Non-Small Cell Lung Cancer

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Both smokers and non-smokers can develop NSCLC. New advances in lung cancer research have led to multiple new treatment options for people with NSCLC.

Types & Stages

There are three main types of NSCLC. Each one starts in a different part of the lungs.

• Adenocarcinoma. This type of NSCLC starts in tiny air sacs of the lungs. It is the most common type.
• Squamous cell carcinoma. This type starts in the inner lining of the lungs.
• Large cell carcinoma. This type starts in the “large cells” of the lungs.

If you are diagnosed with NSCLC, your doctor will run tests to find out what stage it is. The stage means how big the tumor or tumors are, whether it has spread outside of the lungs, and where it has spread to. Early stage NSCLC is only in the lungs. Late stage NSCLC has spread to other parts of the body. NSCLC is often diagnosed after it has spread to other parts of the body.

Signs & Symptoms

NSCLC can cause symptoms like: 

• Persistent cough
• Coughing up blood
• Shortness of breath
• Chest pain

However, some people with NSCLC don’t have any noticeable symptoms.

Diagnosis

At Stony Brook Cancer Center, our doctors use a combination of tests to diagnose NSCLC, such as:

• Imaging tests, like X-ray, MRI, or CT, to look inside the lungs.
   
• Biopsy, to take a sample of lung cells and look at them under a microscope.
   
• Bronchoscopy, to look in your lungs. For this test, a thin, flexible tube with a small video camera on the end (a bronchoscope) is inserted down your throat and into your lungs. During the procedure, doctors can remove suspicious tissue to look at it under a microscope (a biopsy).
   
• Biomarker testing, to look at the genetic and/or protein changes in your cancer cells. This testing can help identify what treatments will work best against your cancer.

Treatment

What treatment you will get depends on many factors, including the type of NSCLC you have and where your tumor or tumors are located.

Your treatment may include:

• Surgery to remove the cancer. Sometimes only a small piece of the lung needs to be removed. Other times, a whole lobe or one whole lung is removed.
   
• Radiation therapy. At Stony Brook Medicine, most of our radiation treatments are given with x-rays and electron beams generated by machines called linear accelerators.
   
• Chemotherapy, a type of drug that stops the growth of cancer cells.
   
• Targeted therapy, which is therapy that is targeted to the genetic or molecular changes in your tumors.
   
• Immunotherapy, a type of therapy that helps your immune system find and attack your tumors.

At Stony Brook Medicine, our Palliative Care Service is available to everyone, no matter the stage of your cancer. This specialized team helps patients and their families cope with the physical, emotional and spiritual distress of cancer. They can provide relief from symptoms of NSCLC and/or its treatment, such as pain, nausea, fatigue and loss of appetite.

Causes & Risk Factors

There are several factors that raise the risk of getting NSCLC, namely:

• Smoking cigarettes, cigars, or a pipe. If you smoke, your risk of lung cancer is 20 times higher than someone who doesn’t smoke.
• Being exposed to secondhand smoke.
• Being exposed to radon, a naturally-occurring radioactive gas. You may be exposed to radon in your home, or at work, for example if you are a miner.
• Working with or near toxic chemicals such as asbestos and arsenic.
• Having radiation therapy to your chest or breast.
• Living in an area with high air pollution.

Not everyone with these risk factors will develop NSCLC. Sometimes people with no risk factors develop NSCLC.

Screening

Screening for lung cancer is done with a test called low dose CT, or LDCT.

Experts recommend getting screened for lung cancer only if you are at high risk of developing the disease. You are considered to be at high risk of developing lung cancer if you: 

• are between 50 and 80 years old,
• have a 20 or more pack-year smoking history,
• and you still smoke or have quit smoking within the last 15 years.

If you are considered to be at high risk, you should get screened with LDCT once a year.