NCCN Guidelines for Patients® | Non-Small Cell Lung Cancer - page 69

NCCN Guidelines for Patients
: Non-Small Cell Lung Cancer
Version 1.2014
Part 7: Treatment by cancer stage
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Par t 5
Par t 6
Par t 7
Par t 8
Par t 9
7.4 Multiple primary tumors
Based on biopsy results or prior lung cancer, your doctors
may think you have more than one primary tumor. Multiple
primary tumors may occur at the same time. Or you may
Pre-treatment test results
Is the cancer
causing symptoms?
Primary treatment
Radiation therapy, or
Supportive care
Stage I, II, III, and IV-M1a
Surgery (preferred),
Can local
treatments be
Did the primary tumors
occur at the same time?
N0 or N1
N2 or N3
Are symptoms
likely to start?
Treat as stage IV
have been treated for one primary tumor and now have
a second primary tumor. Multiple primary tumors may be
the same or a different histologic subtype.
This chart maps the treatment for multiple primary tumors
that haven’t spread outside the chest. Treatment options
depend on which, if any, lymph nodes have cancer. For
N0 or N1 disease, multiple primary tumors that 1) aren’t
causing symptoms, 2) occurred at the same time, and 3)
won’t likely cause symptoms don’t need treatment at this
time. See page 79 for follow-up cancer tests
All other tumors with N0 or N1 disease should be treated.
If local treatments can be received, surgery that spares
as much as the lung as possible is preferred. Otherwise,
radiation therapy or ablation is suggested. If local
treatment isn’t possible, supportive care for symptom
relief may be given. In addition, these tumors and those
with N2 or N3 disease should be treated as described in
Part 7.5 for widespread stage IV lung cancer.
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