Treatment options for non small cell lung cancer (NSCLC)
A team of health professionals decides what treatment you might need. They also decide what treatment options you have.
The most common treatments for non small cell lung cancer are:
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surgery
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radiotherapy
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chemotherapy
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chemotherapy with radiotherapy (chemoradiotherapy)
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immunotherapy
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targeted cancer drugs
Deciding which treatment you need
A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).
Most people are referred to a lung cancer MDT. You might go to a different hospital if there isn't a specialist MDT at your local hospital.
The team usually includes:
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a respiratory physician
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a specialist surgeon
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cancer specialists (oncologists) who specialise in treating cancer with cancer drugs (medical oncologist) and radiotherapy (clinical oncologist)
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a specialist cancer nurse (also called clinical nurse specialist)
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a pathologist (an expert who examines any cancer or tissue the surgeon removes)
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a pharmacist
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a radiologist (who looks at your scans and x-rays)
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a dietician (who offers support and advice about eating and drinking)
The MDT may also include health professionals who look after people with metastatic (advanced) lung cancer. They can help with symptom control. They include:
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the palliative care team
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a clinical nurse specialist for palliative care
Your treatment depends on:
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the type of lung cancer
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where your cancer is
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how far it has grown or spread (the stage)
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your general health and level of fitness
If you’ve been diagnosed with metastatic cancer
Deciding about treatment can be difficult when you have metastatic cancer.
It helps to understand:
- what treatment can do for you
- how it might affect your quality of life
- what side effects does it have
Your doctor or specialist nurse can talk to you about the benefits and possible side effects. You can ask them questions.
You might also find it helps to talk things over with a close relative, a friend or a counsellor at the hospital.
Your choices
Your doctor might offer you a choice of treatments. Discuss each treatment with them and ask how they can control any side effects. This helps you make the right decision for you. You also need to think about the other factors involved in each treatment, such as:
- whether you need extra appointments
- if you need more tests
- the distance you need to travel to and from hospital
You might have to make further choices as your situation changes. It helps to find out as much as possible each time. You can stop a treatment whenever you want to if you find it too much to cope with.
If you decide not to have treatment
You may decide not to have cancer treatments, such as chemotherapy. But you can still have medicines to help control symptoms, such as sickness or pain.
Your doctor or nurse will explain what could help you. You can also ask them to refer you to a local symptom control team to give you support at home.
Treatment overview
The main treatments are:
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surgery
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chemotherapy
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radiotherapy
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chemoradiotherapy (chemotherapy with radiotherapy)
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targeted cancer drugs
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immunotherapy
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symptom control treatment
You have one or more of these treatments. This depends on the stage of your cancer. And how well the treatment works after some time.
Your MDT will discuss your treatment, its benefits and possible side effects. A member of the MDT will inform you about the recommended treatment. You may decide whether you want the suggested treatment or not.
Treatment by stage
Stage 1
Stage 1 means your cancer is small. It hasn’t spread to your lymph nodes or other distant organs.
If you have surgery
If you are fit enough, you usually have surgery to remove:
- part of your lung (a lobectomy, segmentectomy or wedge resection)
- all of the lung (pneumonectomy)
Your fitness for surgery depends on your general health and how well you are likely to recover.
After surgery, your doctor might offer you chemotherapy, 
or . This lowers the chance of your cancer coming back. It is called adjuvant treatment.
If your surgeon is not able to remove all of your tumour, you might have radiotherapy after surgery.
If you’re not having surgery
If you aren’t fit enough for surgery or you decide that you don't want to have it, you might have:
- radiotherapy - this is usually
stereotactic ablative body radiotherapy (SABR) . If you can’t have SABR, you might have conventional radiotherapy or radiotherapy that is divided into small doses and given more often. This is also known as continuous hyperfractionated accelerated radiotherapy (CHART) radiofrequency ablation
Stage 2
If you have surgery
Some people might have chemotherapy or chemotherapy with before surgery ( chemotherapy).
If you are fit enough, you usually have surgery to remove:
- part of your lung (a lobectomy, segmentectomy or wedge resection)
- all of the lung (pneumonectomy)
Following surgery, your doctor may recommend chemotherapy, chemotherapy combined with immunotherapy or chemotherapy with a called osimertinib. This is if your tumour tested positive for the EGFR mutation.
This will lower the chance of your cancer coming back. This is called adjuvant treatment.
If the surgeon couldn’t remove all the cancer, you might have radiotherapy after your operation.
If you’re not having surgery
If your cancer can be removed with surgery, but you aren’t fit enough for surgery, you may be offered one or more of the following treatments:
- radiotherapy - this is usually
stereotactic ablative body radiotherapy (SABR) - if you can’t have SABR, you might have conventional radiotherapy or radiotherapy that is divided into small doses and given more often, also known as continuous hyperfractionated accelerated radiotherapy (CHART)
Stage 3A
Below is an overview of treatment options for stage 3A lung cancer.
If you have surgery
You might have one or more of the following treatments before surgery:
- neoadjuvant chemotherapy
- neoadjuvant chemotherapy with immunotherapy
If you are fit enough, you usually have surgery to remove:
- part of your lung (a lobectomy)
- all of the lung (pneumonectomy)
Your fitness for surgery depends on your general health and how well you are likely to recover.
After surgery, some people might be offered on or more of the following treatments:
- chemotherapy
- chemotherapy with immunotherapy
- radiotherapy
- targeted cancer drugs
This is called adjuvant treatment. Your doctor will tell you whether this is appropriate for you.
If you’re not having surgery
If you can’t have surgery, you might have radiotherapy, chemoradiotherapy (chemotherapy at the same time as radiotherapy) or sequential chemotherapy and radiotherapy.
You might then have immunotherapy after chemoradiotherapy. Immunotherapy uses our immune system to fight cancer. It works by helping the immune system recognise and attack cancer cells.
Stage 3B and 3C
The treatment options for stages 3B and 3C are more complex and will depend on factors such as whether:
- your cancer can be removed with surgery
- it has spread to lymph nodes in the space between the lungs (mediastinum)
- how many tumours there are in the lung
It might include one or more of the following treatments:
- neoadjuvant chemotherapy with or without immunotherapy before surgery
- surgery
- chemotherapy after surgery
- chemotherapy with radiotherapy (chemoradiotherapy)
- immunotherapy
- targeted cancer drugs
Stage 4
Treatment aims to control the cancer for as long as possible and help to reduce symptoms.
If you are well enough you might have one or more of the following treatments depending on your situation:
- targeted cancer drugs
- immunotherapy
- chemotherapy with immunotherapy
- chemotherapy
- stereotactic radiosurgery (SRS) on any cancer left behind (residual disease)
- brain SRS or whole brain radiotherapy for brain metastases
To control symptoms, you might also have one or more of these treatments:
- external radiotherapy
- internal radiotherapy (brachytherapy)
- laser treatment
- freezing the tumour (cryotherapy)
- a rigid tube (called a stent) to keep the airway open
- a rigid tube (called a stent) to keep a big vein called the superior vena cava open
Clinical trials
Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.
