Understanding the Prognosis of Non-Small Cell Lung Cancer
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Medically reviewed by Susan Russell, MDMedically reviewed by Susan Russell, MD
Non-small cell lung cancer (NSCLC) is the most common form of lung cancer, accounting for 80-85% of all cases. It develops when abnormal lung cells grow uncontrollably, forming a tumor.
There are three main subtypes of NSCLC: adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Each subtype starts in different lung cells, but treatment and prognosis for each are similar. Prognosis refers to the expected trajectory and outcome of a disease.
The prognosis of non-small cell lung cancer varies depending on the specific subtype and the stage of cancer at diagnosis. Early-stage NSCLC—when the cancer is confined to one or two lungs— generally has a better prognosis than more advanced stages, when the cancer has metastasized (spread) to nearby lymph nodes or distant organs. Additionally, certain subtypes of NSCLC tend to grow more rapidly than others, which can influence prognosis.
Prognosis Details for Non-Small Cell Lung Cancer
The prognosis of non-small cell lung cancer depends on several factors, including the stage of the cancer at diagnosis. Staging provides a comprehensive picture of the extent of cancer.
To determine the cancer stage, healthcare providers use a staging system called TNM. TNM focuses on three key aspects:
(T) Tumor size and location: The size of the primary tumor and whether it has grown into nearby tissues or organs
(N) Lymph node involvement: Whether cancer has spread to lymph nodes in the chest near the lungs
(M) Metastasis: Whether the cancer has spread beyond the lungs to distant organs or body areas, such as the liver, brain, or bones; metastasis is common in more advanced stages
Staging helps inform treatment decisions and can determine potential outcomes.
Early-Stage Prognosis
In the early stages of NSCLC, the primary tumor is small and has not spread to distant organs. Detecting lung cancer early offers the best chance for successful treatment and a positive prognosis.
Here's a look at the prognosis for each early stage of NSCLC:
Stage 0: Cancer cells are limited to only the top layer of cells in the airways and have not spread to other lung tissues. Stage 0 NSCLC is curable with treatment, which usually involves surgical removal of the cancer cells and the affected part of the lung, laser therapy, or brachytherapy (internal radiation).
Stage 1: The primary tumor is no larger than 3 or 4 centimeters and has not spread to any lymph nodes in the chest or other body areas. Treatment may include surgery, chemotherapy, or radiation therapy.
Stage 2: The cancer has not spread to other organs or body areas but may have spread within the lungs or to nearby lymph nodes in the chest. Treatment typically involves surgery, chemotherapy, immunotherapy, and/or targeted therapy.
Advanced-Stage Prognosis
Advanced NSCLC, including stage 3 and stage 4, means cancer has spread beyond the lungs to nearby or distant lymph nodes or other organs in the body, such as the brain, liver, or bones.
While the prognosis for advanced stages of NSCLC is poorer than that of earlier stages, advancements in treatment options have improved outcomes in recent years. In some cases, treatment for advanced NSCLC focuses on managing the disease and improving quality of life rather than achieving a cure.
The prognosis for stage 3 NSCLC varies widely, depending on which lymph nodes the cancer has spread to, such as those in the chest or neck. Treatment typically includes a combination of chemotherapy, radiation therapy, immunotherapy, and/or surgery.
Stage 4 is the most advanced form, with cancer having spread to distant organs. Stage 4 cancers can be challenging to treat and cure. Treatment options depend on how far the cancer has spread and your overall health and may include chemotherapy, surgery, and radiation therapy. If your tumor has specific gene mutations (changes), targeted therapies or immunotherapies may help you feel better, even if they do not cure the cancer.
Survival Rates for NSCLC
Survival rates for non-small cell lung cancer represent the percentage of people still alive for a specific period after diagnosis. The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program collects data on various cancers, including NSCLC. The program categorizes NSCLC stages based on the extent to which cancer has spread.
While the SEER system is similar to the TNM staging system, SEER uses a broader grouping:
Localized: There is no evidence of cancer spread beyond the lung
Regional: The cancer has spread to nearby lymph nodes
Distant: The cancer has spread to distant organs beyond the lungs
Here's a breakdown of the five-year survival rate for NSCLC from 2012-2018:
Localized: 65%
Regional: 37%
Distant: 9%
All SEER stages combined: 28%
It's important to remember that survival rates represent averages from years past and do not predict a specific person's outcome. While lung cancer is the leading cause of cancer-related deaths in the United States, thanks to advancements in treatment options, survival rates and the prognosis for NSCLC continue to improve.
Factors That Influence Prognosis
Several factors influence your prognosis with non-small cell lung cancer. Healthcare providers consider each of these factors to assess the likely course and outcome of the disease:
Stage: This is the most critical factor in determining prognosis. Detection and diagnosis of NSCLC in earlier stages offer a better chance of successful treatment than in advanced stages.
