Non-Small Cell Lung Cancer: The Basics
Lung cancer is caused by lung cells growing out of control. As the number of cells grows, they form into a tumor. There are many types of lung cancers. This article will focus on non-small cell lung cancer.
Non-Small Cell Lung Cancer (NSCLC)
- 85% of all lung cancers.
- Generally slower growing than small cell lung cancer.
- Divided into different types based on the cells that make up the tumor.
- Types: adenocarcinoma, squamous cell carcinoma, and poorly differentiated or large cell carcinoma.
Lung cancer that has spread from the lung to another part of the body is called metastatic cancer. Other types of lung cancer include small cell, mesothelioma, and carcinoid tumors. These cancers are not discussed here.
Risks
Smoking cigarettes (now or in the past) is the leading cause of lung cancer. Lung cancer in non-smokers has been rising in recent years. Other causes for lung cancer include radon, radiation, asbestos, and pollution.
Screening
Smokers or former heavy smokers can have a special test (CT scan) to screen for lung cancer. This test can find lung cancer sooner and may help patients live longer. Speak to your healthcare provider to decide if this test is right for you.
Signs of Lung Cancer
The early stages of lung cancer may not have any signs. As the tumor grows in size, it can cause signs.
- Cough (one that doesn't go away or gets worse). A cough is the most common sign. Many long-term smokers have a cough that doesn't go away. If there is a change in your cough, see your doctor.
- Chest pain.
- Hard time breathing or wheezing.
- Coughing up blood or bloody phlegm.
- New hoarseness or change in speech.
- Having pneumonia or bronchitis that keeps coming back.
- Weight loss and loss of appetite.
- Feeling tired.
Diagnosis of Lung Cancer
When your healthcare providers think you may have lung cancer, they will order tests. Here are some of the tests:
- Chest x-ray.
- CT scan ("Cat Scan", a 3-D x-ray).
- Sputum cytology (looking at your phlegm for cancer cells).
- A PET scan and an MRI scan of the brain are often done to look at other parts of the body where lung cancer can spread.
These tests are important but a biopsy is the only way to know for sure if you have cancer. A biopsy:
- Looks at a piece of the lung for cancer cells.
- Is used to find out the cancer type, how normal it is [grade], and if it has spread.
- May look at samples from lymph nodes to check for cancer.
- The biopsy may be done using a bronchoscopy (a small camera passed down your throat into the lungs) or by surgery.
A pathology report sums up these results and is sent to your healthcare provider, typically 5-10 days after the biopsy. This report is an important part of planning your treatment. You can ask for a copy of your report for your records.
Staging Lung Cancer
To guide treatment, lung cancer is "staged." This stage is based on:
- Size and location of the tumor.
- Whether cancer cells are in the lymph nodes.
- Whether cancer cells are in other parts of the body.
Stages range from stage I (smallest, most confined tumors) to stage IV (tumors that have spread to other parts of the body, also called metastatic cancer). The stage and type of lung cancer will guide your treatment plan.
Treatment
Often, these treatments are used:
- Surgery: In some cases, surgery is done to remove as much of the cancer as possible.
- Chemotherapy: Chemotherapy is the use of medications that can kill cancer cells throughout the entire body. Most patients will receive chemotherapy either given before surgery (called neoadjuvant) or after surgery (called adjuvant). Chemotherapy can also be given before, during, or after radiation therapy.
- Radiation therapy: Radiation therapy, the use of high-energy X-rays to kill cancer cells, can be used with surgery, or when surgery is not possible.
This article is a basic guide to non-small cell lung cancer. You can learn more about your type of lung cancer and treatment by using the links below.
References
American Cancer Society. 2019. Found at: https://www.cancer.org/cancer/non-small-cell-lung-cancer
NCCN Guidelines Version 4.2019: Non-Small Cell Lung Cancer. https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf
National Cancer Institute SEER Stat Fact Sheets: Lung and Bronchus Cancer http://seer.cancer.gov/statfacts/html/lungb.html
Brahmer, J., Reckamp, K. L., Baas, P., Crinò, L., Eberhardt, W. E., Poddubskaya, E., ... & Waterhouse, D. (2015). Nivolumab versus docetaxel in advanced squamous-cell non–small-cell lung cancer. New England Journal of Medicine, 373(2), 123-135.
