OVERVIEW

What is non-small cell lung cancer?

Based on pathological examination, lung cancer can be divided into small cell carcinoma and non-small cell carcinoma. Non-small cell lung cancer includes squamous cell carcinoma, adenocarcinoma, large cell carcinoma, and other types.

Compared with small cell carcinoma, the cancer cells of non-small cell carcinoma grow and divide more slowly, and their spread and metastasis occur relatively later. Non-small cell lung cancer accounts for about 80% of all lung cancers.

How common is non-small cell lung cancer?

Lung cancer is one of the most common malignant tumors in China, with its incidence and mortality rates consistently ranking first among all cancers. Therefore, there are also many people diagnosed with non-small cell lung cancer.

SYMPTOMS

What are the manifestations of non-small cell lung cancer?

Early-stage non-small cell lung cancer often has no obvious symptoms. As the disease progresses, the following symptoms may appear: cough (especially a persistent dry cough), sputum production, blood in the sputum or bloody sputum, chest pain, fever, shortness of breath, etc. Additionally, systemic symptoms such as weight loss and fatigue may occur.

When cancer cells invade or metastasize to other areas, corresponding symptoms may arise, such as hoarseness (due to recurrent laryngeal nerve involvement) or headache (due to brain metastasis).

What are the common metastatic sites of non-small cell lung cancer?

Non-small cell lung cancer can spread to other parts of the body through local invasion, the lymphatic system, or the bloodstream. Common metastatic sites include the lungs, mediastinal or superficial lymph nodes, liver, bones, and brain. Follow-up examinations should focus on these areas.

Does coughing up blood or blood-streaked sputum mean I have non-small cell lung cancer?

Many conditions can cause hemoptysis (coughing up blood) or blood-streaked sputum, such as tuberculosis, pneumonia, or lung cancer. Tuberculosis, in particular, has a high incidence rate, so these symptoms do not necessarily indicate lung cancer.

However, coughing up blood or blood-streaked sputum signals a potential health issue, and medical attention should be sought promptly.

CAUSES

What causes non-small cell lung cancer?

• Smoking: Considered the most common high-risk factor for lung cancer, as well as for many other diseases. Strongly advised to quit smoking.
• Environmental factors: Air pollution, vehicle exhaust, exposure to toxic gases or harmful dust in the workplace.
• History of chronic lung diseases: Benign conditions such as tuberculosis or chronic obstructive pulmonary disease (COPD), with long-term recurrent episodes, can increase the risk of lung cancer.
• Genetic factors: Individuals with a family history of lung cancer have a higher likelihood of developing the disease compared to the general population.
• Other factors: Ionizing radiation, immunodeficiency, etc.

Who is more likely to develop non-small cell lung cancer?

Long-term heavy smokers, individuals with immediate family members who have had lung cancer, those suffering from chronic obstructive pulmonary disease, tuberculosis, silicosis, or pneumoconiosis, and people with a long-term history of asbestos exposure.

Is non-small cell lung cancer contagious?

No, it is not contagious.

Is non-small cell lung cancer hereditary?

Current knowledge suggests that lung cancer has a hereditary tendency. Therefore, individuals with a family history of lung cancer should remain vigilant—avoid smoking, undergo regular check-ups, and seek medical attention promptly if symptoms suggestive of lung cancer arise.

DIAGNOSIS

What tests are needed for non-small cell lung cancer?

For individuals with lung cancer symptoms, hospital examinations are required. Typically, a chest CT or X-ray will be performed. If space-occupying lesions are detected or there is a high suspicion of lung cancer, a bronchoscopy may be recommended. For lesions located at the periphery, a CT-guided biopsy may be necessary.

A definitive diagnosis requires a pathological biopsy of the suspicious area, which can confirm whether lung cancer is present. Additionally, some patients with contraindications for biopsy may undergo sputum cytology (collecting the patient's coughed-up sputum and sending it to the pathology lab for microscopic examination to detect tumor cells).

TREATMENT

In which departments should patients with non-small cell lung cancer seek medical attention?

