Learning you or a loved one has non-small cell lung cancer (NSCLC) can mean a lot of new decisions to make, tests to undergo, and treatment options to consider. For some people, one of those treatment options might be chemotherapy.

Chemotherapy — or simply “chemo” — is a treatment that uses drugs to kill cancer cells. It isn’t always part of the treatment plan for NSCLC. Some people may never have chemo. Others might undergo chemo before or after surgery, or even as a main treatment if surgery isn’t a good option. In some cases, it can be combined with other treatments to help improve your prognosis (outlook). These may include immunotherapy, which helps your immune system recognize and attack cancer cells, or targeted therapy, which blocks specific proteins or genes that help cancer grow.

In this article, we’ll break down when and why chemo is used for treating NSCLC. We’ll also discuss what to expect if your doctor recommends chemo — knowing what’s involved may help you feel more prepared for the road ahead.

What Is Chemotherapy?

Chemotherapy is one of the oldest and most widely used cancer treatments. It’s been around since the 1950s, when doctors first discovered that certain cytotoxic drugs (drugs that can kill cancer cells) could slow, stop, or even cure certain cancers. Since then, chemo has become a key part of cancer care, including some types of lung cancer, such as NSCLC.

Chemo works by targeting certain cells, including cancer cells, that grow and divide quickly. It’s this speedy growth that allows cancer to spread. Chemo drugs move through your bloodstream, reaching cancer cells anywhere in the body, not just the lungs. Most chemotherapy drugs are given intravenously, meaning they’re delivered directly into a vein. This typically happens in a hospital or clinic. However, some chemotherapy drugs come in pill form and can be taken by mouth at home.

When Is Chemotherapy Used for NSCLC?

NSCLC is the most common type of lung cancer. It includes several subtypes, such as adenocarcinoma and squamous cell carcinoma, and tends to grow more slowly than small cell lung cancer.

Your oncologist will take into account several factors when recommending your treatment plan. They’ll consider the stage of your cancer (how large and far it’s spread), your overall health, and whether the tumor can be removed with surgery. They’ll also study the results from your imaging tests and the tissue from your biopsy, looking for any specific mutations (gene changes) or molecular markers — substances or changes in your cells that help identify certain types of cancer.

Depending on what the oncologist finds, the goal of your treatment plan might be to cure cancer, shrink the tumor, help prevent the cancer from coming back, or ease your symptoms and improve quality of life. Each treatment plan is unique and based on what will provide the best possible outcome for your specific situation.

Before Surgery

Sometimes, chemo is given before surgery to help shrink the lung tumor. This method is called neoadjuvant chemotherapy. The goal is to make the tumor smaller and easier to remove during your procedure. It may also help lower the risk of the cancer coming back after surgery.

Chemo may be given before surgery to help shrink the lung tumor. This method is called neoadjuvant chemotherapy.

Your doctor might recommend this approach if the tumor is large, is close to important structures in the chest, or has spread to nearby lymph nodes. It’s often used for stage 2 or stage 3 NSCLC.

Depending on the results of your biopsy, neoadjuvant chemo is sometimes combined with immunotherapy. If your tumor has certain mutations, such as in the epidermal growth factor receptor (EGFR) gene, other treatments like targeted therapy may be considered instead.

Chemotherapy After Surgery

Even after a successful surgery to remove a lung tumor, some cancer cells may still be hiding in the body. These leftover cells can’t always be seen on X-rays or imaging scans, but they can grow into bigger problems later.

Adjuvant chemotherapy is given after surgery to kill any remaining cancer cells and lower the risk of the cancer returning. It’s also commonly used in people with stage 2 or stage 3 NSCLC. If you have early-stage cancer — such as stage 1 — but your doctor thinks your cancer has a high likelihood of coming back, it might be recommended in this situation, too. Adjuvant chemotherapy doesn’t guarantee that your cancer won’t return, but it can improve survival rates and help increase the chances of giving you the best possible outcome.

Adjuvant chemotherapy may be given after surgery to kill any remaining cancer cells and lower the risk of the cancer returning.

