What is non-small cell lung cancer?

Non-small cell lung cancer is one of the two main kinds of lung cancer. This cancer occurs when abnormal cells in the lining of the lung start to grow rapidly.

NSCLC tends to grow at a slower rate when compared to small cell lung cancer, and it is often discovered when it has already spread in the lungs. But when non-small cell lung cancer is found early, you have more treatment options. For example, many of our hospitals offer advanced surgical procedures that preserve as much of your healthy lung tissue as possible.

For later stages of NSCLC, you may have access to innovative therapies like immunotherapy or clinical trials. No matter what type or stage of non-small cell lung cancer you have, our team will work with you to understand your options and feel confident in your treatment plan.

Types of non-small cell lung cancer

There are three types of non-small cell lung cancer, depending on the type of cell where the cancer starts. The type you have will guide which treatments work best for you.

  • Adenocarcinoma: The most common type of NSCLC cases are adenocarcinoma of the lung. It begins in the cells in the lung lining that make mucus, called the epithelial cells.
  • Squamous cell carcinoma: The second most comment non-small cell lung cancer cases are squamous cell carcinoma. However, this type is the most common among smokers. It starts in a thin, flat cell that lines the lungs and is the most likely to spread.
  • Large cell carcinoma: Large cell carcinoma is the least common type of non-small cell lung cancer, making up only about 1 in 10 cases. This type of cancer can only be diagnosed when large cancer cells are seen under the microscope and aren’t defined as adenocarcinoma or squamous cell carcinoma.

Non-small cell lung cancer vs. small cell

Non-small cell lung cancer and small cell lung cancer get their names from how the cancer cells look under a microscope; small cell lung cancer is rounder and smaller than NSCLC. But the most important difference between the two is how fast they tend to spread. Non-small cell lung cancer is less aggressive than small cell lung cancer.

Non-small cell lung cancer:

  • The most common type of lung cancer
  • Slower growing
  • Generally, has a better prognosis

Small cell lung cancer:

  • A less common type of lung cancer
  • Tends to grow and spread faster
  • More likely to return after treatment
man with non-small cell lung cancer leaning on a tree smiling and looking at camera

Non-small cell lung cancer symptoms

Many non-small cell lung cancer cases aren’t caught in the early stages because they don’t cause any lung cancer symptoms. Patients usually start to experience symptoms when the cancer has already spread, which is why screening is so important. For those deemed as high risk for lung cancer, such as current and past smokers, annual lung cancer screenings help catch lung cancer early—before symptoms begin.

When NSCLC does start to cause symptoms, they may feel similar to other lung conditions, such as a chest infection. While symptoms are often caused by something other than cancer, it’s important to pay attention to what your lungs are telling you and speak with your doctor about any ongoing discomfort.

When to see a doctor

Symptoms from a respiratory infection or other minor lung issue may get better on their own. However, you should visit your doctor if you notice any ongoing lung symptoms: 

  • A cough that gets worse or won’t go away
  • Coughing up blood
  • Changes in your voice, like hoarseness
  • Shortness of breath or wheezing
  • Chest pain
  • Loss of appetite
  • Fatigue

NSCLC causes and risk factors

Many causes and risk factors for non-small cell lung cancer (NSCLC), specifically a history of smoking, are well known. However, it is possible for people who have never smoked to develop the condition. Other factors, from your environment to your genetics, might play a role, too. Sometimes, it’s possible to develop lung cancer without a known cause.

