Lung Cancer

Introduction

NSCLC begins when healthy cells in the lung change and grow out of control, forming a mass called a tumor, a lesion, or a nodule. This can begin anywhere in the lung and the tumor can be cancerous or benign. When a cancerous lung tumor grows, it may shed cancer cells. These cells can be carried away in blood or float away in the fluid, called lymph that surrounds lung tissue.

When a cancer cell moves into a lymph node or to a distant part of the body through the bloodstream, it is called metastasis.

Risk Factors and Prevention

The following factors may raise a person’s risk of developing NSCLC:

  • Tobacco and smoking.Tobacco smoke damages cells in the lungs, causing the cells to grow abnormally. Regular exposure to smoke from someone else’s cigarettes, cigars, or pipes can increase a person’s risk of lung cancer, even if that person does not smoke. This is called Environmental Tobacco Smoke (ETS) or “secondhand” tobacco smoke. Smoking marijuana and using electronic cigarettes may also increase the risk of lung cancer, but the actual risk is unknown.
  • Asbestos. These are hair-like crystals found in many types of rock and are often used as fireproof insulation in buildings. When asbestos fibers are inhaled, they can irritate the lungs.
  • Radon. Exposure to radon has been associated with an increased risk of some types of cancer, including lung cancer.
  • Air pollution. Research has found that exposure to outdoor air pollution can lead to lung cancer.
  • Other substances. Other factors that may increase the risk of lung cancer include exposure to radiation, arsenic, nickel, and chromium.
  • Genetics. Some people have a genetic predisposition for lung cancer.

Symptoms and Signs

People with NSCLC may experience the following symptoms or signs.

  • Fatigue
  • Cough
  • Shortness of breath
  • Chest pain, if a tumor spreads to the lining of the lung or other parts of the body near the lungs
  • Loss of appetite
  • Coughing up phlegm or mucus
  • Coughing up blood
  • Unintentional weight loss
  • Hoarseness

NSCLC can spread anywhere in the body through a process called metastasis. It most commonly spreads to the lymph nodes, other parts of the lungs, bones, brain, liver, and structures near the kidneys called the adrenal glands. Metastases from NSCLC can cause:

  • More breathing difficulties
  • Bone pain
  • Abdominal or back pain
  • Headache
  • Weakness
  • Seizures
  • Speech difficulties
  • Rarely, a lung tumor can release hormones that cause problems such as low blood sodium levels or high blood calcium levels

Treatment

There are 5 main ways to treat NSCLC:

  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Targeted therapy
  • Immunotherapy

Surgery

The goal of surgery is to completely remove the lung tumor and the nearby lymph nodes in the chest.

The following types of surgery may be used for NSCLC:

  • Lobectomy
  • A wedge resection
  • Segmentectomy
  • Pneumonectomy

The time it takes to recover from lung surgery depends on how much of the lung is removed and the person’s health before surgery. Many of these surgeries are now minimally invasive compared to the past.

Additional treatments can be given before and after your surgery to help lower the risk of recurrence.

Neoadjuvant therapy, also known as induction therapy, is a therapy given before your surgery. In addition to treating the primary tumor and lowering your risk of recurrence, this type of therapy is also used to help reduce the extent of surgery.

Adjuvant therapy is treatment that is given after surgery. It is intended to get rid of any lung cancer cells that may still be in the body after surgery. This helps lower the risk of recurrence, though there is always some risk that the cancer will come back.

Radiation therapy

Like surgery, radiation therapy cannot be used to treat widespread cancer. Radiation therapy only destroys cancer cells directly in the path of the radiation beam. It also damages the healthy cells in its path. For this reason, it cannot be used to treat large areas of the body. Sometimes, intensity modulated radiation therapy (IMRT) or stereotactic body radiation therapy (SBRT) can be used.

Some people with Stage I NSCLC or people who cannot have surgery may be treated with stereotactic radiation therapy as an alternative treatment to surgery.

Therapies using medication

Treatments using medication are used to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body. 

Medications are often given through an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). If you are given oral medications, be sure to ask your health care team about how to safely store and handle it.

The types of medications used for NSCLC include:

  • Chemotherapy
  • Targeted therapy
  • Immunotherapy

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. It has been shown to improve both the length and quality of life for people with lung cancer of all stages.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. The type of lung cancer you have, such as adenocarcinoma or squamous cell carcinoma, affects which drugs are recommended for chemotherapy.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.

Immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.