Non-Small Cell Lung Cancer Treatment

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, making up about 80 to 85 percent of all lung cancers.⁶

NSCLC has several subtypes, classified by the types of cells. Each type grows and spreads in different ways. The classification is determined by looking at the malignant (cancerous) cells under a microscope and is important because classification helps doctors choose appropriate treatment regimens, as well as determine the prognosis or projected outcome of the cancer.

In addition, treatment recommendations for NSCLC are based on the stage of the lung cancer and the general health of the patient.²

Types of non-small cell lung cancer

Microscopic examination and laboratory tests are used to identify the type of NSCLC. This classification provides doctors with information on the growth characteristics of the malignancy and is one of the factors in developing treatment recommendations.

Doctors may also test the tumor for biomarkers, such as gene changes and proteins like PD-L1. These results help guide treatment, especially for stage 2 and higher NSCLC.^4,5

Types of NSCLC include:¹

• Adenocarcinoma
• Squamous cell carcinoma
• Large cell carcinoma
• Adenosquamous carcinoma
• Sarcomatoid carcinoma
• Carcinoma of salivary gland type

Staging

The staging of NSCLC describes the extent of the disease, including tumor size, lymph node involvement, and the spread of the cancer into nearby or distant areas of the body (metastases).²

• Stage 1: The tumor is 4 cm or smaller and has not spread to any lymph nodes. There are no metastases.
• Stage 2: The tumor is up to 7 cm. It may have spread to nearby lymph nodes in the lung or, for some smaller tumors, to a single group of lymph nodes in the center of the chest on the same side. There are no metastases.
• Stage 3: The tumor may be any size. The cancer has often spread to lymph nodes in the center of the chest, on the other side of the chest, or above the collarbone, or the tumor is very large or growing into nearby structures. Stage 3 is divided into substages 3A, 3B, and 3C. There are no metastases.
• Stage 4: Stage 4 includes any size tumor and any amount of lymph node involvement. The main determinant of stage 4 is the presence of metastases. Stage 4A means the cancer has spread to the other lung, the lining around the lungs or heart, or a single site outside the chest. Stage 4B means it has spread to more than one site outside the chest.

The lung cancer staging system was updated in 2025, so stage descriptions in older materials may differ slightly.⁴

Treatment options

There are several different treatment modalities for NSCLC, although not all treatment options are appropriate for every patient. Treatment options may include:²

• Surgery – removal of the tumor, which may include removing a portion or all of a lung
• Radiation therapy – the use of high-energy rays targeted at the cancer
• Chemotherapy – the use of drugs to kill cancer cells
• Targeted therapy – a class of drugs that focuses on specific gene changes or proteins in the cancer cells
• Immunotherapy – a class of drugs that boosts the patient’s immune system to find and destroy cancer cells
• Palliative care – supportive care that does not treat the cancer itself, but aims to improve quality of life and can be given at any stage, alongside other treatment
• Complementary medicine – practices which are used in combination with standard medical treatment, such as dietary supplements, massage, acupuncture, and hypnosis

Treatment by stage

Treatment options will differ based on the stage and substage of NSCLC, although not all treatment options are appropriate for every patient. These options may include:^3,5

• Stage 1 NSCLC: Surgery to remove the cancer is usually the main treatment for stage 1 NSCLC, as the cancer is localized (contained within the lung). Some lymph nodes will be removed for testing to ensure the cancer has not spread. For some higher-risk cancers, chemotherapy, immunotherapy, or targeted therapy may be recommended after surgery. In patients who are not good candidates for surgery, stereotactic body radiation therapy (SBRT), also known as SABR (stereotactic ablative radiotherapy), is the main treatment option. Radiofrequency ablation (RFA) may be an option for some small tumors.
• Stage 2 NSCLC: Treatment often begins with chemotherapy, with or without immunotherapy, to shrink the cancer before surgery. Patients who are healthy enough then have surgery to remove the cancer and a sampling of nearby lymph nodes. After surgery, treatment may include chemotherapy, immunotherapy, or targeted therapy, depending on biomarker test results.
• Stage 3A NSCLC: Stage 3A NSCLC is usually treated with a combination of therapies, planned by a team that may include a medical oncologist, radiation oncologist, and thoracic surgeon. If the tumor can be removed, chemotherapy (with or without immunotherapy) or chemotherapy plus radiation may be given before surgery, with more treatment afterward if needed. If the tumor cannot be removed, treatment usually starts with chemotherapy and radiation together, followed by immunotherapy, or targeted therapy for cancers with an EGFR mutation.
• Stage 3B and 3C NSCLC: These cancers usually cannot be removed completely by surgery. For patients healthy enough to tolerate it, treatment is typically chemotherapy and radiation together, followed by immunotherapy, or targeted therapy for cancers with an EGFR mutation. Patients who cannot tolerate combined treatment may receive radiation or chemotherapy alone. Clinical trials may also be an option.
• Stage 4 NSCLC: Because stage 4 NSCLC has spread to distant sites in the body, it is difficult to cure. The tumor is tested for biomarkers to guide treatment. If a targetable gene change is found, targeted therapy is often the first treatment. Otherwise, immunotherapy alone or with chemotherapy is common. Radiation, surgery, and other treatments may also be used to control the cancer and relieve symptoms. Cancers that have spread to only one other site can sometimes be treated with surgery and/or radiation, in addition to the treatment of the primary tumor in the lung.