Your treatment management
Treatments for NSCLC
There are many different types of treatment available for people with lung cancer. This page will take you through some of the treatments you may currently be taking or may take in the future.
Remember, your healthcare team are always the best source of information about your cancer and its treatment, and can give you personalised information. So don’t hesitate to get in touch with them with any questions you may have.
What are side effects?
As much as possible, cancer treatments are designed to only damage the cancer in your body. But sometimes heathy parts of your body can be damaged too. The damage to these healthy parts is what causes side effects.1
What should I do if I have a side effect?
Your healthcare team can tell you more about any side effects you may experience while you’re receiving a treatment. You should always tell them if you have a side effect, either at appointments or after you have gone home. They can help you manage side effects by adjusting the dose of any chemotherapy you are taking, and/or by prescribing supportive medications to help ease them.
You should never take a medicine (or a herbal or complementary therapy) to treat a side effect unless your healthcare team has already told you it is safe to do so.
If a side effect is very bad, your healthcare team may stop a treatment you are receiving. Some people worry about this, and avoid talking about their side effects, but it is important that you are always honest with your healthcare team. This is because:
- Leaving a bad side effect untreated can cause more harm to you than the good the cancer treatment is doing. By talking to your healthcare team, and allowing them to support you, you can make sure you are getting the best possible care
- Side effects for some medicines are still actively being monitored. By reporting what side effects you experience, you can help other people who are going through the same treatment, and a similar cancer experience, as you
What is it?
There are many different types of chemotherapy available, but all of them treat cancer in a similar way. They attack cells that are dividing and growing quickly in your body (like cancer cells) to help control the cancer.2
How do I receive it?
This will depend on the type of chemotherapy you have.
Intravenous (IV) chemotherapies:
Some chemotherapies are given with an IV drip in hospital or at a clinic. Every clinic is different, but as a general guide:
- You may have an appointment with your oncologist before each chemotherapy session. During these appointments, your oncologist will check your general health to make sure you are well enough to receive chemotherapy
- On the day of your chemotherapy session, when you arrive at the clinic you may need to fill in some paperwork, and confirm your name, date of birth, and address
- Your nurse will explain what kind of chemotherapy you will be receiving and make sure that you are seated comfortably. Most chemotherapy suites have big comfy chairs that you can relax in
- You may be given some medicine that will help manage any side effects that you get while you receive the chemotherapy. For example, anti-emetic medication will help in case you start to feel a bit nauseated
- When your treatment is ready, a nurse will bring it over in a plastic bag with a tube coming out of it. On the end of the tube is a needle, which the nurse will carefully insert into a vein – usually either on the back of your hand or in your arm
- You can then sit back and wait while the treatment flows out of the bag and into your vein
- If at any point you feel worried, or unwell, call a nurse over, and they will help you
- Once your treatment is over, the nurse will remove the needle and give you some instructions. When they think you are ready to leave the clinic, you can head home
Oral chemotherapies
Other chemotherapies are available as pills or tablets that you can take at home. You will need to come in and see your oncologist for some health checks before beginning to take them, and at regular intervals afterwards. The number of pills you take, how often you take them, and for how long will depend on the specific medicine you have been prescribed.
Top tips
- If you are receiving IV chemotherapy, you may be at the clinic for quite a while. Bring some home comforts and things to keep you comfy and distracted, for example, a blanket, pillows, a book, a craft project, or a tablet with your favourite movie or TV series loaded onto it
- Some people receiving IV chemotherapy sometimes get a side effect where they might notice a funny, metallic taste in their mouth. Sucking on some sweets or chewing gum might help with this
- If you are taking pills or tablets at home, you might occasionally forget to take your treatment. In these cases, make sure you know what to do. Don’t assume you can take a double dose next time – many treatments strongly advise against this
What side effects might I get?
Side effects will vary depending on exactly what chemotherapy you are receiving. Your healthcare team will be able to tell you what are the most common side effects that occur in people who are receiving the same therapy as you.
We have put together a list of common side effects that can affect people who are receiving chemotherapy.2 Looking at this may feel a bit overwhelming, or cause you some worries, but it is important to remember that everyone is different, and you may only experience some of the these side effects. You may also have different side effects, or experience none of these at all.
- Feeling tired most of the time
- Feeling sick, and/or vomiting
- Hair loss
- An increased risk of picking up infections
- A sore mouth
- Dry, sore, or itchy skin
- Diarrhoea or constipation
What is it?
Radiotherapy is a type of treatment where radioactivity is used to try and damage the cells in tumours. There are a few different ways to receive radiotherapy.3
External radiotherapy3,4
External radiotherapy uses very narrow beams of high-intensity radiation (a bit like an invisible laser) to reach and damage tumours inside your body.
Internal radiotherapy3,4
An implant containing radioactive material is put into your body near the cancer, or radioactive material is injected into your blood, or given to you as a drink.
How do I receive it?
External radiotherapy
External radiotherapy is given with a special machine,4 so you need to attend an appointment at a hospital or clinic.
