stage 2

Stage 2 can mean different things. It is divided into stage 2A and 2B.

Stage 2A means that the cancer is between 4cm and 5cm in size but hasn't spread to any lymph nodes.

Stage 2B can mean:

• the cancer is up to 5cm in size and has spread into nearby lymph nodes or
• the cancer is between 5cm and 7cm but hasn't spread into any lymph nodes or
• there is more than one area of cancer in one lobe of the lung or
• the cancer has spread into structures close to the lung

Surgery is the main treatment. Your surgeon might remove:

• part of your lung (a lobectomy)
• all of the lung (pneumonectomy)

After surgery, you might have chemotherapy or possibly a targeted cancer drug to lower the chance of your cancer coming back.

Depending on the results of your surgery, you might have radiotherapy after your operation.

If you aren’t fit enough for surgery you might have:

• radiotherapy
• chemoradiotherapy – chemotherapy with radiotherapy

Stage 3

Stage 3 means your cancer is in more than one lobe of the lung, or it has spread to lymph nodes or nearby structures in the chest. 

There are many different treatment possibilities for stage 3 non small cell lung cancer. Your doctor will discuss your options with you. Your team will decide if they think that surgery would be a safe and effective treatment for your cancer.

Possible treatments include:

Chemoradiotherapy followed by surgery

You might have chemoradiotherapy (chemotherapy and radiotherapy) followed by surgery to remove part or all of the lung. Your fitness for surgery depends on your general health and how well you are likely to recover.

After surgery you might have more chemotherapy.

Surgery followed by cancer drugs

You might have surgery to remove all or part of the lung. This is usually followed by chemotherapy. You might then have radiotherapy. Some people may have a targeted cancer drug instead of chemotherapy after surgery.

If you can’t have surgery

If you can’t have surgery, you might have chemoradiotherapy (chemotherapy with radiotherapy).

You might then have immunotherapy after chemoradiotherapy. Immunotherapy uses our immune system to fight cancer. It works by helping the immune system recognise and attack cancer cells.

Or you might have a targeted cancer drug. Targeted cancer drugs interfere with the way cancer cells grow. 

Stage 4

Stage 4 means your cancer has spread to your other lung or to a distant part of your body such as the liver or bones.

Treatment aims to control the cancer for as long as possible and help with symptoms.

You might have:

• chemotherapy
• targeted cancer drugs
• immunotherapy
• radiotherapy
• symptom control treatment, such as treatment to help you breathe more easily

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.