Some risk factors for non-small cell lung cancer include:

  • Tobacco use: Smoking is one of the main risk factors for all types of lung cancer. About 80-90% of lung cancers are linked to smoking history, and secondhand smoke may also increase your risk.
  • Asbestos exposure: People who work with asbestos have an increased risk of lung cancer. Protective equipment is important to help reduce this risk.
  • Radon: Radon is an odorless gas that naturally occurs in the environment. If high levels of this gas become concentrated indoors, like in your home, this exposure increases your risk of lung cancer.
  • Air pollution: Regular exposure to high levels of air pollution may also cause you to have a higher risk of lung cancer. You can check your air pollution forecast and avoid outdoor activities when the level is high.
  • Workplace exposure: Some jobs expose people to other substances or chemicals linked to a risk of lung cancer. These include coal or wood cooking flames, fumes from diesel, radiation exposure or chemicals like arsenic, chromium and nickel.
  • Existing medical conditions: If you’ve been diagnosed with another lung condition, it may significantly increase your risk for lung cancer, including chronic obstructive pulmonary disease and pulmonary fibrosis.
  • Previous radiation therapy: If you’ve had radiation therapy in your chest area to treat another type of cancer, it can increase your risk for lung cancer. This could include treatment for breast cancer or some types of lymphoma.
  • Genetics: Some types of lung cancer may be affected by genetics. If you have a strong family history of lung cancer, talk with your doctor about your risk.

Diagnosing NSCLC

If you have a high risk of lung cancer, an annual screening can diagnose it early, when it’s most treatable. For those between 50 and 80 years old with a history of smoking, a low-dose CT scan can look for early signs of lung cancer before any symptoms appear.

If you’re experiencing any non-small cell lung cancer symptoms, your care team has many different imaging tests and other diagnostic tools to help get to the source of your symptoms. If lung cancer is found, then your team may use additional tests to understand your specific diagnosis and what treatments may work for you.

Medical history and physical exam

Your provider will ask about your medical and family history and perform an exam. Your care team may then recommend specific tests to diagnose the cause of your symptoms.

Non-small cell lung cancer staging

Based on your diagnostic tests, your non-small cell lung cancer will be put into one of five lung cancer stages, ranging from 0 to 4. The lower the number, the less the cancer has spread in the body.

  • Stage 0: You only have abnormal cells found in the inner lining of the lungs, and these cells haven’t spread.
  • Stage 1: The tumor may be up to 4 centimeters, but it’s still only in the lung and hasn’t spread to the lymph nodes.
  • Stage 2: Your tumor may be larger and have spread into the nearby lymph nodes on that side of the chest.
  • Stage 3: At this stage, your tumor may be more than 7 centimeters and have spread to lymph nodes in the chest or nearby tissues.
  • Stage 4: In the most advanced stage, lung cancer has spread to at least one place in the body, far away from the lungs.

 

Non-small cell lung cancer treatment

Your team will work with you to create a plan for your non-small cell lung cancer treatment. Several treatments are available for your care and the options depend on the stage and type of your cancer.

Unlike small cell lung cancer, surgery is one of the main treatments for non-small cell lung cancer, especially in the earlier stages. Other treatments include ablation procedures, chemotherapy, radiation therapy, targeted therapies and immunotherapy.

Surgery

If you have early-stage, non-small cell lung cancer, surgery helps remove all or as much of the tumor as possible while preserving the remaining healthy lung tissue. Our lung cancer care teams offer several surgical options, including minimally invasive approaches for your care.

  • Lobectomy: One of the most common options in early-stage lung cancer is a lobectomy, which removes just the lobe (section) in the lung where the tumor is located.
  • Wedge resection: This surgical procedure removes the area of cancer in your lung and a wedge shape of healthy tissue around it.
  • Segmentectomy: A segmentectomy removes only one segment of the lobe that contains cancer, rather than an entire lobe.
  • Pneumonectomy: A pneumonectomy may be needed if all the cancer can’t be removed with a lobectomy. This procedure takes out your entire lung on one side.

 

Non-small cell lung cancer prognosis and survival rate

Every case of non-small cell lung cancer is different, but survival rates can help you understand more about your prognosis and guide your treatment decisions based on whether your cancer is localized, regional or distant.

Early non-small cell lung cancer detection is vital to an improved survival rate. In early, localized NSCLC—before cancer has spread—the five-year survival rate is 63%. For regional lung cancer, it’s 37%, and for lung cancer that has spread to at least one distant place in the body, it’s 9%.

older woman looking off to the right side standing in front of plain wall

Frequently asked questions