Once there, you will lie on a bed and have marks made on your skin in a long-lasting ink, so that the technician can always line up the radiation in the same place. If you are having radiotherapy on your head or neck, you will have a mask that holds your head in place, and the ink marks will be made on this.4
The radiotherapy technician will adjust the machine and the position you are lying in so that the radiation can reach where the cancer is. Once ready, the machine sends an invisible beam of radiation to your cancer.4
After you have had your radiotherapy, the technician may give you some instructions to follow, and then you can head home.
Internal radiotherapy
If you are having an implanted therapy, this may require some surgery.4 In these cases, your healthcare team will guide you through exactly what will happen. How long implants are left in varies. Some may only be there for a few minutes, whereas others may be a few days. Some very small implants can be left in permanently, as they only contain a small amount of radiation, and this gradually decreases over time. You may need to stay in hospital for a few days while any excess radiation leaves your body, and visitors may be limited during this time to avoid exposing them to any radiation you may be emitting.4.5
If you are receiving a therapy that you inject or swallow, you will receive this in a hospital or clinic. Again, you may need to stay in the hospital for a while until the excess radiation has left your body.4
Top tips
- If you are going to be in hospital for a while after internal radiotherapy, confirm any rules around visits from friends and family. Immediately after you receive your implant or swallow your radiotherapy, you may not be allowed any visitors. Later, visits might be restricted, and pregnant women and very young children may not be allowed to visit at all5
What side effects might I get?
Side effects with radiotherapy typically appear in the week or two after your appointment and go away on their own. They might include:3
- Sore, red skin
- Fatigue (a deep and lasting tiredness)
- Hair loss around the area where the radiation has been focused
- Nausea (feeling sick or stomach pain)
- Diarrhoea
- Sore mouth
- Loss of appetite
What is it?
Surgery is used to try and remove areas of the cancer from within your body. Sometimes this is done to remove all the cancer, and other times it is done to reduce the amount of cancer ahead of you receiving another type of treatment.6
How is surgery carried out?
Your exact surgical procedure will depend on where your cancer is growing, and what type of surgery you are having. If you are having surgery that requires a general anaesthetic, your experience might be something like the following:
- You will have a consultation with a surgeon (your oncologist may also be there too). They will review your medical file and any X-rays and scans you have had7
- On the day of your surgery:
- You will be asked not to eat or drink anything for several hours beforehand7
- You will be given a hospital gown to wear, and some tight socks, called compression stockings – these help to prevent blood clots from forming in your legs7
- You may also be asked to have a shower, and shave any body hair over the area that is being operated on (a surgical nurse might help with this)7
- You will also be asked to review and sign some paperwork7
- When it is time for your surgery, a specialist doctor called an anaesthetist will come and visit you. They will have calculated the amount of anaesthesia medicine you need to help you go to sleep and give this to you with either an injection or a face mask.8 They might ask you to count backwards from ten as the medicine takes effect. Most people fall asleep very quickly, after counting only a few numbers
- Once you are asleep, you will be wheeled into the surgical theatre where the surgeon and their team will be waiting, and they will perform your surgery. The anaesthetist will join them, and keep an eye on your anaesthesia levels, and vital signs8
- When the surgery is completed, you will be wheeled back to a recovery ward, where you will be looked after while the anaesthesia wears off. You may find that when you wake up, you feel quite groggy and confused8 – this is normal, and will eventually stop on its own
- The healthcare team will give you and your loved one some advice on anything you need to do in the coming days to help you recover, and your surgeon may visit you to discuss how the surgery went
- You may need to spend some time in hospital while you recover initially. If you go home on the same day, you probably won’t be able to drive, so somebody will need to pick you up, and keep an eye on you for the rest of the day
Top tips
- If you are likely to be in hospital for a few days, make sure you bring some entertainment from home – a book, craft project, or a tablet loaded with your favourite movies or TV series are good ideas
- If you are worried about anything after your surgery, get in touch with your healthcare team. They can give you advice, and support you if needed
Side effects
As with any treatment, any side effects you experience will depend on your situation, and what your surgery has involved. Some common side effects of surgery include:9
- Pain
- Fatigue
- Loss of appetite
- Swelling, and/or bruising around the surgical site
- Liquid coming out from around any scars or stitches
- A bit of bleeding may sometimes happen around the scar
- Feeling groggy, confused, and/or nauseated from anaesthesia (usually immediately after waking up, but this gets better after a while)
As cancer becomes advanced and spreads to different parts of your body, the way it is treated may also need to change.
If your cancer is advanced, you may still receive some of the treatments described above, but instead of only treating your lungs, they may also be used to treat any areas where the cancer may have spread. You may also begin new treatments, depending on what your healthcare team decide is best for you. Some of these advanced cancer treatments are described below.
Targeted therapy
Targeted therapies are designed to find specific parts of cancer cells that make them stand out from healthy cells.10 These treatments can be made either from chemicals or from proteins called ‘monoclonal antibodies’.
Targeted therapies include treatments known as ‘inhibitors’, which are specifically designed to treat either ALK, RET, or ROS1 alterations in NSCLC.11
You can learn more about these alterations and how they are involved in NSCLC here
How do I receive it?
