Development of an immune-related gene prognostic risk model and ...
What Is Extensive Small-Cell Lung Cancer?
This cancer is called small cell based on the size and shape of the cells under a microscope. It starts in hormone-producing cells of the lung. The cells change and start to grow out of control.
Your doctor will describe your cancer as limited or extensive, depending on where the diseased cells have spread. If they haven't moved beyond one of your lungs or the nearby lymph nodes, it's limited. Once they move into these areas, it's extensive.
How Common Is Extensive Small-Cell Lung Cancer?If you have extensive small-cell lung cancer, this means the disease is already spread. Doctors diagnose small-cell lung cancer in about 15% of the nearly 230,000 new lung cancer cases in the U.S. Each year.
About 1 in 3 people with this condition find out that they have it in the early, or limited stage. But most get their diagnosis when it's already advanced. This is because small cell moves very quickly. By the time you learn you have it, it may already have spread to the other side of your chest. In some cases, it may already be in other parts of your body as well, like your liver or bones.
SymptomsEarly on, you may have few or even no symptoms. Later on, you may:
Once the condition becomes more advanced, it can affect other parts of your body. You may:
Small-cell lung cancer also may make hormones. Or the cancer may scramble your immune system so it attacks healthy cells instead of the cancer cells. Roughly 1 in 5 people with cancer may have these effects, called paraneoplastic syndromes.
More than half of the time, symptoms appear before your cancer is diagnosed. Since these symptoms involve other organs, your doctor may at first suspect some other cause than lung cancer. The symptoms of a paraneoplastic syndrome depend on the organ that's affected. You may have:
More rarely, you'll have:
The one thing that makes you most likely to develop this disease is having smoked or used tobacco in the past. Heavy smokers face the greatest risk. Your chances also go up if you've lived with someone who smoked.
Several other things can raise your chances of developing this illness:
Fewer people these days are diagnosed with small-cell lung cancer. One reason may be that fewer people smoke. There's also less tar in cigarettes on the market. If you do smoke, there are still payoffs to quitting after your diagnosis. Not only will you feel better, but it will be easier for you to get through treatment. It may also extend your life.
When your cancer is extensive, it will be hard to get rid of all of it. You may get chemotherapy and radiation, as that appears to treat small-cell lung cancer better than other types.
In recent years, researchers have been doing more to find better ways to treat this less common form of lung cancer. It's impossible to predict outcomes for every person, but with current treatments, people with extensive small-cell lung cancer can often live 6 to 12 months. You may want to talk to your doctor early on about whether you qualify for a research study. This will give you more options for treatment.
Living With Stage 4 Lung Cancer: Survival Rates, Treatments, Emotional Support, And More
Treatments for stage 4 lung cancer typically focus on lessening symptoms, prolonging survival, and improving quality of life. ASCO emphasizes that lung cancer is treatable at any stage of the disease.
Generally, therapies for stage 4 lung cancer aren't intended to cure the cancer. But the American Cancer Society points out that, in rare cases, some stage 4A lung cancers that are limited to the lungs and only one other site (such as the brain) can be treated and even cured with surgery, radiation, chemotherapy, or a combination of these treatments.
Options for all other types of stage 4 lung cancers depend on the type of cancer, where it has spread, whether certain gene mutations feed the cancer, and a person's overall health.
Sometimes, doctors will combine different treatments and other supportive modalities to improve a person's quality of life. This approach, known as palliative care, focuses on relieving pain and making a person more comfortable. According to the NIH, palliative care can be given along with standard medical treatments and can be started at the time of diagnosis.
Targeted TreatmentsIf you have advanced lung cancer, your doctor will likely order special tests to see if your tumor contains certain gene mutations, according to the American Cancer Society. Targeted treatments slow the growth of tumors by focusing on these specific defects in lung cancer cells. Some of these treatments target mutations in the following genes:
Immunotherapy uses the body's own immune system to recognize and fight cancer cells. If a person's lung tumor cells contain high levels of the protein PD-L1, they may be more likely to respond to immunotherapy treatments called checkpoint inhibitors, says the American Cancer Society.
ChemotherapyChemotherapy uses drugs to kill cancer cells in the body. According to the American Cancer Society, chemo can be used along with targeted treatments or immunotherapy for stage 4 lung cancers.
SurgeryDoctors sometimes perform surgery to remove tumors if they cause pain. The Canadian Cancer Society notes that surgery may be done for stage 4 lung cancers that have spread to the brain, adrenal gland, or liver.
Additionally, doctors may perform procedures to drain fluid if it builds up in the space around the lungs or heart, according to the American Cancer Society.
