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Lung cancer - non-small cell

Cancer - lung - non-small cell; Non-small cell lung cancer; NSCLC; Adenocarcinoma - lung; Squamous cell carcinoma - lung

 

Non-small cell lung cancer is the most common type of lung cancer . It usually grows and spreads more slowly than small cell lung cancer .

There are 3 common types of non-small cell lung cancer (NSCLC):

  • Adenocarcinomas are often found in an outer area of the lung.
  • Squamous cell carcinomas are usually found in the center of the lung next to an air tube (bronchus).
  • Large cell carcinomas can occur in any part of the lung. They tend to grow and spread faster than the other 2 types.

Causes

 

Smoking causes most cases (around 90%) of lung cancer. The risk depends on the number of cigarettes you smoke each day and for how long you have smoked. Being around the smoke from other people (secondhand smoke) also raises your risk of lung cancer. But some people who have never smoked do develop lung cancer.

Research shows that smoking marijuana may help cancer cells grow. But there is no direct link between smoking marijuana and developing lung cancer.

Constant exposure to high levels of air pollution and drinking water that has a high level of arsenic can increase your risk of lung cancer. A history of radiation therapy to the lungs can also increase risk.

Working with or near cancer-causing chemicals or materials can also increase the risk of developing lung cancer. Such chemicals include:

  • Asbestos
  • Chemicals such as uranium, beryllium, vinyl chloride, nickel chromates, coal products, mustard gas, chloromethyl ethers, gasoline, and diesel exhaust
  • Certain alloys, paints, pigments, and preservatives
  • Products using chloride and formaldehyde

 

Symptoms

 

Symptoms may include:

  • Chest pain
  • Cough that does not go away
  • Coughing up blood
  • Fatigue
  • Loss of appetite
  • Losing weight without trying
  • Shortness of breath
  • Wheezing

Early lung cancer may not cause any symptoms.

Other symptoms that may be due to NSCLC, often in the late stages:

  • Bone pain or tenderness
  • Eyelid drooping
  • Hoarseness or changing voice
  • Joint pain
  • Nail problems
  • Swallowing difficulty
  • Swelling of the face
  • Weakness
  • Shoulder pain or weakness

These symptoms can be due to other, less serious conditions. It is important to talk to your health care provider if you have symptoms.

 

Exams and Tests

 

The doctor will perform a physical exam and ask about your medical history. You will be asked if you smoke, and if so, how much you smoke and for how long you have smoked. You will also be asked about other things that may have put you at risk of lung cancer, such as exposure to certain chemicals.

When listening to your chest with a stethoscope, the doctor may hear fluid around the lungs or areas where the lung has partially collapsed. This may suggest cancer.

Tests that may be done to diagnose lung cancer or see if it has spread include:

  • Bone scan
  • Chest x-ray
  • Complete blood count ( CBC )
  • CT scan of the chest
  • MRI of the chest
  • Positron emission tomography ( PET ) scan
  • Sputum test to look for cancer cells
  • Thoracentesis (sampling of fluid buildup around the lung)

In most cases, a piece of tissue is removed from your lungs for examination under a microscope. This is called a biopsy. There are several ways to do this:

  • Bronchoscopy combined with biopsy
  • CT-scan-directed needle biopsy
  • Endoscopic esophageal ultrasound (EUS) with biopsy
  • Mediastinoscopy with biopsy
  • Open lung biopsy
  • Pleural biopsy

If the biopsy shows cancer, more imaging tests are done to find out the stage of the cancer. Stage means how big the tumor is and how far it has spread. NSCLC is divided into 5 stages:

  • Stage 0. The cancer has not spread beyond the inner lining of the lung.
  • Stage I. The cancer is small and has not spread to the lymph nodes.
  • Stage II. The cancer has spread to some lymph nodes near the original tumor.
  • Stage III. The cancer has spread to nearby tissue or to far away lymph nodes.
  • Stage IV. The cancer has spread to other organs of the body, such as the other lung, brain, or liver.

 

Treatment

 

There are many different types of treatment for NSCLC. Treatment depends on the stage of the cancer.

