Non-small cell lung cancer treatment

This page was reviewed under our medical and editorial policy by

Peter Baik, DO, Thoracic Surgeon

This page was reviewed on January 8, 2023.

If you or a loved one has been diagnosed with non-small cell lung cancer (NSCLC), it’s easy to feel overwhelmed by the treatment options. While your care team will recommend a specific treatment plan based on the stage of your cancer, and other factors, it’s also helpful to understand the various options to treat NSCLC.

Here’s an overview of the most common non-small cell lung cancer treatment options.

Surgery for NSCLC

Patients with early-stage non-small cell lung cancer typically undergo some type of surgery. Surgery for NSCLC is a complex medical procedure performed under general anesthesia that removes either all or part of a lung, along with some nearby lymph nodes, via incisions near the ribs or back.

For smaller cancers, some surgeries may be performed with video assistance or robotic tools, which use smaller incisions and often lead to quicker recovery times.

The type of surgery recommended depends on the type and size of the cancer and the health of the lungs. But lung cancer surgeries typically require an extensive period of rest and recovery afterward.

Side effects after non-small cell lung cancer surgery may include:

  • Blood clots
  • Excessive bleeding
  • Reactions to general anesthesia
  • Pneumonia
  • Infection
  • Prolonged air leak

To help reduce complications and side effects after surgery, always follow the aftercare instructions provided by your care team.

Photodynamic therapy for NSCLC

Photodynamic therapy, or PDT, uses a light-sensitive drug to target and kill cancer cells. It’s typically used for patients with tumors in the airway who cannot receive radiation or undergo surgery, and in patients who have tumors in both lungs, have recurring cancer or who are unable to undergo anesthesia for medical reasons. It’s also used on NSCLC tumors blocking the airway and causing breathing problems.

A few days before the procedure, you’ll be given a medication (orally or via an injection) that makes cells very sensitive to light. On the day of the therapy, a bronchoscope with a laser on the end will shine a light on the cancer cells, and because of the light sensitivity drug you’ve taken, the light activates the drug to kill the cancerous cells.

Photodynamic therapy may cause side effects in some patients, including:

  • Extreme sensitivity to light for at least six weeks (You’ll need to cover up and avoid being in the sun during this time.)
  • Bleeding and/or blood in your phlegm
  • Pain and soreness around your chest
  • Nausea

Chemotherapy for NSCLC

Chemotherapy drugs are delivered into the bloodstream either via an IV or in a pill taken orally. The medication is designed to kill cancer cells, and it’s often useful in shrinking or destroying a tumor.

This treatment has been used for all stages of non-small cell lung cancer (except stage 0), although not everyone needs it. Chemotherapy may be given before or after surgery, and it may also be used to treat recurrent cancer or cancer that’s grown in size.

Chemotherapy is administered in cycles of a few weeks to a few months, followed by a rest period. Your doctor will choose from among several types of chemotherapy drugs, sometimes in combination with one or more other chemotherapy drugs.

Pre-surgery chemotherapy is used to shrink a tumor so it’s easier to surgically remove. This drug may also be given in addition to radiation therapy, a treatment known as neoadjuvant chemoradiation. In contrast, adjuvant chemotherapy is given after surgery and is used to kill cancer cells that may have been left behind.

Non-small cell lung cancer treatment stage IV (advanced) and those with locally advanced disease may also receive chemotherapy, since it’s been shown to be useful in treating cancer that’s spread outside the lungs and into other parts of the body, such as the liver or bones.

Chemotherapy often causes side effects, including:

Side effects usually aren’t permanent and tend to go away after treatment.

Targeted therapy for NSCLC

Advanced non-small cell lung cancer treatment may also include targeted therapy, which target cells that fuel cancer growth. This treatment is sometimes given in combination with chemotherapy.

Some targeted therapies are designed to either block blood vessels from fueling the cancer’s growth or direct specific genes to stop the growth of cancer cells. This treatment is usually given orally.

Targeted therapy may be recommended for NSCLC patients with stage 2, 3A, 4A and 4B disease, and for cancers that have returned or progressed over time.

