Treatment Options for Early-Stage Non-Small Cell Lung Cancer (NSCLC)

Susan L. Smith, MN, PhD Disclosures Published on Jun 2, 2021

This article is for people who have early-stage non-small cell lung cancer (NSCLC) and their care partners, or anyone who wants to learn more about NSCLC. The goal of this patient education activity is to help patients and care partners engage in shared decision-making with their doctor about treatment options for early-stage NSCLC.

You will learn about:

What NSCLC is
Lung cancer stages
Treatment for early-stage (stage 1, 2, or 3) NSCLC and its goals
Possible side effects of treatment
Questions to ask your doctor

All medicines listed in this activity may not be approved by the US Food and Drug Administration (FDA) for NSCLC but are recommended by the National Comprehensive Cancer Network (NCCN).

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Test Your Knowledge

What Is Non-Small Cell Lung Cancer (NSCLC)?

Cancer is when certain cells in your body start growing out of control. Cancer that starts in the lungs is called lung cancer.

There are 2 main types of lung cancer -- small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Each of these grows differently and is treated differently. NSCLC is much more common than SCLC.

The 3 main types of NSCLC are:

Adenocarcinoma -- the most common -- that usually forms in the tiny air sacs in your lungs (alveoli)
Squamous cell carcinoma that forms in the main airways or passageways in your lungs (bronchi)
Large cell carcinoma that forms in the large cells anywhere in the lungs

Lung Cancer Stages

Cancer stage is the extent, or degree, of cancer. Your doctor will consider stage when evaluating the most likely course of your cancer (your prognosis) and to help plan treatment.

NSCLC stages range from 0 to 4:

Stage 0 is rare and is called in situ ("in place") because cancer cells have formed in the airways, but not deeper in the lungs
Stage 1, stage 2, and stage 3 mean cancer cells have grown into the lung tissue. With stage 2 and 3, some cells may have spread (metastasized) to nearby lymph nodes
Stage 4 is lung cancer that has spread to other parts of the body, such as the brain

Treating Stage 1, 2, or 3 NSCLC

There are several treatment options for stage 1, 2, and 3 -- or early stage -- NSCLC that may be used alone or in combination. Which your doctor recommends will depend on your NSCLC stage, the number of primary tumors (main groups of cancer cells in your lungs), and your overall health and wishes.

Treatment may include surgery, radiation therapy, chemotherapy (or "chemo"), chemoradiation that combines radiation with chemotherapy, medicines, and joining a clinical trial.

The Goals of Treatment

The goals of treating early-stage NSCLC can include:

Cure or control cancer
Remove all, or most, cancer
Stop or delay cancer from coming back
Improve your quality of life

No one treatment is for everyone, so you will make a plan with your doctor that best fits your goals and individual needs. Be sure to talk to your doctor and healthcare team about your personal preferences for your treatment plan.

Treatment Options for Early-Stage NSCLC

Treatment options for stage 1, 2, or 3 NSCLC that may be used alone or in combination include:

Surgery to remove all or as much of the cancer as possible
Radiation therapy that uses high-energy waves (such as x-rays) to kill cancer cells, stop them from making new cells, or shrink tumors
Chemotherapy to kill cancer cells or stop them from completing their life cycle so they can't increase in number
Chemoradiation that combines radiation with chemotherapy
Medicines such as targeted therapy to destroy cancer cells or stop them from growing, or immunotherapy that helps your immune system -- your body's natural defense system -- find and kill cancer cells

Possible Side Effects of Treatment

Different treatments can have different side effects. Some that may happen with treatments for NSCLC can include:

Fatigue (tiredness), loss of appetite, or weight changes (radiation therapy, chemotherapy, immunotherapy)
Nausea (chemotherapy, immunotherapy)
Diarrhea (chemotherapy, targeted therapy, immunotherapy)
Skin changes or rash (radiation therapy, targeted therapy, immunotherapy)

Chemotherapy may also cause liver problems, decreases in certain blood cell levels, risk of infection, mouth sores, vomiting, numbness and tingling in the hands and feet, and hair loss.

After surgery, some people may have pain, swelling, scars, or numbness in the area where the surgery was.

Not all side effects are listed here. Ask your doctor, pharmacist, or healthcare team for a complete list.

Managing Side Effects

Before you start treatment, ask your doctor about any side effects that may happen and when you should call them or go to the emergency room because of side effects.

Some side effects can go away on their own over time, while others may last longer. Your doctor may recommend adding a medicine before, during, or after treatment to help. Together, you can discuss ways to manage side effects.

Tracking and recording your symptoms, all medicines you take, and any side effects in a journal or diary can be helpful for when you talk with your doctor.