Non-small cell lung cancer (NSCLC)

A PET-CT scan combines 2 types of scan. A CT takes a series of x-rays to build up a 3D picture. A PET measures the activity of cells in the body.

During a biopsy, a doctor or nurse takes samples of cells or tissue from the abnormal area. They look at the biopsy samples under a microscope to check for cancer cells. You usually have a biopsy to find out for certain if you have lung cancer. There are different ways of collecting biopsies, including:

• bronchoscopy biopsy
• CT scan and biopsy
• lung needle biopsy
• EBUS and biopsy
• EUS and biopsy
• neck lymph node biopsy.

A mediastinoscopy is sometimes done instead of an EBUS or EUS. It lets the doctor look at the area in the middle of your chest (the mediastinum) and nearby lymph nodes. You have it under a general anaesthetic. 

A thoracoscopy lets the doctor look at the lining of the lungs (pleura). It is usually done under a general anaesthetic.

An MRI scan uses magnetism to build up a detailed picture of areas of your body.

Your doctors may arrange more detailed tests on cancer cells taken during a biopsy or surgery. They look for certain gene changes (mutations) in the cancer cell. This can show if the cancer cell is making an abnormal protein or has too much of a certain protein. 

The results can tell your doctor if certain targeted or immunotherapy drugs are likely to work for you.

Sometime doctors take a blood sample and look for pieces of cancer cells and of the tumour DNA. This is called a liquid biopsy. It is rarely done and still being researched. It may tell them more about the genetics of the cancer and help with treatment decisions.

If your treatment plan involves having surgery or radiotherapy your doctor will arrange breathing tests (lung-function tests) and exercise tests.

These help doctors see how well your lungs are working. You may also have tests to check how well your heart is working.

It may be possible to remove NSCLC with surgery. This will depend on the size and position of the cancer.

Chemotherapy may be given before or after surgery for NSCLC. Or it can be given with radiotherapy treatment. This is called chemoradiation. Chemotherapy can also be given to control symptoms when lung cancer has spread.

Radiotherapy may be used instead of surgery to treat early stage NSCLC. It can also be given with or after chemotherapy. This is called chemoradiation. Radiotherapy can also be given to control symptoms.

Targeted therapy and immunotherapy drugs can be used to treat advanced NSCLC. Your doctor will do tests on the cancer cells to find out if certain drugs are suitable for you. 

Tumour ablation treatments use heat or laser light to treat very early-stage lung cancers. Ablation treatment can also be used if the cancer is blocking an airway.

You can have treatments to help relieve any symptoms caused by the cancer. This is sometimes called supportive care or palliative care.

Below is a sample of the sources used in our lung cancer information. If you would like more information about the sources we use, please contact us at  cancerinformationteam@macmillan.org.uk

National Institute for Health and Care Excellence (NICE). Lung cancer – Diagnosis and management. Clinical guideline 2019.

Metastatic non-small cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. 2018.

European Society for Medical Oncology (ESMO). Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up. 2017.

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr David Gilligan, Consultant Clinical Oncologist.

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