Targeted therapies can be either an intravenous treatment (you can read more about IV therapies under the ‘Chemotherapy’ section, above), or pills or tablets that you can take at home.10
Top tips
See the top tips in the ‘Chemotherapy’ section above.
What side effects might I get?
Even though targeted therapies are designed to find cancer cells and avoid damaging healthy cells, they can still cause some side effects. These can be different from chemotherapy side effects.
The exact side effects you get will depend on what treatment you are taking. Your healthcare team can take you through exactly what is known about your treatment, but some typical side effects of targeted therapies might include:11
- Nausea and vomiting
- Diarrhoea
- Fatigue (a deep and lasting tiredness)
- Changes to your vision (including blurred or dulled vision)
- Changes to the number of red and white blood cells in your body
- Swelling in certain parts of the body
- Problems with your liver, nerves, and heartbeat
Immunotherapy
Immunotherapy is different from a lot of other treatments. Instead of working to directly attack cancer, immunotherapy helps boost your immune system so that it can fight the cancer more effectively.12
How do I receive it?
Immunotherapies are usually given intravenously, through a needle in your arm or the back of your hand (you can read more about IV therapies under the ‘Chemotherapy’ section above.13)
Top tips
Some people find the idea of their immune system attacking their cancer empowering,14 and there is lots of information in the news about immunotherapies being highly effective. But it’s important to be aware that not everyone who tries immunotherapy responds – in some people, it just doesn’t seem to work.15 This can be disappointing, but try and focus on the fact that there are lots of other treatments available for you to try, and your healthcare team are there to support you along the way.
What side effects might I get?
Because immunotherapies work differently from other treatments, their side effects can be a little different too. Common side effects that you might experience are listed below,16 but these will vary between immunotherapies and individual people, so it’s best to ask your healthcare team for advice that’s most relevant to you:
- Fatigue (feeling deeply tired)
- Diarrhoea
- Fever
- Shortness of breath
- Rash and/or blisters
- Nausea and/or vomiting
- Itching
- Headache
- Weight loss
- Difficulty falling, or staying, asleep
- Decreased appetite
Click on one of the options below to learn more
- American Cancer Society. Chemotherapy side effects. 2016. Available from: https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/chemotherapy/chemotherapy-side-effects.html. Last accessed July 2021.
- NHS. Chemotherapy. 2017. Available from: https://www.nhs.uk/conditions/chemotherapy/. Last accessed July 2021.
- NHS. Radiotherapy. 2017. Available from: https://www.nhs.uk/conditions/radiotherapy/. Last accessed July 2021.
- NHS. Radiotherapy: What happens? 2017. Available from: https://www.nhs.uk/conditions/radiotherapy/what-happens/. Last accessed July 2021.
- American Cancer Society. Internal radiation therapy (brachytherapy). 2017. Available from: https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/radiation/internal-radiation-therapy-brachytherapy.html. Last accessed July 2021.
- Cancer.net. What is cancer surgery? 2019. Available from: https://www.cancer.net/navigating-cancer-care/how-cancer-treated/surgery/what-cancer-surgery. Last accessed July 2021.
- Macmillan. What happens before surgery? 2016. Available from: https://www.macmillan.org.uk/information-and-support/treating/surgery/surgery-explained/what-happens-before-surgery.html. Last accessed July 2021.
- Cancer.net. What to expect when having surgery. Available from: https://www.cancer.net/navigating-cancer-care/how-cancer-treated/surgery/what-expect-when-having-surgery. Last accessed July 2021.
- Cancer.net. Side effects of surgery. 2018. Available from: https://www.cancer.net/navigating-cancer-care/how-cancer-treated/surgery/side-effects-surgery. Last accessed July 2021.
- Cancer Research UK. What are targeted cancer drugs? 2017. Available from: https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/targeted-cancer-drugs/what-are-targeted-cancer-drugs. Last accessed July 2021.
- American Cancer Society. Targeted Therapy drugs for Non-Small Cell Lung Cancer. 2018. Available from: https://www.cancer.org/cancer/non-small-cell-lung-cancer/treating/targeted-therapies.html. Last accessed July 2021.
- Cancer.net. Understanding immunotherapy. 2019. Available from: https://www.cancer.net/navigating-cancer-care/how-cancer-treated/immunotherapy-and-vaccines/understanding-immunotherapy. Last accessed July 2021.
- American Cancer Society. Immune checkpoint inhibitors. 2019. Available from: https://www.cancer.org/cancer/non-small-cell-lung-cancer/treating/immunotherapy.html. Last accessed July 2021.
- Cancer.net. What it’s like taking immunotherapy to treat cancer. 2017. Available from: https://www.cancer.net/blog/2017-08/what-its-taking-immunotherapy-treat-cancer. Last accessed August 2019.
- Darvin P et al. Exp Mol Med 2018; 50(12): 165.
- Cancer.net. What you need to know about immunotherapy side effects. 2018. Available from: https://www.cancer.net/blog/2018-02/what-you-need-know-about-immunotherapy-side-effects. Last accessed July 2021.