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Metastatic Non Small-Cell Lung Cancer: NCCN Guidelines for Patients

December 8, 2022 - read ≈ 7 min

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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 has spread far within the body.

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 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.

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.

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.

Learn more about stage 1 through 3 lung cancers that have not spread far in NCCN Guidelines for Patients: Early and Locally Advanced Non-Small Cell Lung Cancer, available at NCCN.org/patientguidelines.

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

What stage is metastatic lung cancer?

Stage 4 lung cancer is metastatic cancer, but other stages may become metastatic cancer as well. Metastatic lung cancer is cancer that has spread far from the first lung tumor.

  • After treatment of stage 1, stage 2, and stage 3 lung cancer, the cancer may appear in distant body parts. If this happens, the cancer is not staged again. Instead, it is referred to as metastatic lung cancer.
  • Stage 4 lung cancer is metastatic lung cancer at diagnosis.

What are the symptoms of metastatic lung cancer?

Symptoms caused by metastatic NSCLC depend on where the cancer is. Examples of its signs and symptoms are:

  • Trouble breathing, chronic cough, and chest pain
  • Pain in bone or spine
  • Yellowing of the skin or eyes called jaundice
  • Constant feeling of a full stomach
  • Headaches, dizziness, or seizures
  • Weakness or numbness of arms or legs
  • Fatigue and unexplained weight loss

Can metastatic lung cancer be treated?

Yes! 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, metastatic lung cancer is unlikely to be cured.

Metastatic lung cancer is not often treated with local treatment. Local treatment includes surgery, radiation therapy, and chemoradiation. It may be an option if metastases are limited. An example is cancer that has spread to only the brain or adrenal gland. Local treatments may also be used to reduce (palliate) symptoms caused by a metastasis.

Most often, systemic therapy is used to treat metastatic lung cancer and is the focus of this book. Systemic therapy affects all cancer in the body. It can treat widespread metastases. Medical oncologists are cancer doctors trained to use systemic therapy.

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. Your cancer center may also have patient navigators, who 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.
  • Metastatic lung cancer has spread far from where it started.
  • Symptoms of metastatic lung cancer depend on where the cancer is in the body.
  • There are newer treatments for metastatic lung cancer that better control the cancer and improve quality of life.
  • Most often, systemic therapy is used to treat metastatic lung cancer. Systemic therapy affects all cancer in the body.
  • A team of experts will work together with you to diagnose and treat the cancer as well as support you.


You can read more about Metastatic 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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