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Treatment Choices for Non-Small Cell Lung Cancer, by Stage

Non-small cell lung cancer is one of the two major types of lung cancer that can affect smokers and non-smokers. It affects patients similar to other types of lung cancer, such as squamous cell carcinoma and adenocarcinoma. 

Symptoms include a persistent cough, breathlessness, weight loss, and coughing up blood. Surgery, chemotherapy, and radiation are just a few examples of treatment. Based on the stage the cancer is at and how much it has progressed, appropriate treatment choices can be considered. In this article, we will see what the various kinds of treatment choices are for non-small cell lung cancer treatment through its various stages.

Treating Occult Cancer

They are usually cancers in their early stages. Bronchoscopy and possibly other tests are typically repeated every few months to check for tumors. If a tumor is discovered, treatment will be determined by its stage. Malignant cells can be seen on sputum cytology in these cancers, but no apparent tumor can be discovered with bronchoscopy or imaging tests.

Treatment During Stage 0 NSCLC

Since stage 0 NSCLC is restricted to the lining layer of the airways and has not spread to the lung tissue or other areas, it is usually curable solely through surgery. If you are healthy enough, you can usually be treated with a segmentectomy or wedge resection (removal of part of the lobe of the lung). 

Cancers in certain locations (such as where the windpipe divides into the left and right main bronchi) may be treated with a sleeve resection, but they may be difficult to remove completely without removing a lobe (lobectomy) or even an entire lung (pneumonectomy).

Treatment During Stage 1 NSCLC

If you have stage I NSCLC, surgery may be your only option. This can be accomplished by either removing the tumor-bearing lobe of the lung (lobectomy) or removing a smaller piece of the lung (sleeve resection, segmentectomy, or wedge resection).  Stage 1 can be a difficult time for the patient to deal with, but with these treatment methods, it can be cured.

Segmentectomy or wedge resection is usually reserved for very small stage I cancers and patients with other health issues that make removing the entire lobe risky. Nonetheless, most surgeons believe that if the patient can tolerate it, a lobectomy is preferable because it provides the best chance of cure.

Treatment During Stage 2 NSCLC

People with stage II NSCLC who are fit for cancer treatment typically have cancer removed via lobectomy. Sometimes, the entire lung must be removed (pneumonectomy). Any lymph nodes that are suspected of harboring cancer are also removed. The extent of lymph node involvement and the presence of cancer cells at the edges of removed tissues are important considerations when organizing the next step of treatment.

Treatment During Stage 3A NSCLC

There are two sub-stages within stage 3. These are stage 3A and stage 3B. Radiation therapy, chemotherapy (chemo), and/or surgery may be used as the initial treatment for stage IIIA NSCLC. As a result, treatment planning for stage IIIA NSCLC frequently necessitates the collaboration of a medical oncologist, a radiation oncologist, and a thoracic surgeon. Your treatment options are determined by the size of the tumor, its location in your lung, the lymph nodes to which it has spread, your overall health, and how well you tolerate treatment.

Chemotherapy is often combined with radiation therapy for patients who can tolerate it (also called chemoradiation).

Treatment During Stage 3B

Stage IIIB NSCLC generally means that it has spread to lymph nodes near the other lung or in the neck and it may have spread to important structures in the chest. Surgery cannot completely remove these cancers. 

Treatment, as with other stages of lung cancer, is determined by the patient’s overall health. If you are in relatively good health, chemotherapy (chemo) combined with radiation therapy may be beneficial (known as chemoradiation).  

If surgery, radiation, and chemoradiation are unlikely to be effective treatments, an immunotherapy drug such as pembrolizumab (Keytruda) or cemiplimab (Libtayo) may be considered as the first line of defense. Since these cancers can be difficult to treat, participating in a clinical trial of newer treatments may be a good option for some people.

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