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

78 NCCN Guidelines for Patients ® : Lung Cancer – Non-Small Cell, 2018 Multiple primary tumors This section presents treatment options for two or more unrelated masses of cancer cells. These masses are called multiple primary tumors. Those that have spread to N2 or N3 lymph nodes are treated like metastatic disease. Read Part 7 for treatment options. Read this section to learn treatment options for N0 or N1 disease. Treatment options are grouped by whether symptoms are present. Options for survivorship are on page 80. Symptoms absent Guide 18 lists treatment options for multiple tumors not causing symptoms. Options are grouped by whether the tumors appeared at the same time or not. Co-occurring tumors These tumors appeared at the same time. Some of these tumors may not cause symptoms soon. They may be slow-growing. Others may be in a place that won’t cause severe symptoms. If symptoms won’t start soon, treatment isn’t needed at this time. Some co-occurring tumors may cause symptoms in the near future. In these cases, treatment is advised. Treatment options depend on if local treatments may cure the cancer. If local treatments are options, surgery is preferred by NCCN experts. The surgery should spare as much of the lung as possible. Other options for local treatment are radiation therapy or ablation. Local treatment may not be an option. In these cases, chemotherapy with or without local treatments for symptom relief may be received. A second option is observation, also known as watch and wait. Observation is a period of testing to watch changes in cancer status. Back-to-back tumors These tumors appeared one after the other. If local treatments are options, surgery is preferred by NCCN experts. The surgery should spare as much of the lung as possible. Other options for local treatment are radiation therapy or ablation. Local treatment may not be an option. In these cases, chemotherapy with or without local treatments for symptom relief may be given. A second option is observation, also known as watch and wait. Observation is a period of testing to watch changes in cancer status. Symptoms present Guide 19 lists treatment options for multiple tumors causing symptoms. Treatment options depend on if local treatments may cure the cancer. If local treatments are options, surgery is preferred by NCCN experts. The surgery should spare as much of the lung as possible. Other options for local treatment are radiation therapy or ablation. Local treatment may not be an option. In these cases, chemotherapy with or without local treatments for symptom relief may be received. A second option is observation, also known as watch and wait. Observation is a period of testing to watch changes in cancer status. 6 Non-metastatic cancer Multiple primary tumors

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