RadiationRadiation therapy can be used to shrink tumors and help relieve symptoms of stage 4 lung cancer. It's commonly used to treat lung cancers that have spread to the bones or brain and in patients who can't have chemotherapy, explains the Canadian Cancer Society.
Photodynamic TherapyPhotodynamic therapy uses special photosensitizing drugs along with light to kill cancer cells. The Mayo Clinic says that this treatment can be used for lung cancers that grow into an airway and cause coughing, bleeding, or difficulty breathing.
Complementary and Integrative ApproachesComplementary therapies may be used along with standard treatments to help people with stage 4 lung cancer reduce side effects, lessen anxiety, and feel better.
Some of the modalities listed by the American Lung Association include:
Participating in a clinical study may allow individuals with stage 4 lung cancer to receive cutting-edge treatments that aren't otherwise available. Talk to your doctor if you're interested in joining a clinical trial.
New Study Supports Saving More Lung Tissue In Lung Cancer Surgeries
The traditional treatment for early-stage non-small cell lung cancer is a lobectomy, where a surgeon eradicates cancerous tissue by removing an entire lung lobe.
Yet, new research finds that select patients with early-stage disease who undergo a less invasive procedure have comparable outcomes, sparking hope for a less aggressive approach to lung cancer surgery.
The 10-year study, published in the New England Journal of Medicine and led by University of Chicago Medicine medical oncologist Everett Vokes, MD, adds evidence that supports a new standard to preserve lung tissue in cancer patients whenever possible.
"It's great to know that we can safely offer our patients a procedure that allows for the preservation of functional lung tissue as long as patients are properly staged and the surgical team has the necessary experience," said Vokes.
Lung cancer is one of the most common forms of cancer in the United States and causes the most cancer deaths in both men and women. While related to having a history of smoking, lung cancer is increasingly diagnosed in nonsmokers as well as former smokers. An estimated 235,000 new cases of lung cancer will be diagnosed in 2023.
Most patients will be diagnosed after the cancer has spread to other parts of their body. Fortunately, improved screening in smokers means doctors are detecting lung cancer at earlier stages.
In this study, 697 patients with peripheral stage 1 tumors less than 2 centimeters in size were randomly assigned to undergo a lobectomy or a sublobar resection, where part of the cancerous lobe is removed.
In the case of the latter, patients received either a wedge resection, which involves removing a nonanatomic, wedge-shaped piece of tissue containing the tumor, or an anatomical segmentectomy in which surgeons remove the anatomic lung segment with the tumor, along with the small airway, individual artery and vein that feed and drain the region.
After a median follow-up of seven years, the multicenter, phase 3 randomized trial found disease-free survival was similar between lobectomies and sublobar resections. Five-year disease-free survival and five-year overall survival were similar, supporting the less-invasive procedure as the preferred option.
"This is a very important study that will change how we treat patients with small early-stage lung cancers—especially as we move into the era of lung cancer screening, where we hope to find many more small nodules that could be treated with this tailored surgical approach," said UChicago Medicine thoracic surgeon Jessica Donington, MD, MSCR.
The research follows a study by Japanese researchers published last year in The Lancet that compared lobectomy to segmentectomy (but not wedge resection). That study revealed patients who received segmentectomies fared better in terms of overall survival, but not for local recurrence. Saving lung tissue seemed to help with survival from other diseases and secondary cancers.
"Overall survival in this most recent trial was around 80% in both arms," said Donington, adding that more therapies are needed for lung cancer. "These are the earliest-stage patients and our smallest tumors. We've done all of the currently recommended therapy and yet overall survival is still only 80%, when it's well above 90% for similar-stage breast cancer or prostate cancer."
Generally, healthy nonsmokers with relatively good lung function can tolerate lobectomies without long-term side effects. However, patients with reduced lung function, due to smoking or other comorbidities, may be too sick to undergo the procedure.
"There are times when we can't do a lobectomy because there's just not enough good lung for us to be able to remove an entire lobe," said Donington. "This research is good news for all patients."
Both Donington and Vokes cautioned the importance of lung cancer patients finding a surgeon skilled in performing sublobar resections, which are more technically challenging surgeries than a lobectomy.
More information: Nasser Altorki et al, Lobar or Sublobar Resection for Peripheral Stage IA Non–Small-Cell Lung Cancer, New England Journal of Medicine (2023). DOI: 10.1056/NEJMoa2212083
Citation: New study supports saving more lung tissue in lung cancer surgeries (2023, March 24) retrieved 29 March 2023 from https://medicalxpress.Com/news/2023-03-lung-tissue-cancer-surgeries.Html
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