1. What is lung cancer? 

Lung cancer starts when cells in the lungs grow abnormally and form a tumor or lump. There are two main types of lung cancer: 

• Non-small-cell lung cancer (NSCLC) – This is the most common form, making up about 85–90% of lung cancer cases. It includes types like adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. 

• Small-cell lung cancer (SCLC) – Less common and behaves differently under a microscope. 

 

2. What are the risk factors for lung cancer? 

• The biggest risk factor is smoking. 

• Lung cancer rates are decreasing among men, but increasing among women, reflecting changes in smoking patterns over time. 

 

3. What are the common symptoms of lung cancer? 

If you notice any of these symptoms, see a doctor for evaluation: 

• Persistent cough or frequent chest infections 

• Shortness of breath or breathlessness 

• Hoarseness or voice changes 

• Chest pain or pain in the ribs 

• Coughing up blood 

• Unexplained weight loss, fatigue, appetite loss, or fever 

 

4. How is lung cancer diagnosed? 

• Clinical examination by a doctor to review symptoms. 

• Imaging tests like X-ray, CT scan, or even a PET-CT scan to locate and assess the cancer. 

• Biopsy (tissue or cells from the tumor) is done to confirm the diagnosis of NSCLC. 

 

5. What treatment options are available for NSCLC? 

Treatment depends on the stage and type of cancer, as well as the patient's overall health. Common treatments include: 

• Surgery – Removal of the tumor or part of the lung. 

• Chemotherapy – Use of drugs to kill cancer cells. Can be used alone or with other treatments. 

• Targeted therapy – Drugs that target specific cancer cell functions to block their growth. 

• Immunotherapy – Treatments that help the body’s immune system fight cancer. 

• Radiotherapy – Using radiation to shrink or stop the growth of the tumor. 

In many cases, a combination of treatments is used for the best outcome. 

 

6. How is lung cancer “staged”? 

Cancer is staged based on: 

• Tumor size 

• Lymph node involvement 

• Whether it has spread to other parts of the body 

The stage helps doctors decide which treatments are best for you. 

How is early-stage (Stage I-II) NSCLC treated? 

Q: What is the main treatment for early-stage (Stage I-II) NSCLC? 

A: The primary treatment for early-stage NSCLC is surgery to remove the tumor. 

Q: Can chemotherapy be used in early-stage NSCLC? 

A: Yes, chemotherapy may be given after surgery (called adjuvant chemotherapy) for Stage II and Stage III NSCLC and some Stage IB patients. 

Q: What if surgery is not an option? 

A: If surgery isn’t possible or preferred, radiotherapy (like stereotactic ablative radiotherapy [SABR]) may be an alternative to surgery. 

Q: When might radiotherapy be used after surgery? 

A: Adjuvant radiotherapy may be used after surgery for Stage II and Stage III NSCLC patients. 

 

2. How is locally advanced (Stage III) NSCLC treated? 

Q: What treatment is used for locally advanced (Stage III) NSCLC? 

A: Treatment for Stage III NSCLC often involves multiple therapies (called multimodal therapy) such as: 

• Induction therapy (chemotherapy with or without radiotherapy to shrink the tumor before surgery) followed by surgery. 

• Chemoradiotherapy (chemotherapy and radiotherapy given together or sequentially). 

• Surgery followed by adjuvant chemotherapy and/or radiotherapy. 

Q: What if the tumor is not removable (unresectable)? 

A: For unresectable Stage III NSCLC, chemoradiotherapy is typically the preferred treatment. Alternatively, chemotherapy and radiotherapy may be given one after the other. 

Q: Is immunotherapy an option for Stage III NSCLC? 

A: Yes, immunotherapy may be offered to some patients with unresectable Stage III NSCLC after chemoradiotherapy. 

 

3. How is metastatic (Stage IV) NSCLC treated? 

Q: What does metastatic (Stage IV) NSCLC mean? 

A: Stage IV NSCLC means the cancer has spread beyond the lungs to other parts of the body, making it harder to treat. 

Q: Can metastatic NSCLC be treated with surgery or radiotherapy? 

A: It's rare to treat metastatic NSCLC with surgery or radiotherapy alone. Treatment typically involves chemotherapy and other therapies. 

Q: What chemotherapy is used for metastatic NSCLC? 

A: The main treatment for metastatic NSCLC is intravenous chemotherapy with a combination of two drugs. Bevacizumab (a targeted therapy) may also be added. 

Q: Can immunotherapy be used for metastatic NSCLC? 

A: Yes, for some patients, especially those with high levels of PD-L1 protein (a result of molecular testing), immunotherapy drugs like pembrolizumab can be used as first-line treatment. 

Q: What if the tumor has specific mutations? 

A: If the tumor has mutations in genes like EGFR, BRAF, ALK, or ROS1, targeted therapies are the best treatment. These drugs are taken orally and work by specifically blocking the signals that make cancer cells grow. 

 

4. What happens after initial treatment for metastatic NSCLC? 

Q: How is metastatic NSCLC treated after the first treatment (relapse or recurrence)? 

A: After 4–6 cycles of chemotherapy, maintenance treatment is given to help keep the cancer from coming back. Options include: 

• Pemetrexed (a chemotherapy drug) 

• Erlotinib (if the tumor has EGFR mutations) 

Q: What if the cancer comes back after treatment? 

A: If the cancer relapses, other options like second- and third-line treatments may be offered: 

• Chemotherapy (e.g., pemetrexed or docetaxel) 

• Immunotherapy (e.g., nivolumab, pembrolizumab, or atezolizumab) 

• Antiangiogenic therapy (e.g., nintedanib or ramucirumab) combined with chemotherapy. 

• Targeted therapies (e.g., afatinib, gefitinib, osimertinib) for patients with specific mutations. 

 

Q: Are there options for patients with EGFR mutations who have already been treated with first-line therapies? 

A: Yes, for patients with EGFR mutations who have received first-line treatment, osimertinib can be used if there’s a confirmed T790M mutation. 

Q: What if the tumor has a BRAF mutation or ALK rearrangements? 

A: 

• BRAF mutations: Patients who received dabrafenib and trametinib may go on to receive second-line chemotherapy. 

• ALK rearrangements: Patients who received crizotinib may be treated with second-line targeted therapies like ceritinib, alectinib, or brigatinib. 

 

 

Follow-Up After Lung Cancer Treatment : 

1. How often do patients need follow-up after treatment for Stage I–III NSCLC? 

Q: How often will I be checked after completing treatment for Stage I–III NSCLC? 

A: After completing treatment for Stage I–III NSCLC, you'll typically have clinical and radiological exams every 6 months for the first 2 years. After that, follow-up appointments will be scheduled annually. 

 

2. How often do patients need follow-up after treatment for metastatic NSCLC? 

Q: How frequently will I need follow-up if I’ve completed treatment for metastatic NSCLC? 

A: For metastatic NSCLC, follow-up includes radiological exams every 6–12 weeks. This helps doctors monitor your progress and start second-line treatments if necessary.