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There are two main types of lung cancer: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). NSCLC is the more common type, accounting for 80 percent to 85 percent of lung cancer diagnoses. NSCLC includes several subtypes, each of which can affect treatment options and prognosis, or disease outlook.
A cancer prognosis is often described using the five-year survival rate, which represents the percentage of people still alive five years after their diagnosis. The five-year survival rate for NSCLC is about 28 percent for all stages combined. However, there are many details about your lung cancer and overall health condition that can affect your individual outcome.
Read on to learn more about risk factors your doctor considers when determining your prognosis with NSCLC.
In addition to early detection, several factors can influence the disease outlook for NSCLC. These prognostic factors are discussed below.
NSCLC is most commonly diagnosed in older adults. The average age of diagnosis is 70. People under 40 or older than 75 tend to have a poorer prognosis, although early intervention may improve outcomes.
Overall health and lifestyle play a significant role in NSCLC prognosis. People who maintain good nutrition, exercise, and have fewer health conditions tend to live longer and have a higher likelihood of achieving remission (few or no signs and symptoms of cancer). High levels of inflammation throughout the body can indicate poor health. Recent research suggests that cancers can produce localized inflammation that helps keep them from being attacked by the immune system.
One oncology study showed that people with high levels of inflammation at diagnosis had a worse prognosis than those who had normal levels of inflammation. People with high levels of inflammation often have other complications, such as malnutrition or chronic diseases that negatively affect prognosis.
Unintentional or unexplained weight loss is another poor prognostic factor, particularly for people whose cancers can’t be treated with surgery.
The American Cancer Society reports that about 80 percent of lung cancer deaths are related to smoking cigarettes. Secondhand exposure to smoke also increases the risk of developing and dying from lung cancer.
The good news is that quitting smoking can improve prognosis even after an NSCLC diagnosis. For example, quitting smoking can significantly improve lung and heart health, improve overall well-being, and increase the ability to tolerate side effects of treatments like chemotherapy.
Whether your cancer cells have certain gene changes and proteins has been linked to NSCLC prognosis. These markers of probable disease outcome are known as predictive biomarkers.
In some cases, the expression of certain proteins can predict how well the cancer cells will respond to treatment. These proteins help doctors design the most effective treatment for each individual living with NSCLC.
Cancer cells can alter themselves to hide from the immune system, leading to a worse prognosis. Tumors that are recognized by the immune system generally have better outcomes. Immunotherapy drugs known as checkpoint inhibitors work by activating immune cells to detect and destroy cancer cells.
Doctors may also look at how well your immune system recognizes and defends against cancer. The types and numbers of immune cells that respond to a tumor can influence NSCLC prognosis. For example, lung tumors that have been invaded by certain kinds of T cells — a type of immune cell that can kill cancer cells — tend to have a better prognosis.
People with family members who’ve been diagnosed with lung cancers may have a higher risk of developing NSCLC. A family history of lung cancers is linked with a lower age of diagnosis and an increase in the risk of advanced non-small cell lung cancer at diagnosis. This tends to affect women more than men, according to a study in the journal Thoracic Cancer.
Comorbidities are conditions that can occur alongside a primary condition. Having one or more additional health conditions may affect NSCLC prognosis in several ways.
First, some conditions associated with lung cancer, such as chronic obstructive pulmonary disease (COPD) or heart disease, may decrease survival rates independently of NSCLC.
Second, comorbidities may also conceal signs and symptoms, leading to delayed diagnosis.
Comorbidities may affect prognosis in indirect ways. For instance, congestive heart failure may make some people with NSCLC unfit for surgery, while comorbidities such as dementia, liver disease, or kidney disease may interfere with some people receiving treatment for NSCLC.
The most common NSCLC comorbidities include:
Additionally, cancer research shows that about 38 percent of people living with lung cancer also have anemia, which negatively affects prognosis in people with NSCLC. Older people and people who smoke cigarettes are more likely to have additional conditions that complicate treatment or negatively affect prognosis.
Other factors can influence a person’s NSCLC prognosis, including the stage of disease at the time of diagnosis and NSCLC subtype. The earlier a cancer is detected, the better the prognosis.
However, some signs and symptoms of NSCLC tend to appear only after the disease has spread, and tumors have spread to other parts of the body in a process known as metastasis. This means that most instances of NSCLC are diagnosed at a later stage.
Clinical staging helps doctors determine whether and how far the cancer has spread before treatment begins. This process involves gathering information from physical exams, CT scans, other imaging tests, blood work, and biopsies. The staging results guide the development of a treatment plan and help estimate prognosis.
Overall, tumors that can be surgically removed are linked to the best prognosis. If resection surgery is part of treatment, pathological staging may be used to get a more accurate picture of the stage and prognosis.
NSCLC staging is based on the TNM system, which assesses:
People living with lung cancer that’s early stage and localized (fully contained in lung tissue) have a better prognosis than those with metastatic NSCLC. For instance:
NSCLC is an umbrella term that covers several subtypes of lung cancer. The most common subtypes are the following:
These NSCLC subtypes arise from different types of lung cells. Although their treatment and outlook are typically similar, these subtypes may respond differently to treatment, depending on specific details of the cancer, particularly with lung adenocarcinoma.
Advanced medicine allows doctors to target specific cancer cell pathways with modern treatment options. This targeted treatment is called personalized medicine and has improved the overall prognosis of NSCLC.
Every year, tens of thousands of people in the United States living with NSCLC achieve partial remission or even complete remission, meaning all signs of the cancer disappear. After treatment, most people continue regular visits with their oncologists and get tests including physical exams, CT scans, and blood tests to monitor for signs of cancer relapse. In the first few years after remission, these visits may occur every three months. After two to three cancer-free years, follow-ups may be reduced to every six months. Prognosis tends to be worse for relapsed disease because returning cancer is often more resistant to treatment.
Declining smoking rates and advances in NSCLC diagnosis and treatment have led to improved overall lung cancer survival over the past 30 years. New treatments continue to be developed and tested in clinical trials.
Today, even people with advanced or metastatic lung cancer can often enjoy a higher quality of life, thanks to newer, targeted therapies that help prolong life and improve well-being.
On MyLungCancerTeam, the social network for people with lung cancer and their loved ones, more than 15,000 members come together to ask questions, give advice, and share their stories with others who understand life with lung cancer.
Are you living with non-small cell lung cancer? Have you discussed your prognosis with your cancer care team? Share your experience in the comments below, or start a conversation by posting on your Activities page.
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A MyLungCancerTeam Member
Had LC 24 years ago at age 46. Then returned in 2021 and 2024. Still here at age 70.
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