Non-Small Cell Lung Cancer (NSCLC)

In this section, you or a loved one can find out more about medical treatments, research studies and practical information about non-small cell lung cancer. Read on to find answers to some of your questions as well as links to other information. Being informed is an important first step towards becoming an active decision-maker in your care plan.

Lung cancer starts when cells of the lung become abnormal and begin to grow out of control. As more cancer cells develop, they can form into a tumour and spread to other areas of the body.

There are subtypes of NSCLC, which start from different types of lung cells, but they are grouped together as NSCLC because the general approach to treatment and the outlook are often similar.

Adenocarcinoma

This type of lung cancer occurs mainly in current or former smokers, but it is also the most common type of lung cancer seen in non-smokers. Adenocarcinoma is usually found in the outer parts of the lung, arising from cells that would normally secrete mucus and other substances. Although it tends to grow slower than other types of lung cancer and is more likely to be found before it has spread, this varies from patient to patient. 

Squamous cell (epidermoid) carcinoma

These cancers start in early versions of squamous cells, which are flat cells that line the inside of the airways in the lungs. They are often linked to a history of smoking and tend to be found in the central part of the lungs, near a main airway (bronchus).

Large cell (undifferentiated) carcinoma

This type of cancer grows anywhere in the lungs. It grows and spreads rapidly and can be difficult to treat. A type of cancer in this group, known as large cell neuroendocrine carcinoma, is fast-growing and very similar to small cell lung cancer. 

Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a person's age or family history, can't be changed. Several risk factors can make you more likely to develop lung cancer.

Risk factors you can change:

• Tobacco smoke: Smoking is the leading risk factor for lung cancer. The longer you smoke, the greater your risk. Cigar smoking and pipe smoking are almost as likely to cause lung cancer as cigarette smoking.
• Second-hand smoke: If you don't smoke, breathing in the smoke of others (called second-hand smoke or environmental tobacco smoke) can increase your risk of developing lung cancer.
• Exposure to asbestos: People who work with asbestos are several times more likely to die of lung cancer. Lung cancer risk is much greater in workers exposed to asbestos who also smoke. 

Risk factors you cannot change:

• Previous radiation therapy to the lungs
• Air pollution
• Personal or family history of lung cancer
• Exposures to radon in the home (the second most common reason for lung cancer overall in the UK and the most common cause in non-smokers) 
• In some parts of the world, arsenic in the drinking water 
• Exposure to other cancer-causing agents in the workplace, including radioactive ores, inhaled chemicals, diesel exhaust and others 

Usually the symptoms and effects of lung cancer do not appear until the disease is already advanced. Even when lung cancer causes symptoms, people may mistake them for other problems, such as an infection or effects from smoking. Some lung cancers are found by accident as a result of tests for other conditions. 

The most common symptoms of lung cancer are:

• A cough that does not go away or gets worse
• Chest pain that is often worse with deep breathing, coughing or laughing
• Coughing up blood 
• Feeling tired or weak
• Hoarseness
• Infections such as bronchitis and pneumonia that do not go away
• Wheezing/shortness of breath
• Weight loss and loss of appetite

When lung cancer spreads to distant organs, it may cause:

• Bone pain 
• Nervous system changes 
• Yellowing of the skin and eyes
• Lumps near the surface of the body

Some lung cancers can cause a set of very specific symptoms that are known as syndromes. Some of these syndromes include: 

Horner syndrome

Cancers of the top part of the lungs can affect certain nerves to the eye and part of the face, causing a group of symptoms including: 

• Drooping or weakness of one eyelid
• A smaller pupil (dark part in the centre of the eye) in the same eye
• Reduced or absent sweating on the same side of the face 

Superior vena cava syndrome (SVC)

A large vein, the superior vena cava, returns blood from the upper part of the body to the heart. It is located near the right lung and lymph nodes. If there is a tumour near it, the tumour can press on the SVC and block the blood from returning to the heart. This blockage can lead to swelling in the face, neck, arms and upper chest. It can also cause headaches, dizziness or changes in the level of consciousness. SVC syndrome can occur gradually or suddenly, and may require emergency treatment. 

Paraneoplastic syndromes

Some lung cancers can make hormone-like substances that enter the bloodstream and cause problems with distant tissues and organs, even though the cancer has not spread to those tissues or organs. These problems are called paraneoplastic syndromes. 

Some of the more common paraneoplastic syndromes that can be caused by non-small cell lung cancer (NSCLC) include:

• High blood calcium levels (hypercalcemia), which can cause frequent urination, thirst, constipation, nausea, vomiting, stomach pain, weakness, fatigue, dizziness, confusion and other nervous system problems
• Excess growth/thickening of certain bones, especially those in the finger tips, which is often painful 
• Blood clots
• Excess breast growth in men

Follow-up Care

Your health care team will continue to check to make sure that the cancer has not returned, manage any side effects, and monitor your overall health. 

This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years and watching for recurrence or second cancer. 

Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor who is familiar with your medical history can give you personalised information about your risk of recurrence. 

Some people may have blood tests or imaging tests as part of regular follow-up care, but testing recommendations depend on several factors including the type and stage of cancer originally diagnosed and the types of treatment given.

Complementary methods refer to treatments that are used along with your regular medical care. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage. Alternative treatments are used instead of a doctor's medical treatment. Make sure that you talk to your cancer care team; they can help you to find out about what is known about the method, which can help you to make an informed decision.

Choosing to stop treatment

When treatments have been tried and no longer control the cancer, it could be time to weigh up whether or not you continue treatment. There are many reasons that you might decide not to get cancer treatment. If you choose not to treat the cancer, you can still get supportive care to help with pain and other symptoms.

Help getting through treatment

Hospital- or clinic-based support services are an important part of your care. These might include nursing or social work services, financial aid, nutritional advice, rehab or spiritual help.

In many cases, more than one type of treatment is used. Depending on the stage of the cancer and other factors, treatment options for people with NSCLC can include: 

• Surgery
• Radiofrequency ablation (RFA)
• Radiation therapy
• Chemotherapy
• Targeted therapies
• Immunotherapy

Palliative care (treatment that relives pain but does not treat the underlying condition) can also be used to help with symptoms. 

Please note that the information on this website is intended for informational purposes only and should not be used as a substitute for seeking medical advice or treatment from a healthcare professional. You should not use this information to diagnose or treat a medical condition or health problem. Speak to a healthcare professional if you have any questions about your health, medical condition, symptoms or treatment options.

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