Treatment by stage for non small cell lung cancer

Stage 1

Stage 1 non small cell lung cancer is very uncommon. You normally have surgery to remove part of the lung (a lobectomy) or all of the lung (a pneumonectomy). If you can't have an operation for other health reasons, your doctor may suggest radiotherapy instead to try to cure the cancer. Another option for small tumours if you cannot have surgery is RFA, or radio frequency ablation.

Stage 2

For stage 2 non small cell lung cancer, depending on the position of the tumour, you may be offered surgery to remove part of the lung (a lobectomy) or all of the lung (a pneumonectomy). If the cancer is completely removed, your specialist may suggest chemotherapy to try to lower the risk of the cancer coming back. This is called adjuvant chemotherapy. It is important that your doctor talks to you beforehand about the benefits and side effects of chemotherapy. If you can't have surgery, you may be offered radiotherapy to try to get rid of the cancer completely.

Stage 3

For stage 3 non small cell lung cancer you may be able to have surgery, depending on where the cancer is in the lung. You may need to have the whole lung removed (a pneumonectomy). If there are cancer cells in the middle area of the chest (the mediastinum), your doctor may suggest radiotherapy instead. The cancer may be too close to your heart to operate safely.

If your doctor spots signs of cancer in the lymph nodes on the same side of your chest as the lung cancer, they may advise you to have chemotherapy before the surgery. This is called neoadjuvant chemotherapy. If cancer cells are not found in the lymph nodes until after the surgery your doctor is likely to advise you to have chemotherapy and possibly radiotherapy after the operation.

If your doctor spots signs of cancer in the lymph nodes on the opposite side of your chest, surgery is not possible but you may have a course of chemotherapy. After the chemotherapy it might be possible to have further treatment with radiotherapy. You may also have further treatment with a biological therapy called erlotinib (Tarceva).

Stage 4

Treatment for stage 4 non small cell lung cancer aims to control the cancer for as long as possible and to shrink the tumour down to reduce symptoms. Many trials have used chemotherapy in this situation and we now know that it can improve survival time as well as relieving symptoms. A biological therapy called erlotinib (Tarceva) is sometimes used when chemotherapy is no longer working. It aims to control symptoms and try to help people live longer.

You may also have radiotherapy to control symptoms such as pain or a cough. As well as radiotherapy, other treatments can relieve a blockage and reduce symptoms if you have a tumour in one of the main airways (the left or right bronchus). These treatments include internal radiotherapy (brachytherapy), laser treatment, freezing the tumour (cryotherapy), using a rigid tube (a stent) to keep the airway open, and light therapy (photodynamic therapy - PDT). There is detailed information about treatments to relieve an airway blockage in the advanced lung cancer treatment section.