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Early and Locally Advanced Non-Small Cell Lung Cancer: NCCN Guidelines for Patients

September 7, 2022 - read ≈ 7 min



The NCCN Guidelines for Patients were developed by the National Comprehensive Cancer Network (NCCN). NCCN is an organization that unites leading cancer care centers in the United States of America. Its activities are focused on scientific research, treatment and education of patients.

Lung cancer basics

Lung cancer starts in the cells of the lungs. Non-small cell lung cancer is the most common type of lung cancer.

This chapter answers some common questions about this cancer when it is early or locally advanced.

What is lung cancer?

Lung cancer is a cancer of lung cells. Other cancers that have spread to the lungs are not lung cancers. For example, stomach cancer that has spread to the lungs is still stomach cancer. The lungs are the main organs of the respiratory system. They deliver oxygen to the blood and remove carbon dioxide from the blood.

Lung cancer often forms from cells that line the airways

Almost all lung cancers are carcinomas. Lung carcinomas form from cells that line the airways of the lungs. The airways of the lungs are called the bronchus, bronchioli, and alveoli.

Lung carcinomas are divided into 2 main groups based on how the cells look.

  • Small cell lung cancer (SCLC) is a cancer of neuroendocrine cells. The NCCN Guidelines for Patients® on SCLC can be found at NCCN.org/patientguidelines.
  • Non-small cell lung cancer (NSCLC) is much more common than SCLC

There are several types of NSCLC

Each type of NSCLC forms from a particular kind of cell. Below are common types of NSCLC:

  • Adenocarcinoma often forms from cells that line the alveoli and make mucus. It is the most common type of lung cancer.
  • Large cell carcinoma forms from any of the large cells that are found throughout the airways.
  • Squamous cell carcinoma forms from cells that line the bronchi.
What is cancer?
Cancer is a disease that affects cell growth. When cells become cancerous, they don’t behave like normal cells. They break the rules of normal cell growth.
• Lung cancer cells make many new cancer cells. They also do not die when they should. This overgrowth of cancer cells becomes a mass of tissue called a tumor.
• Lung cancer cells don’t stay in place. They can grow through the airway and into the lung tissue. They can grow through the lung wall and invade other body parts.
• Lung cancer cells can break away from a tumor and spread. They can enter the bloodstream or a fluid called lymph and spread to other places.
This out-of-control cell growth can harm the body. Cancer cells crowd out and overpower normal cells. Without enough normal cells, cancer cells can cause organs to stop working.
Scientists have learned a great deal about cancer. As a result, today’s treatments work better than treatments in the past. Also, many people with cancer have more than one treatment option.

What are the stages of lung cancer?

The stage of lung cancer describes the extent of the cancer in the body. It is used to assess the outlook of the cancer called the prognosis. It is used to plan treatment. It is also used for research.

For some people, cancer staging is done twice. The stage assigned before any tissue (biopsy) testing is called the clinical stage. The second stage is called the pathologic stage and is based on tissue tests. Cancer that is outside of the lungs may not be found until after surgery.

Staging is based on the AJCC system

The American Joint Committee on Cancer (AJCC) staging manual is used to stage lung cancer. The stages of NSCLC range from stage 0 to stage 4. Often, the stages are written with Roman numerals — stages 0, I, II, III, and IV.

Stage 0 cancer is only in the airway

Stage 0 is rare. Abnormal or cancer cells have formed in the airways but haven’t grown into the lung tissue. Stage 0 is also called carcinoma in situ.

Stage 1 through 3 cancers haven’t spread far at the time of diagnosis

Stage 1, stage 2, and stage 3 cancers have grown into lung tissue. Some have spread to nearby disease-fighting tissue called lymph nodes.

Stage 4 cancer has spread far

To be stage 4, lung cancer must have already spread far by the time of diagnosis. Most lung cancers are stage 4 at diagnosis. Lung cancer tends to spread to these body parts:

  • Brain, liver, bone, and adrenal glands
  • From one lung to the other lung

DO NOT be afraid to ask your medical team ANY questions at any time!!! Your questions will help you and them. No question is stupid.

– Steve,
Cancer survivor

What stages are early and locally advanced lung cancers?

Stage 1 and stage 2 cancers are also described as early-stage cancers. Stage 3 cancers are locally advanced.

Some early and locally advanced cancers spread far after diagnosis and then are called metastatic cancer.

Learn about treatment of metastatic cancers, including stage 4, in NCCN Guidelines for Patients:
Metastatic Non-Small Cell Lung Cancer, available at NCCN.org/patientguidelines.

What are the symptoms of early and locally advanced lung cancer?

Early cancers may not cause symptoms but many advanced cancers do. Some symptoms of lung cancer are:

  • A new cough that doesn’t go away
  • A chronic cough that worsens
  • Coughing up bloody mucus
  • Getting short of breath quicker than before
  • Ongoing pain in the chest or upper back
  • Frequent lung infections that don’t go away or keep coming back

Lung cancer is often found because of symptoms and less often found in x-rays before symptoms start. Lung cancers may be found by chance in x-rays or through a cancer screening program.

Learn more about screening in NCCN Guidelines for Patients: Lung Cancer Screening, available at NCCN.org/patientguidelines.

Can early and locally advanced lung cancer be treated?

Yes! For most lung cancers, the aim of treatment is to reduce symptoms, control the cancer, and extend life. Newer treatments are better at controlling the cancer and improving quality of life.

At this time, few lung cancers are cured. Early-stage cancers are highly treatable and sometimes curable. Locally advanced cancers are rarely cured. A cure may be possible if the cancer didn’t spread much.

Treatment takes team work

A team of health care providers is involved in diagnosing and treating lung cancers. Your primary doctor may be the first to suspect you have lung cancer and refer you to specialists. The diagnostic, treatment, and supportive care experts are explained throughout this book. These experts are supported by nurses, technicians, and assistants, who are often on the frontline of cancer care. Patient navigators can help you through the maze of cancer care.

Key points

  • Lung cancer is a cancer of lung cells. Other cancers that spread to the lungs are not lung cancer.
  • Lung cancer often starts in the cells that line the airways. These cancers are called carcinomas. Non-small cell lung cancer (NSCLC) is a group of carcinomas.
  • Common types of NSCLC are adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.
  • The cancer stage is a rating of the extent of the cancer. Stages of lung cancer range from stage 0 to stage 4.
  • Stage 1, stage 2, and stage 3 cancers have not spread far from the lung tumor.
  • Early cancers often do not cause symptoms but many advanced cancers do.
  • A team of experts will work together and with you to diagnose and treat the cancer as well as support you.

You can read more about Non-Small Cell Lung Cancer, its treatment methods and follow-up after treatment in the full text of the recommendations for patients by downloading it below.

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