Non-Small Cell Lung Cancer

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.

Different imaging tests are available to give you and your care team a closer look at your lungs. Some common imaging tests that are used to look for signs of lung cancer and understand if it has spread include:

• Chest X-ray: Regular screenings with chest X-rays are not recommended as the primary tool for diagnosing lung cancer. However, signs of lung cancer or visible tumors can be found on an X-ray, so you may have this as an initial test if you’re experiencing symptoms.
• Computed tomography (CT) scan: A low-dose CT scan is the primary imaging test used to screen for lung cancer. You may also have a CT scan as a follow-up to another imaging test.
• Magnetic resonance imaging (MRI) scan: An MRI scan creates images of soft tissues in the body. This imaging test is often used to see how far lung cancer has spread in the chest.
• Positron emission tomography (PET) scan: PET scans help highlight cancer cells in the body using a special radioactive sugar. Sometimes, they are combined with a CT scan to help diagnose lung cancer and see if it has spread.
• Bone scan: A bone scan uses a small injection of radioactive tracer to detect lung cancer that has spread to the bones.

Sputum, sometimes called phlegm, is the mucus that you cough up from your airways. A sputum cytology test collects samples of your sputum and then looks for cancer cells under a microscope in the lab. This test doesn’t find all lung cancers, so it’s typically performed as part of a broader treatment plan.

Thoracentesis takes a fluid sample from your chest to look for cancer cells. During this procedure, a spot on your chest is numbed and a needle is carefully inserted to draw a fluid sample.

Learn more about thoracentesis

A lung biopsy uses several different methods to take tissue samples in or around the lungs. These tissue samples are then reviewed by a pathologist—a doctor who specializes in diagnosing conditions using samples of body tissue or fluid—to look for signs of cancer.

• Fine-needle aspiration (FNA) biopsy: A small needle is guided by imaging through spaces between your ribs to take a sample of fluid or tissue from your lung.
• Bronchoscopy: Your care team may take a biopsy during a bronchoscopy, which uses a scope inserted through your throat to reach your airways. Many of our locations offer robotic bronchoscopy, which improves precision.
• Thoracoscopy or video-assisted thoracic surgery (VATS): Thoracoscopy is a minimally invasive surgical procedure that uses small incisions and surgical instruments guided by a tiny video camera. Your surgeon may take a sample of tissue during the procedure.
• Endobronchial ultrasound: This procedure uses ultrasound to guide a bronchoscope down the throat and into the major airways. It can be used to see lymph nodes in your lungs and take samples without an incision.
• Endoscopic esophageal ultrasound: Endoscopic esophageal ultrasound combines an upper digestive tract endoscopy with ultrasound imaging. Your care team can reach the nearby lymph nodes and take tissue samples.
• Mediastinoscopy or mediastinotomy: These procedures let your surgeon reach the lymph nodes under your breastbone in your chest. Mediastinoscopy uses a small incision and scope, while mediastinotomy uses a slightly larger incision on your chest between the ribs.

Some lung cancer cells have specific biomarkers, proteins or mutated genes that are different from healthy cells. As part of your lung cancer diagnosis, you may have biomarker testing , also called molecular testing, to look for these changes. If your test shows a specific biomarker, your care team may recommend therapies that are designed to target it.

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.

Radiofrequency ablation is used to destroy harmful cells using heat from high-energy radio waves. In lung cancer, radiofrequency ablation can be used to destroy small tumors that are located near the outer edge of your lung.

You may have radiation therapy and other treatments like surgery or chemotherapy for non-small cell lung cancer. Radiation therapy uses high-energy rays from outside the body or radioactive materials placed inside the body to target cancer.

• External beam radiation therapy (EBRT): EBRT is the most common radiation therapy for non-small cell lung cancer. It targets cancer in your lungs and areas where it has spread, using focused radiation rays from outside the body.
• Brachytherapy: Brachytherapy is internal radiation therapy. It places radioactive material into or near the tumor, often using a small pellet, seed, wire or catheter.

Several chemotherapy drugs are used today to treat non-small cell lung cancer. While the very early stages of the condition may not need any chemotherapy, it’s common to have it incorporated into your treatment plan when lung cancer has spread.

• Neoadjuvant chemotherapy: This term means that you will have chemotherapy treatments before you have surgery. It may help shrink your tumor or reduce the chances of your NSCLC returning.
• Adjuvant chemotherapy: Adjuvant chemotherapy is given after lung cancer surgery. The goal is to destroy cancer cells that might remain in your body after your surgery.

Surgery may not be an option for locally advanced NSCLC, where your cancer has started to spread to nearby tissues. In this case, you’ll have chemotherapy and potentially radiation therapy. For metastatic NSCLC, when non-small cell lung cancer has spread to distant areas of the body, chemotherapy could help slow its growth.

Targeted therapy is often a treatment in later stages of non-small cell lung cancer and can be used alongside chemotherapy. These drugs target specific gene mutations or proteins that differentiate your lung cancer cells different than healthy cells. As they specifically target cancer cells, targeted therapies tend to have fewer side effects than chemotherapy.

Monoclonal antibodies are a common type of targeted therapy for non-small cell lung cancer. These lab-made antibodies mimic the natural antibodies used by your immune system, helping your body better target and kill cancer cells.

Immunotherapy is another group of therapies used for non-small cell lung cancer, especially in the later stages of treatment. These therapies work by helping your immune cells better find and attack cancer.

One of the most common types of immunotherapies for NSCLC is immune checkpoint inhibitors. These block specific “checkpoints” on cancer cells to allow your immune cells to recognize the cells as harmful and destroy them.