Subtype: Some subtypes of NSCLC, such as large cell carcinoma, grow and spread more quickly than others and can be more difficult to treat.
Age: Younger people generally have a better prognosis than older adults. This may be due to a combination of factors. For example, younger people generally have fewer comorbidities and a greater ability to tolerate chemotherapy and other treatments.
Sex: Women have a slightly better prognosis than men.
Performance status: This is a measurement of how well you can perform daily activities while living with cancer. Generally, the higher your performance status, the better your prognosis.
Smoking history: People who currently or used to smoke have a poorer prognosis than people who never smoked. Research shows that current smokers have a 68% higher mortality, and former smokers have a 26% higher mortality compared to people who never smoked.
Underlying conditions: People with NSCLC who have underlying conditions like chronic obstructive pulmonary disease (COPD), heart disease, or diabetes generally have a poorer prognosis than those who are otherwise in good health.
Gene mutations: NSCLC cancer cells with changes in specific genes may be more responsive to targeted therapies, which can improve prognosis.
Strategies for Coping With Prognosis
A diagnosis of non-small cell lung cancer, discussions about prognosis, and learning to live with lung cancer can be overwhelming and emotionally challenging. Finding ways to cope with these challenges and leaning on support can help you navigate your NSCLC journey.
Practicing Emotional and Psychological Coping Strategies
Coming to terms with a lung cancer diagnosis and how it will impact your life can take some time. You might experience a rollercoaster of emotions, including fear, anxiety, anger, sadness, or frustration. Here are some tips for managing the emotional and psychological aspects of an NSCLC diagnosis:
Acknowledge your feelings: Allow yourself to feel what you're feeling and express your emotions. There is no right or wrong way to do this, but the important thing is not to bottle up your feelings. Consider journaling, talking to a trusted friend or family member, or seeking professional counseling.
Talk to your healthcare team: Open communication with your cancer care team is crucial. Don't hesitate to ask questions about your prognosis, treatment options, and potential side effects. The more informed you are, the more empowered you feel to manage your care.
Relaxation techniques: Practices such as mindfulness meditation, deep breathing exercises, guided imagery, and yoga can help manage stress and positively impact emotional well-being.
Join a support group: Connecting with others who understand what you're going through can be helpful. Online and in-person NSCLC support groups can provide a safe space to share your experiences, ask questions, and gain emotional support from others facing similar challenges.
Caring For Your Physical Well-Being
Taking care of your physical health can support your overall health and give your body the strength required to get through treatment. You can care for your physical well-being while living with NSCLC through:
Exercise: Regular physical activity, including gentle exercise like walking, can help improve your mood, energy levels, and overall strength. Talk to your healthcare provider to discuss which exercises and how much physical activity they recommend.
Diet: Eating a balanced and nutritious diet with plenty of fruits, vegetables, healthy fats, lean proteins, and whole grains can help ensure your body gets the nutrients it needs to maintain your strength and support your immune system before, during, and after treatment.
Sleep: Getting enough quality sleep is essential for your physical and mental health. Aim for seven to eight hours of good-quality sleep every night. Sleep problems are common in people with cancer, so talk to your healthcare provider if you have trouble falling asleep or staying asleep.
Supportive care: Supportive care therapies, such as massage therapy and acupuncture, can help reduce pain and improve sleep and quality of life in people with cancer.
Finding Additional Support
A diagnosis of NSCLC can be overwhelming, but you do not have to navigate your cancer journey along. Many organizations provide resources and support for people living with NSCLC. These organizations offer information about the disease, treatment options, financial aid, and emotional support. Here are some reputable sources:
The National Cancer Institute: Provides comprehensive cancer information, supports research, and offers resources for patients and caregivers
The American Cancer Society: Offers patient support, advocacy, and funding for cancer research
The Lung Cancer Foundation: Provides comprehensive support, including a HelpLine, support groups, educational materials, clinical trial information, and guidance on financial resources
CancerCare: Offers free professional support services, including counseling, support groups, and workshops, for people living with cancer and their loved ones
National Lung Cancer Partnership: Provides resources and support for people with lung cancer, including information about clinical trials, financial assistance for treatment, and research updates
A Quick Review
Non-small cell lung cancer (NSCLC) is the most common form of lung cancer, accounting for up to 85% of all lung cancer diagnoses. After an NSCLC diagnosis, it's natural to wonder about your prognosis, meaning the outcome of the disease and treatment. Your healthcare provider will consider several factors when determining your prognosis, including the subtype and stage of cancer, your age, sex, and overall health.
It's important to remember that the prognosis is just your healthcare provider's best guess. With advancements in treatment options, the prognosis for people with NSCLC continues to improve.
Living with NSCLC comes with challenges, but you don't have to face this journey alone. There are many resources available to help you cope with the emotional and physical challenges of lung cancer. With proper support and treatment, it is possible to live well with NSCLC.
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