Centers for Disease Control. Hookahs. Found at: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/hookahs/index.htm
Daniel, M et al. Persistent Smoking after a diagnosis of lung cancer is associated with higher reported pain levels. 2010. Found at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684817/
Ettinger, D. S., Akerley, W., Borghaei, H., Chang, A. C., Cheney, R. T., Chirieac, L. R., ... & Grannis, F. W. (2012). Non–small cell lung cancer. Journal of the National Comprehensive Cancer Network, 10(10), 1236-1271.
Ferketich, A. K., Niland, J. C., Mamet, R., Zornosa, C., D'Amico, T. A., Ettinger, D. S., ... & Otterson, G. A. (2013). Smoking status and survival in the national comprehensive cancer network non–small cell lung cancer cohort. Cancer, 119(4), 847-853.
Friboulet, L., Li, N., Katayama, R., Lee, C. C., Gainor, J. F., Crystal, A. S., ... & Pferdekamper, A. C. (2014). The ALK inhibitor ceritinib overcomes crizotinib resistance in non–small cell lung cancer. Cancer Discovery, 4(6), 662-673.
Govindan, R., Ding, L., Griffith, M., Subramanian, J., Dees, N. D., Kanchi, K. L., ... & Chen, K. (2012). Genomic landscape of non-small cell lung cancer in smokers and never-smokers. Cell, 150(6), 1121-1134.
Guckenberger, M., Allgäuer, M., Appold, S., Dieckmann, K., Ernst, I., Ganswindt, U., ... & Sterzing, F. (2013). Safety and Efficacy of Stereotactic Body Radiotherapy for Stage I Non–Small-Cell Lung Cancer in Routine Clinical Practice: A Patterns-of-Care and Outcome Analysis. Journal of Thoracic Oncology, 8(8), 1050-1058.
Howington, J. A., Blum, M. G., Chang, A. C., Balekian, A. A., & Murthy, S. C. (2013). Treatment of stage I and II non-small cell lung cancer: diagnosis and management of lung cancer: American College of Chest Physicians evidence-based clinical practice guidelines. CHEST Journal, 143(5_suppl), e278S-e313S.
Jha, P., Ramasundarahettige, C., Landsman, V., Rostron, B., Thun, M., Anderson, R. N., ... & Peto, R. (2013). 21st-century hazards of smoking and benefits of cessation in the United States. New England Journal of Medicine, 368(4), 341-350.
Kozower, B. D., Larner, J. M., Detterbeck, F. C., & Jones, D. R. (2013). Special treatment issues in non-small cell lung cancer: Diagnosis and management of lung cancer: American College of Chest Physicians evidence-based clinical practice guidelines. CHEST Journal, 143(5_suppl), e369S-e399S.
Langer, C. J. (2014). Emerging Immunotherapies in the Treatment of Non–Small Cell Lung Cancer (NSCLC). Pathways, 15, 19.
Lantz, P. M., Mendez, D., & Philbert, M. A. (2013). Radon, smoking, and lung cancer: the need to refocus radon control policy. American Journal of Public Health, 103(3), 443-447.
Leone, F. T., Evers-Casey, S., Toll, B. A., & Vachani, A. (2013). Treatment of tobacco use in lung cancer: diagnosis and management of lung cancer: American College of Chest Physicians evidence-based clinical practice guidelines. CHEST Journal, 143(5_suppl), e61S-e77S.
Lee, C. K., Brown, C., Gralla, R. J., Hirsh, V., Thongprasert, S., Tsai, C. M., ... & Van Vu, V. (2013). Impact of EGFR inhibitor in non–small cell lung cancer on progression-free and overall survival: a meta-analysis. Journal of the National Cancer Institute, djt072.
Li, T., Kung, H. J., Mack, P. C., & Gandara, D. R. (2013). Genotyping and genomic profiling of non–small-cell lung cancer: Implications for current and future therapies. Journal of Clinical Oncology, 31(8), 1039-1049.