Surgery is the common treatment for NSCLC that has not spread beyond nearby lymph nodes. The surgeon may remove:

  • One of the lobes of the lung (lobectomy)
  • Only a small part of the lung (wedge or segment removal)
  • The entire lung (pneumonectomy)

Some patients need chemotherapy . Chemotherapy uses drugs to kill cancer cells and stop new cells from growing. Treatment may be done in the following ways:

  • Chemotherapy alone is often used when the cancer has spread outside the lung (stage IV).
  • It may also be given before surgery or radiation to make those treatments more effective. This is called neoadjuvant therapy.
  • It may be given after surgery to kill any remaining cancer. This is called adjuvant therapy.
  • Chemotherapy is usually given through a vein (by IV). Or, it may be given by pills.

Controlling symptoms and preventing complications during and after chemotherapy is an important part of care.

Radiation therapy can be used with chemotherapy if surgery is not possible. Radiation therapy uses powerful x-rays or other forms of radiation to kill cancer cells. Radiation may be used to:

  • Treat the cancer, along with chemotherapy, if surgery is not possible
  • Help relieve symptoms caused by the cancer, such as breathing problems and swelling
  • Help relieve cancer pain when the cancer has spread to the bones

Controlling symptoms during and after radiation to the chest is an important part of care.

The following treatments are mostly used to relieve symptoms caused by NSCLC:

  • Laser therapy. A small beam of light burns and kills cancer cells.
  • Photodynamic therapy. Uses a light to activate a drug in the body, which kills cancer cells.

 

Support Groups

 

You can ease the stress of illness by joining a cancer support group . Sharing with others who have common experiences and problems can help you not feel alone.

 

Outlook (Prognosis)

 

The outlook varies. Most often, NSCLC grows slowly. In some cases, it can grow and spread quickly and cause rapid death. The cancer may spread to other parts of the body, including the bone, liver, small intestine, and brain.

Chemotherapy has been shown to prolong life and improve the quality of life in some patients with stage IV NSCLC.

Cure rates are related to the stage of disease and whether you are able to have surgery.

  • Stage I and II cancers have the highest survival and cure rates.
  • Stage III cancer can be cured in some cases.
  • Stage IV cancer that has returned is almost never cured. The goals of therapy are to extend and improve quality of life.

 

When to Contact a Medical Professional

 

Call your provider if you have symptoms of lung cancer, particularly if you smoke.

 

Prevention

 

If you smoke, now is the time to quit. If you are having trouble quitting, talk with your doctor. There are many methods to help you quit, from support groups to prescription medicines . Also, try to avoid secondhand smoke.

If you smoke or used to smoke, talk with your doctor about getting screened for lung cancer. To get screened, you need to have a CT scan of the chest.

 

 

Open References

References

Ettinger DS, Wood DE, Akerley W, et al. NCCN Clinical Practice Guidelines in Oncology: Non-small cell lung cancer, Version 6.2015. J Natl Compr Canc Netw . 2015;13(5):515-524. PMID: 25964637 www.ncbi.nlm.nih.gov/pubmed/25964637 .

Horn L, Eisenberg R, Gius D, et al. Cancer of the lung. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology . 5th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 72.

Moyer VA; U.S. Preventive Services Task Force. Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med . 2014;160(5):330-338. PMID: 24378917 www.ncbi.nlm.nih.gov/pubmed/24378917 .

National Cancer Institute. Non-Small Cell Lung Cancer Treatment (PDQ) - health professional version. Bethesda, MD: National Cancer Institute. Updated July 7, 2016. www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq . Accessed August 31, 2016.

Silvestri GA, Pastis NJ, Tanner NT, Jett JR. Clinical aspects of lung cancer. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine . 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 53.

 
  • Lungs

    Lungs - illustration

    The major features of the lungs include the bronchi, the bronchioles and the alveoli. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.

    Lungs

    illustration

  • Secondhand smoke and lung cancer

    Secondhand smoke and lung cancer - illustration

    Secondhand smoke has been classified as a known cause of lung cancer in humans (Group A carcinogen).

    Secondhand smoke and lung cancer

    illustration

    • Lungs

      Lungs - illustration

      The major features of the lungs include the bronchi, the bronchioles and the alveoli. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.

      Lungs

      illustration

    • Secondhand smoke and lung cancer

      Secondhand smoke and lung cancer - illustration

      Secondhand smoke has been classified as a known cause of lung cancer in humans (Group A carcinogen).

      Secondhand smoke and lung cancer

      illustration

    A Closer Look

     

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        Review Date: 8/1/2015

        Reviewed By: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, MA.Internal review and update on 09/01/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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