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

83 NCCN Guidelines for Patients ® : Lung Cancer – Non-Small Cell, 2018 Part 7 is a guide to the treatment options for metastatic lung cancer. This cancer has spread to distant sites. The treatment aim is to reduce symptoms, control the cancer, and extend life. Supportive care is also important for your well-being. Overview This section is a guide to treatment for metastatic lung cancer. These cancers include stage IV. They also include earlier stages that have spread to distant sites. A score of M1a means the cancer has spread to distant sites within the chest. A score of M1b means the cancer has spread to sites beyond the chest. Supportive care Talk with your treatment team about starting supportive care early. Supportive care has been shown to extend and enhance life for people with metastatic lung cancer. Performance score Doctors use many factors to plan treatment for metastases. One important factor is your health. If your health is poor, some treatments may not be good for you. A performance score is a rating of your ability to do activities. It is used by doctors as a measure of general health. The ECOG ( E astern C ooperative O ncology G roup) Performance Scale is a common scoring system. It consists of four scores. † † A score of 0 means you are fully active. † † A score of 1 means you are able to do all self-care activities but are unable to do hard physical work. † † A score of 2 means you are able to do all self- care activities and spend most of waking time out of bed but are unable to do any work. † † A score of 3 means you are unable to do all self-care activities and any work and spend most of waking time in bed. † † A score of 4 means you are fully disabled. Limited sites You may be able to receive local treatment if metastases are limited. You should also be in fairly good health other than cancer. Local treatments include surgery, radiation therapy, and chemoradiation. In certain cases, local treatments may provide the best chance for a cancer control. For M1a, local treatment may be used if the cancer spread is limited. An example is one tumor in the non-primary lung. M1a also includes cancer spread to the pleura and its fluid. If needed, the pleural fluid may be drained or the two pleural layers fused. Very rarely does M1b disease spread to only one site beyond the chest. Such sites include the brain and adrenal gland. In these cases, local treatment may be received. However, local treatment isn’t suggested if there is N3 disease. N3 disease includes cancer spread to lymph nodes near the collarbone or in the neck. Multiple sites Most often, local treatment is not a good option for metastatic lung cancer. Such cancers include those that have spread to more than one site within and beyond the chest. In these cases, treatment depends on the type of lung cancer and biomarkers. 7 Metastatic cancer Overview

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