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Bristol-Myers Squibb Oncology
About Non-Small Cell Early-Stage Lung Cancer
The following is a list of questions to ask your doctor About Non-Small Cell Early-Stage Lung Cancer  as well as tips for preparing for these conversations.

What type of lung cancer do I have?

There are two main types of lung cancer: small cell and non-small cell lung cancer, which is actually a group of five different types of lung cancer. Non-small cell lung cancer is much more common, accounting for about 85 percent of all lung cancers. Small-cell lung cancer has a very high propensity to spread, but its quickly growing cells are very responsive to chemotherapy. By contrast, in non-small cell lung cancer, the cells are less likely to travel through the bloodstream and spread throughout the body.

What stage is my lung cancer?

Doctors use stage I-IV to describe the characteristics of the lung tumor: its size and if cancer cells have spread beyond the lungs. Early-stage lung cancer includes stage I, a single-cancer nodule in the lung, or stage II, when lymph nodes near the tumor are involved in addition to the nodule. Stage I is usually broken up into two groups, Ia and Ib. Stage Ia includes very small tumors, less than 3 centimeters across and Ib includes any larger tumors. Advanced-stage lung cancer is considered stage III, when lymph nodes in the central part of the chest are involved, and stage IV, where the tumor has spread beyond a tumor lobe and, sometimes, outside of the chest. This staging system is used to guide treatment decisions.

What type of treatment will I need?

Treatment decisions are made based on the size, location and extent of your disease and can include surgery, radiation therapy and chemotherapy. If the disease is caught early, a lobectomy, where the cancerous region of the lung is removed surgically, may be recommended. Radiation therapy involves the delivery of high-energy beams aimed directly at the affected part of the lung. Radiation might be given before surgery to shrink the tumor or following surgery to help kill any cancer cells that may be left behind.

Chemotherapy is a therapy that works best when cancer cells are rapidly growing. And since non-small cell, early-stage lung cancer does not spread readily, doctors have not considered chemotherapy after surgery useful until very recently. Chemotherapy given after surgery, called adjuvant therapy, can help to kill stray cancer cells that may have spread to other parts of the body. Two very large studies presented in 2004 have shown that adjuvant chemotherapy can prolong life in certain patients with stage I lung cancer. Chemotherapy has not yet been studied in the very small Ia tumors, but for the Ib tumors, new information suggests adjuvant chemotherapy is helpful. This information also supports using adjuvant chemotherapy for stage II disease. These two studies reported a 10 to 15 percent improvement in survival at four to five years after surgery.

Will I experience side effects from therapy?

Chemotherapy is generally given intravenously in cycles with week- or month-long breaks in between. Because chemotherapy kills all the rapidly dividing cells in the body, it often affects healthy cells as well as cancerous ones. So many patients experience nausea and vomiting, mouth sores, hair loss, fatigue and infection.

There are mediations available to help relieve some of the side effects of chemotherapy. Drugs are available that minimize the chemotherapy-related anemia that leads to fatigue, by boosting your red blood cell count, which raises energy levels. Other medications can boost white blood cell counts to raise infection-resistance. Antiemetics help to control nausea and vomiting. There are also medications to help soothe mouth sores. Although there is no treatment for hair loss, hair begins to grow back as soon as treatment is stopped.

How you can prepare for this discussion:

  • Bring a tape recorder or a friend as another set of ears to your doctor's appointments to be sure you do not miss any of the information
  • Gather all your medical notes and laboratory results in a three-ring binder
  • Educate yourself in advance about treatment options and their side effects
  • Consider your personal goals for treatment
  • Talk to other patients who have undergone treatment
  • Prepare a list of your concerns and questions in advance
  • Determine the support system available to you during your care
  • Make a list of any side effects you have experienced with other medications
  • List all vitamins, herbals, dietary supplements and other prescription and over-the-counter medications you are taki
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