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

62 NCCN Guidelines for Patients ® : Lung Cancer – Non-Small Cell, 2018 One primary tumor This section presents treatment options for one or more related masses of cancer cells. Treatment options are listed by cancer stage. Cancer is staged based on tests given before treatment. This is called the clinical stage. To learn your options for initial treatment, read the section that is a match to the clinical stage. For example, if the cancer is stage II, read the section called Stage II . Options for adjuvant treatment will depend on the results of surgery. During surgery, your doctors may find more cancer than first thought. This may change the stage of the cancer. If the cancer is upstaged, read the section that is a match to the pathologic stage. For example, if the cancer was upstaged from stage II to stage III, read the section Stage III for adjuvant treatment. Stage I Guide 8 lists the treatment options for stage I. In stage IA, the lung tumor is 3 cm or smaller. A stage IB tumor can be as large as 4 cm. Initial treatment Options for initial treatment depend on if you are able to have surgery. If lung surgery is an option, removal of the tumor and lymph nodes is advised. The goal of surgery is to cure the cancer. You may be unable or refuse to have surgery. In this case, radiation therapy is an option. The goal of radiation therapy is to cure the cancer. You may receive conventional radiation therapy. Conventional radiation therapy gives radiation in small doses for weeks and targets both the tumor and some normal tissue. One example is 3D-CRT. A newer type of radiation therapy—SABR—is also advised. Ablation may be an option for some stage IA tumors in the outer third of the lung. Adjuvant treatment Adjuvant treatment is given to reduce the chances of the cancer returning. Options are grouped by type of initial treatment. After surgery Cancer-free surgical margins are often a sign that all the cancer was removed. In this case, you may start your survivorship plan. However, cancer cells may remain for some stage IB cancers. In these cases, chemotherapy may be received. Cancer likely remains when tumors are larger than 4 cm, after a wedge resection, or cancer cells barely look like normal cells. When cancer cells are in the surgical margins, a second surgery is the option preferred by NCCN experts. A second option is radiation therapy. If you have stage IB cancer, chemotherapy may be added to surgery or radiation therapy. After radiation therapy For stage IA, no more treatment is needed. You may start your survivorship plan. For stage IB, no more treatment is needed if all the cancer was likely treated. Chemotherapy may be received if cancer cells likely remain in your body. Cancer likely remains when tumors are larger than 4 cm or cancer cells barely look like normal cells. Chemotherapy may also be given if it is unknown whether cancer is in lymph nodes. 6 Non-metastatic cancer One primary tumor – Stage I

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