Since the symptoms of non-small cell lung cancer mainly include cough (especially irritating dry cough), sputum production, blood in sputum or hemoptysis, chest pain, fever, and shortness of breath, most patients visit the respiratory medicine department before a definitive diagnosis is made.

For patients highly suspected of having lung cancer, they can seek medical attention in the oncology department, thoracic surgery department (or cardiothoracic surgery department), or respiratory medicine department.

Can non-small cell lung cancer be cured?

Currently, many early-stage non-small cell lung cancers can be cured through standard and comprehensive treatment. The cure rate for advanced-stage patients is very low, but with advancements in medical technology and drug development, many patients may achieve long-term survival with the tumor.

How is non-small cell lung cancer treated?

Treatment plans vary depending on the stage at diagnosis.

In principle, early and intermediate stages are primarily treated with surgery, followed by chemotherapy or radiotherapy based on the pathological stage. Surgery for early and intermediate stages can maximize the chances of a cure.

Advanced stages are treated with chemotherapy-based comprehensive therapy. Elderly or frail patients may consider targeted therapy (which refers to the use of targeted drugs designed to act on surface antigens or gene mutations of tumor cells, with minimal impact on normal cells and relatively fewer side effects).

Can all early and intermediate-stage non-small cell lung cancers be treated with surgery?

Most early and intermediate-stage non-small cell lung cancers can be treated with surgery. However, surgery is not suitable if the tumor is located near major blood vessels, the patient is in poor general condition or has poor lung function, or if the patient has other chronic diseases that make them unable to tolerate surgery.

What risks might non-small cell lung cancer patients face during surgery?

Potential risks during surgery include:

• Anesthesia accidents;
• Cardiovascular or cerebrovascular accidents, such as myocardial infarction, stroke, or pulmonary embolism;
• Major bleeding during or after surgery, pneumothorax, hydrothorax, pleural effusion, pneumonia, etc.;
• Impaired respiratory function, such as bronchial fistula, pleural infection, fever, or difficulty breathing;
• Impaired cardiac function, such as arrhythmia, heart failure, or respiratory failure.

Although lung cancer surgery carries various risks, the overall incidence is very low. With proper surgical indications, thorough preoperative preparation, and active cooperation from patients and their families, most surgeries are safe and reliable.

Does non-small cell lung cancer surgery require the removal of the entire lung?

Depending on the stage and location of the non-small cell lung cancer, either an entire lung or a lobe of the lung may be removed.

This will have some impact on respiratory function, but most patients can tolerate it. Even if an entire lung is removed, most patients can carry out normal daily activities, though strenuous exercise or physically demanding tasks should be avoided.

Why is adjuvant chemotherapy needed after non-small cell lung cancer surgery?

The rationale is that after surgery, microscopic metastases or tumor cells may remain. Adjuvant chemotherapy aims to eliminate these residual cells as much as possible.

This theory has been confirmed by large international clinical studies. However, not all patients require or are suitable for chemotherapy. For example, early-stage (Stage I) patients do not need chemotherapy.

Why do some non-small cell lung cancer patients also require radiotherapy?

The rationale is similar to postoperative chemotherapy. For squamous cell carcinoma or cases where the surgical margin is positive (indicating incomplete removal), radiotherapy is recommended.

What are the common adverse reactions of chemotherapy for non-small cell lung cancer?

Adverse reactions may vary depending on the chemotherapy drugs used. Common reactions include:

• Gastrointestinal reactions: nausea, vomiting, constipation, diarrhea, or abdominal pain;
• Bone marrow suppression, most commonly leukopenia, followed by thrombocytopenia;
• Liver or kidney damage;
• Hair loss, which is more common with taxane drugs but is usually reversible;
• Local adverse reactions, such as phlebitis or tissue necrosis due to chemotherapy drug leakage;
• Allergic reactions, which are rare;
• Others, such as cardiac or skin toxicity, which are relatively rare.

When should chemotherapy start after non-small cell lung cancer surgery?

Depending on the patient's recovery, stage, and other factors, chemotherapy is generally recommended to start within 3–6 weeks after surgery.