Lindeman, N. I., Cagle, P. T., Beasley, M. B., Chitale, D. A., Dacic, S., Giaccone, G., ... & Thunnissen, E. (2013). Molecular testing guideline for selection of lung cancer patients for EGFR and ALK tyrosine kinase inhibitors: guideline from the College of American Pathologists, International Association for the Study of Lung Cancer, and Association for Molecular Pathology. The Journal of Molecular Diagnostics, 15(4), 415-453.
Oxnard, G. R., Binder, A., & Jänne, P. A. (2013). New targetable oncogenes in non–small-cell lung cancer. Journal of Clinical Oncology, 31(8), 1097-1104.
Pallis, A. G., & Syrigos, K. N. (2013). Lung cancer in never smokers: disease characteristics and risk factors. Critical Reviews in Oncology/Hematology, 88(3), 494-503.
Reck, M., Heigener, D. F., Mok, T., Soria, J. C., & Rabe, K. F. (2013). Management of non-small-cell lung cancer: recent developments. The Lancet, 382(9893), 709-719.
Schmidt-Hansen, M., Page, R., & Hasler, E. (2013). The effect of preoperative smoking cessation or preoperative pulmonary rehabilitation on outcomes after lung cancer surgery: a systematic review. Clinical Lung Cancer, 14(2), 96-102.
Senan, S., Paul, M. A., & Lagerwaard, F. J. (2013). Treatment of early-stage lung cancer detected by screening: surgery or stereotactic ablative radiotherapy? The Lancet Oncology, 14(7), e270-e274.
Shaw, A. T., Kim, D. W., Mehra, R., Tan, D. S., Felip, E., Chow, L. Q., ... & Riely, G. J. (2014). Ceritinib in ALK-rearranged non–small-cell lung cancer. New England Journal of Medicine, 370(13), 1189-1197.
Silvestri, G. A., Gonzalez, A. V., Jantz, M. A., Margolis, M. L., Gould, M. K., Tanoue, L. T., ... & Detterbeck, F. C. (2013). Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer: American College of Chest Physicians evidence-based clinical practice guidelines. CHEST Journal, 143(5_suppl), e211S-e250S.
Sundar, R., Soong, R., Cho, B. C., Brahmer, J. R., & Soo, R. A. (2014). Immunotherapy in the treatment of non-small cell lung cancer. Lung Cancer, 85(2), 101-109.
Torres-Durán, M., Barros-Dios, J. M., Fernández-Villar, A., & Ruano-Ravina, A. (2014). Residential radon and lung cancer in never smokers. A systematic review. Cancer Letters, 345(1), 21-26.
United States Environmental Protection Agency. A Citizen’s Guide to Radon. The Guide to Protecting Yourself and Your Family from Radon. 2016. https://www.epa.gov/sites/production/files/2016-12/documents/2016_a_citizens_guide_to_radon.pdf
US News and World Report. Electronic cigarettes and cancer: A Safer Choice? 2017. Found at: https://health.usnews.com/health-care/patient-advice/articles/2017-04-25/electronic-cigarettes-and-cancer-a-safer-choice
Vansteenkiste, J., De Ruysscher, D., Eberhardt, W. E. E., Lim, E., Senan, S., Felip, E., & Peters, S. (2013). Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of oncology, mdt241.
Vogelstein, B., Papadopoulos, N., Velculescu, V. E., Zhou, S., Diaz, L. A., & Kinzler, K. W. (2013). Cancer genome landscapes. Science, 339(6127), 1546-1558.
Welsh, J. W., Komaki, R., Amini, A., Munsell, M. F., Unger, W., Allen, P. K., ... & Chen, S. S. (2013). Phase II trial of erlotinib plus concurrent whole-brain radiation therapy for patients with brain metastases from non–small-cell lung cancer. Journal of Clinical Oncology, 31(7), 895-902.
Wang, Y. Y., Wang, Y. S., Liu, T., Yang, K., Yang, G. Q., Liu, H. C., ... & Yang, J. L. (2013). Efficacy study of CyberKnife stereotactic radiosurgery combined with CIK cell immunotherapy for advanced refractory lung cancer. Experimental and Therapeutic Medicine, 5(2), 453-456.
Zheng, Y. W., Li, R. M., Zhang, X. W., & Ren, X. B. (2013). Current adoptive immunotherapy in non-small cell lung cancer and potential influence of therapy outcome. Cancer Investigation, 31(3), 197-205.