When Surgery Isn’t an Option

There are several reasons why someone with NSCLC may not be able to have surgery to remove their tumor. Sometimes, the cancer has spread too far, or the tumor’s location or size makes it hard to remove safely. For others, co-occurring health conditions, such as heart or lung problems, make surgery too risky. Some people may also be too weak to undergo surgery.

For those who aren’t good candidates for surgery, chemo may play a central role in treatment. It may be combined with radiation therapy, a method that uses high-energy beams to target and destroy cancer cells in a specific area. When chemotherapy and radiation therapy are used together, it’s called chemoradiation or chemoradiotherapy. This combination is used because the chemo helps make the cancer cells more sensitive to radiation, which can make both treatments more effective.

If your tumor can’t be removed with surgery or cancer has spread outside the lungs, chemo may be recommended to shrink tumors and slow their growth.

For Metastatic NSCLC

When NSCLC reaches stage 4, it means the cancer has metastasized (spread) beyond the lungs into other, distant parts of the body. By the time it’s diagnosed, it may have reached the bones, liver, brain, or adrenal glands. At this stage, surgery isn’t usually helpful on its own. However, other treatments, like chemo, can play a big role in managing the disease and improving quality of life.

In metastatic NSCLC, chemotherapy is often used to slow the cancer’s growth, relieve symptoms, and help people live longer. It may be used as part of a combination approach that might include immunotherapy, radiation therapy, or targeted therapy.

Unfortunately, cancer that has metastasized to distant parts of the body is unlikely to be cured by currently available cancer treatment options. However, you may also be able to take part in a clinical trial, which could give you access to new or advanced treatments. To learn more, talk to your oncologist.

What To Expect With Chemotherapy for NSCLC

There’s no one-size-fits-all treatment protocol for chemotherapy. Your individual treatment plan will depend on the stage of your cancer, the type of NSCLC you have, your overall health, and how well your body tolerates the medicines. The type of chemo you get can also depend on other types of therapy you may receive — like immunotherapy, radiation therapy, or targeted therapy — if your doctor recommends a combination approach. The amount or dose of chemo drug you receive also depends on your height and weight.

Chemotherapy Schedules

Chemotherapy is typically given in cycles, often lasting 21 days, with treatment sessions followed by rest periods. During each cycle, you might get chemo once a week or just once at the start, depending on which drugs are used. One course of chemotherapy might include four to eight cycles, lasting about three to six months in total. Some people may need more than one course. The length of your treatment depends on the type and stage of the cancer, which other drugs you’re taking, and how your body responds — including any side effects.

Receiving Chemo

Before treatment, you’ll have some blood work and a physical exam to make sure you’re ready to begin. You might also meet with your oncology team to review symptoms or adjust medications. During treatment, the chemo will most likely be given through an IV line at a cancer center, hospital, or clinic. The infusion usually takes a few hours, and most people can go home the same day. After treatment, you may feel tired, so take some time to rest and recover for a day or two. Your healthcare team will watch closely for side effects, check your blood counts, and monitor how the cancer is responding.

Common Side Effects of Chemotherapy

Side effects can vary depending on which chemotherapy drugs or drug combinations you’re taking. Even with the same drug, different people can have different side effects. Some of the most common side effects of chemotherapy treatment include:

• Weakness or fatigue
• Nausea and vomiting
• Hair loss
• Weight loss or loss of appetite
• Mouth sores
• Diarrhea or constipation
• Higher risk of infection or bruising more easily
• Skin rashes
• Body pains

Be open with your cancer care team about any side effects. Your quality of life is important, and they can recommend ways to manage symptoms and help you feel more comfortable during treatment.

Chemotherapy can feel overwhelming, but understanding what to expect can make it a little easier. With the right care plan — and a team that listens and supports you — you don’t have to face this alone.

Talk With Others Who Understand

On MyLungCancerTeam, the social network for people with lung cancer and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with lung cancer.

Have you had chemotherapy to treat your non-small cell lung cancer? What advice do you have for someone recently diagnosed who will be undergoing chemo? Share your experience in the comments below, or start a conversation by posting on your Activities page.