How many cycles of adjuvant chemotherapy are needed after non-small cell lung cancer surgery?

Adjuvant chemotherapy after non-small cell lung cancer surgery typically involves 4–6 cycles, depending on the treatment plan, the patient's condition, and their response to chemotherapy. For patients with severe reactions, the drug dosage or regimen can be adjusted accordingly.

How often should follow-up examinations be done after non-small cell lung cancer surgery?

Follow-up examinations are recommended every 3 months for the first 2 years after surgery, every 6 months from years 2 to 5, and annually after 5 years. Patients should consult their doctor immediately if they experience any discomfort.

What tests are included in follow-up examinations after non-small cell lung cancer surgery?

Follow-up tests include:

• Physical examination by a doctor, focusing on superficial lymph nodes and the chest/abdomen.
• Blood tests: complete blood count and tumor markers (CEA, CA125, SCC, cytokeratin fragment 19, etc.). The blood count checks for anemia, leukopenia, or thrombocytopenia, while tumor markers (with a positivity rate of about 70%) can indicate early tumor growth or recurrence.
• Chest CT, abdominal ultrasound, CT, or MRI. Bone scans are needed for patients with bone pain. PET-CT is not recommended as a routine test. These tests help determine if the tumor has recurred or metastasized.

What should be done if recurrence or metastasis is found during follow-up after non-small cell lung cancer surgery?

Due to the nature of malignant tumors, recurrence or metastasis is possible after surgery. If detected during follow-up, treatment options—such as surgery, radiofrequency ablation (a procedure where electrodes are inserted into the tumor under ultrasound or CT guidance to generate heat and kill nearby cells), radiotherapy, or chemotherapy—are considered based on the location, number, and size of the recurrence or metastasis.

Some cases detected early can still achieve curative treatment with aggressive therapy.

What targeted drugs are available for non-small cell lung cancer?

Commonly used drugs include gefitinib and erlotinib. The National Health Commission's lung cancer guidelines recommend testing for EGFR gene mutations before using these drugs as first-line treatment for advanced non-small cell lung cancer. Patients with mutations are advised to use them.

Other drugs targeting tumor angiogenesis, such as bevacizumab and endostatin, are also available.

Is it reliable for doctors to recommend clinical trials for advanced non-small cell lung cancer?

National or global clinical trials are typically reviewed and approved by regulatory bodies like the National Medical Products Administration and ethics committees. Before entering trials, preliminary research has been conducted, and most eligible patients benefit, though there is a possibility of harm or inefficacy.

However, new drugs must undergo clinical trials before approval, and patients can access novel and appropriate treatments. Therefore, treatment guidelines recommend eligible patients participate in clinical research.

DIET & LIFESTYLE

What should I pay attention to in my diet after surgery for non-small cell lung cancer?

After surgery, start with small amounts of light liquid food, gradually increasing the quantity and variety of food, focusing on easily digestible options. You can consume vegetables and fruits in moderation, but avoid spicy, greasy, or cold foods. As recovery progresses, you can gradually introduce high-protein and meat-based foods.

What can family members of non-small cell lung cancer patients do for them?

Family members play a crucial role in the treatment of non-small cell lung cancer. First, they should provide emotional and material support, encourage the patient, and boost their confidence in overcoming the illness. They should also motivate the patient to accept suitable treatment plans and maintain an optimistic attitude.

Additionally, family members should assist with pre- and post-operative care, such as preparing meals the patient enjoys (within the doctor's approved food list), spending time talking with the patient, and providing gentle massages when appropriate.

PREVENTION

How to Prevent Non-Small Cell Lung Cancer?

The following measures can reduce the risk of non-small cell lung cancer:

• Quit smoking and drinking: Avoid smoking and secondhand smoke;
• Choose clean living and working environments whenever possible;
• Eat more foods rich in vitamins and fiber, such as fruits and vegetables;
• Exercise: Engage in moderate physical activity, especially if overweight;
• Properly treat benign lung conditions, such as tuberculosis or pneumonia;
• Regular check-ups: Especially recommended for those with a family history, smokers, poor living/working environments, or individuals over 50 years old.