Each type of targeted therapy may cause different side effects, so talk to your care team about what to expect. Generally, targeted therapies for non-small cell lung cancer may cause these side effect:

  • Fatigue
  • Headaches
  • High blood pressure
  • Joint and muscle pain
  • Loss of appetite
  • Skin problems
  • Diarrhea or constipation
  • Low red or white blood cell counts
  • Swelling in the hands or feet

Radiation therapy for NSCLC

Radiation therapy uses high-energy X-rays to destroy cancer cells. It is be used to treat stage 1, 2, 3 and some stage 4 cancers. It also may be combined with chemotherapy.

Radiation therapy may be a primary treatment for those unable to undergo surgery, or it may be used before and after surgery to shrink tumors or kill remaining cells that may have been left behind.

It’s also used to treat cancer that’s spread to other parts of the body, or as a palliative treatment for advanced NSCLC that’s causing pain and discomfort, such as bleeding or swallowing difficulties.

There are several types of radiation therapies:

External beam radiation therapy (EBRT): This treatment is administered via a machine outside the body, using X-rays precisely targeted to the tumor. It’s painless and is given for a few minutes per day over several weeks.

Brachytherapy (internal radiation therapy): With this treatment, a small pellet of radioactive material is placed in or next to the tumor, usually via a bronchoscope. It’s designed to kill cancer cells over time while sparing healthy cells.

Side effects may include:

  • Weight loss and reduced appetite
  • Feeling tired
  • Hair loss
  • Feeling nauseous or vomiting
  • Red, irritated or blistering skin in the area that was targeted with radiation
  • Coughing, sore throat and shortness of breath

Stereotactic body radiation therapy (SBRT): This treatment delivers higher radiation doses to tumors and causes less damage to healthy lung tissue. It's often used instead of surgery in early-stage lung cancer or for patients for whom surgery isn't an option.

Immunotherapy for NSCLC

Immunotherapy is designed to help the immune system more easily identify and kill cancer cells. The indication for immunotherapy use depends on the type of cancer, generic alterations and/or the cancer's stage.

Immunotherapy drugs called checkpoint inhibitors may be recommended, using checkpoint proteins to trigger the immune system into a response. Each drug works differently, but its goal is to reduce the size of a tumor by destroying cancer cells.

Side effects vary depending on the type of immunotherapy used, but they include:

  • Fatigue
  • Nausea
  • Constipation or diarrhea
  • Pain in the joints
  • Itchiness or a skin rash

More serious side effects may also occur, such as:

  • An infusion reaction that feels like a severe allergic reaction
  • A response that causes the immune system to attack healthy cells and organs

Your care team will carefully monitor you throughout your treatment, but let them know right away if you notice any changes to your body during immunotherapy.

Cryotherapy for NSCLC

Cryotherapy is a technique that kills cancer cells by freezing them. The therapy is typically used in NSCLC patients who aren’t suitable candidates for lung resection. This treatment tends to be useful in reducing the tumor’s size when it’s blocking the airway.

This procedure may be used to relieve NSCLC side effects such as:

  • Chest infections
  • Coughing up blood
  • Feeling breathless

Patients who undergo cryotherapy typically are treated on an outpatient basis. They’re given an anesthetic, and a long tube, known as a bronchoscope, is inserted into the throat. At the end of the tube is a device that freezes the tumor, so it becomes smaller.

Side effects that may last a few days after cryotherapy include:

  • Coughing up blood
  • Coughing up pieces of tissue (from the tumor)
  • Feeling pain or discomfort in the chest

Laser therapy for NSCLC

Laser therapy is a treatment option that may be used address airway blockage or bleeding lesions. Like cryotherapy, this treatment is delivered while the patient is under anesthesia and a bronchoscope is inserted down the throat and into the lungs.

Instead of freezing the tumor, a laser is used to burn as much of the cancer as possible. The procedure usually lasts about 30 minutes.

Laser therapy may cause side effects such as:

  • Pain and soreness in and around the throat
  • Bleeding and/or blood in your phlegm

In rare cases, more serious complications may occur, including:

  • Collapsed lung
  • Infection

If you feel unwell or notice breathing problems after your treatment, tell your doctor right away.

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